Citation Nr: 21063693 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 16-46 049A DATE: October 15, 2021 ORDER Service connection for plantar fasciitis of the left foot is granted. Service connection for plantar fasciitis of the right foot is granted. Service connection for a low back disability is granted. Service connection for a left ankle disability is granted. FINDINGS OF FACT 1. The Veteran's left foot plantar fasciitis onset in service and has continued since. 2. The Veteran's right foot plantar fasciitis onset in service and has continued since. 3. The Veteran began experiencing low back symptoms during service and has continued to experience these problems since separating from service. 4. The Veteran began experiencing left ankle symptoms during service and has continued to experience these problems since separating from service. CONCLUSIONS OF LAW 1. The criteria for service connection for plantar fasciitis of the left foot have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for plantar fasciitis of the right foot have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a low back disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a left ankle disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1986 to May 1993. In October 2019, the Veteran testified at a hearing before a Veterans Law Judge (VLJ) who has since retired. A transcript of the hearing has been associated with the Veteran's claims file. In January 2021, the Veteran was notified of his right to request another hearing, but he declined. This current matter was previously before the Board of Veterans Appeals (Board) in February 2020 and February 2021, when it was remanded each time for further evidentiary development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, service connection can also be established through application of a statutory presumption for chronic diseases when manifested to a compensable degree within a year of separation from service. 38 C.F.R. §§ 3.307, 3.309. If a chronic disease is not manifested to a compensable degree within a year of separation of service, then, generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Furthermore, a layperson is competent to report on the onset and continuity of his or her current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Bilateral Foot The Veteran contends that his bilateral plantar fasciitis onset in service and has continued since. His service treatment records (STRs) show that in January 1986 he sought treatment for pains in both feet, and "rule out plantar fasciitis" was noted on the medical care record. He also reported bilateral foot pain again in January 1990, and plantar fasciitis is recorded on his master problem list in his STRs as a minor problem. Additionally, his VA treatment records show that he has a current diagnosis of bilateral plantar fasciitis. Thus, he meets the current diagnosis and in service event elements of the claim, and the only remaining issue is whether a nexus (causal relationship) exists between his bilateral plantar fasciitis and his active duty. In this regard, at the October 2019 hearing, the Veteran testified that he was diagnosed with bilateral plantar fasciitis in service and that he has continued to experience symptoms of his bilateral plantar fasciitis since separation from service. He also testified that, after separation from service, he sought treatment with a private podiatrist, who prescribed custom orthotics for his feet. Unfortunately, the Veteran was unable to get a copy of those treatment records, as the podiatry practice is no longer in business. During the course of this appeal, the Veteran was afforded a VA examination in September 2014. However, for reasons discussed in the previous Board decisions, the Board found this examination to be inadequate. Therefore, it will not be discussed at length in this decision. At a February 2020 VA examination, the Veteran reported that his bilateral foot pain began about 6 months after he entered service and has continued since. He also reported that he was diagnosed with plantar fasciitis during service. The examiner confirmed the Veteran's diagnosis of bilateral plantar fasciitis but determined that it was not related to the Veteran's service. The examiner explained that the Veteran's STRs do not indicate chronic plantar pain. The examiner also explained that, during the Veteran's 1986 medical visit for bilateral foot pain, an impression of rule out plantar fasciitis was made, but that there were no other entries for plantar fasciitis in the Veteran's service treatment records. In April 2020, the Veteran provided a medical examination report from a private physician. The private physician confirmed the Veteran's diagnosis for bilateral plantar fasciitis and found that it was more likely than not that the Veteran's military service caused his bilateral plantar fasciitis. The physician explained that the stress of wearing combat boots and the stress of exercise and basic training most likely caused the Veteran's bilateral plantar fasciitis. In April 2021, the Veteran was afforded another VA examination. The examiner noted that it is possible that wearing combat boots and marching could cause or exacerbate plantar fasciitis by causing inflammation in the tendons and ligaments of the feet. However, the examiner determined that, because the Veteran was not seen until more than 20 years following separation from service, there was no chronicity of care. Thus, the examiner opined that the Veteran's bilateral plantar fasciitis was less likely than not related to his active service. While the Board cannot ignore or disregard the VA examiner's medical conclusions, the Board is free to assess medical evidence and is not compelled to accept a medical opinion. See Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992). Here, the Board finds that both the February 2020 and the April 2021 VA examinations are inadequate. First, the February 2020 VA medical opinion is based on inaccurate factual premises. As noted above, plantar fasciitis is listed in the Veteran's STRs on his master problem list, and records also show that he sought treatment for his bilateral plantar fasciitis at least one other time in service, in January 1990. Thus, the examiner's statement that there were no other entries regarding plantar fasciitis in the Veteran's STRs, aside from the 1986 visit, is incorrect. Second, both VA medical opinions failed to consider the Veteran's competent lay statements regarding the continuity of his plantar fasciitis symptomatology. The Veteran has consistently stated that he has been experiencing bilateral foot pain since it began in service in 1986. While the Veteran was unable to obtain the medical records, he did testify that he sought treatment for his bilateral plantar fasciitis after service. As noted above, as a lay person, the Veteran is competent to testify on that which he has personal knowledge. Layno, 6 Vet. App. at 465. As such, the Board finds his competent lay testimony to be credible. Based on the above, the Board finds that the evidence supports a finding that the Veteran's bilateral plantar fasciitis onset in service and has continued since then. Accordingly, service connection for bilateral plantar fasciitis is granted. Low Back The Veteran contends that his current low back disability is related to his service. His STRs show that, in December 1986, he reported low back pain and was diagnosed with low back strain. His medical records since separation from service show that he has a diagnosis of lumbar disc disease and lumbar strain. See April 2012 Medical Treatment Record Government Facility, February 2020 C&P Exam, and April 2021 C&P Exam. Thus, he meets the current diagnosis and in service event elements of the claim, and the only remaining issue is whether a nexus (causal relationship) exists between his current low back disability and his service. In this regard, at the October 2019 hearing, the Veteran testified that he injured his lower back in service and that it has never resolved. He testified that he has continued to experience lower back pain after he separated from service and to seek treatment for his lower back pain with VA and a private chiropractor. Additionally, he testified that he was diagnosed with a bulging disc in his lower back after a car accident. However, his treating physician stated that it could not be determined when the bulging disc onset. In February 2020, the Veteran was afforded a VA examination. The examiner confirmed the diagnosis of lumbar spondylosis and lumbar disc disease but found that these disabilities were not related to the Veteran's active service. The examiner explained that the Veteran's STRs did not indicate a chronic lower back condition while in service and that, at separation, he denied recurrent lower back pain. The examiner also noted that the Veteran was involved in 2 motor vehicle accidents after service and that it was not until after the second motor vehicle accident that the Veteran began experiencing functional impairment. Further, the examiner noted that disc disease and accompanying arthritis are common age-related developments. In April 2020, the Veteran submitted a medical examination report from a private physician who opined that it was more likely than not that the Veteran's active service caused his current back disability. The physician explained that the Veteran's initial back injury caused straining, tearing, and popping of the tendons and ligaments in the lower back and the vertebral discs. The physician further explained that the injury more likely than not contributed to instability in the Veteran's lower lumbar vertebrae, which more likely than not caused traumatic arthritis and impinging his lower back discs. The Board also notes that, in a July 2015 letter, the Veteran's private chiropractor opined that the Veteran's active duty caused premature advancement in degenerative osteoarthritic changes in his lumbar spine. In April 2021, the Veteran was afforded another VA examination. This examiner also found that the Veteran's lower back disability was less likely than not caused by his service, noting that the Veteran's STRs did not indicate a chronic low back condition while in service and that he did not seek treatment for a low back condition until after his post-service motor vehicle accidents. While the Board cannot ignore or disregard the VA examiner's medical conclusions, the Board is free to assess medical evidence and is not compelled to accept a medical opinion. See Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992). Here, the Board finds both the February 2020 and the April 2021 examinations to be in adequate. Both examiners failed to address the Veteran's competent lay testimony that he has been experiencing lower back pain since service. As noted above, as a lay person, the Veteran is competent to give evidence about observable symptoms such as pain and onset of symptoms. Layno, 6 Vet. App. at 465. As such, the Board finds his competent lay testimony that he has been experiencing lower back pain since service to be credible. Based on the above, the Board finds that the evidence supports a finding that the Veteran began experiencing symptoms of a low back disability in service and has continued to experience these symptoms since separation from service. Service connection for a low back disability is, thus, granted. Left Ankle The Veteran contends that his left ankle disability is related to his active service. While his are silent for any complaints of, treatment for, or diagnoses of, any left ankle conditions, he did report a history of pain in both ankles at his separation examination. His VA medical records show that he has reported experiencing left ankle pain numerous times, and at several visits, his VA primary care physician noted the that his left ankle pain is more than likely related to his military service. See February 2014 Medical Treatment Record Government Facility and February 2020 CAPRI. However, the Board acknowledges that the VA physician did not provide a rationale for this opinion. At the October 2019 hearing, the Veteran testified that he sprained both ankles multiple times during his service. He testified that he often did not seek treatment for his ankle sprains during service because he was concerned about accumulating a thick medical file. In particular, he feared that too many medical complaints during service might hinder his advancement in the military. Thus, after receiving treatment for a right ankle sprain, the Veteran chose to self-treat his left ankle injuries by applying medical advice he received for his previous right ankle injury to avoid a medical visit. At a February 2020 VA examination, the Veteran reported that he began experiencing left ankle pain in 1988 that has continued since then. He also reported that his left ankle pain causes functional impairment, as he is unable to run or walk more than a mile and a half. However, the examiner reported that the Veteran's left ankle examination was normal and determined that the Veteran did not have a current left ankle condition. In April 2020, the Veteran submitted a medical examination report from a private physician. The physician diagnosed the Veteran with left ankle strain and instability and determined that it was more likely than not that his left ankle disability was related to his military service. The examiner explained that the Veteran's reported in-service left ankle sprains more likely than not caused straining and tearing of the talofibular ligaments on the lateral aspect of his left ankle, causing instability in the left ankle. In April 2021, the Veteran was afforded another VA examination. The Veteran reported that he rolled his left ankle multiple times in service and has experienced issues with his left ankle since, including difficulty walking and standing on his left ankle for too long. The examiner confirmed the Veteran's diagnosis of left ankle sprain but found that it was less likely than not related to his service. The examiner explained that there was no evidence in the Veteran's STRs of a left ankle sprain, therefor a nexus could not be established. While the Board cannot ignore or disregard the VA examiner's medical conclusions, the Board is free to assess medical evidence and is not compelled to accept a medical opinion. See Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992). Here, the Board finds both the February 2020 and April 2021 VA examinations to be inadequate. First, the February 2020 examiner's determination that the Veteran did not have a current left ankle condition is in accurate, as both the Veteran's private physician and the April 2021 VA examiner determined the Veteran has a current left ankle disability. Further, neither examiner addressed the Veteran's competent lay statements regarding the onset and continuity of his left ankle pain since service. As noted above, as a lay person, the Veteran is competent to give evidence about observable symptoms such as pain and onset of symptoms. Layno, 6 Vet. App. at 465. As such, the Board finds his competent lay testimony to be credible. (CONTINUED ON NEXT PAGE) Based on the above, the Board finds that the evidence supports a finding that the Veteran began experiencing symptoms of a left ankle disability in service and has continued to experience these symptoms since separating from service. Service connection for a left ankle disability is, thus, granted. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Benson, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.