Citation Nr: 21064232 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 16-20 723 DATE: October 19, 2021 ORDER The appeal for a separate rating for bilateral plantar fasciitis is dismissed. Service connection for obstructive sleep apnea is granted. Service connection for left shoulder disability is granted. FINDINGS OF FACT 1. The Board adjudicated the proper ratings for symptoms of bilateral plantar fasciitis in the September 2020 decision. 2. The evidence shows the Veteran's obstructive sleep apnea began in service. 3. The evidence shows the Veteran's service-connected left ankle disability caused a fall and injury that resulted in his current left shoulder disability. CONCLUSIONS OF LAW 1. The appeal for a separate rating for bilateral plantar fasciitis is dismissed as duplicative. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for service connection for obstructive sleep apnea have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 3. The criteria for service connection for left shoulder disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Air Force from August 1964 to August 1968. 1. The appeal for a separate rating for bilateral plantar fasciitis The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. This appeal includes a lengthy procedural history that showed the diagnoses of pes planus and plantar fasciitis were factually intertwined as both affect the feet. In the September 2020 decision, the Board considered the symptoms present in the Veteran's feet, including pain and tenderness, and assigned ratings for "bilateral pes planus with plantar fasciitis." The regulations prohibit assigning duplicate ratings for the same disability, or symptom set, under several diagnostic codes, known as pyramiding. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. As the September 2020 decision considered the appropriate rating for the symptoms of plantar fasciitis, the issue listed as currently on appeal has already been adjudicated by the Board and should be dismissed as duplicative. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service" also known as the "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Service connection may also be granted on a secondary basis for a disability that is proximately due to or the result of (caused) or worsened beyond its natural progression (aggravated) by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (en banc). The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). When there is an approximate balance of positive and negative evidence regarding any material issue, all reasonable doubt is resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for obstructive sleep apnea Based on the evidence, the Board finds the criteria for service connection for obstructive sleep apnea have been met. 38 C.F.R. § 3.303. The evidence shows a current disability. VA treatment records show diagnosis of moderate obstructive sleep apnea. Thus, the first element of service connection is established. See Holton, 557 F.3d at 1366. Next, the Veteran has reported the onset of symptoms during service, and a medical expert has found those symptoms to be consistent with the development of his sleep apnea. In statements to VA, the Veteran reported not having sleep issues prior to joining the military, noticing problems with snoring and daytime fatigue and sleepiness during the military, and continuing to experience those symptoms after. His wife reported noticing him snoring heavily and being exhausted very early on in their relationship, which began the year after he separated from service. In a September 2016 letter, Dr. T.R.C. wrote that the Veteran had clearly described the onset of symptoms of possible sleep apnea while in the service and the symptoms being constant since separation. Dr. T.R.C. notes that the study of obstructive sleep apnea was essentially non-existent at the time the Veteran was in service and it would have been impossible for the Veteran to have been diagnosed at that time. Dr. T.R.C. concluded that it is at least as likely as not that the Veteran's obstructive sleep apnea began during his service. The Veteran's and his wife's statements are consistent, and the Board sees no reason to doubt their credibility. Moreover, Dr. T.R.C. provided an opinion with consideration of the evidence and explanation of the conclusion, which the Board finds to be adequate and probative. There are no other opinions of record on the etiology of the Veteran's sleep apnea. Therefore, the Board relies on Dr. T.R.C.'s opinion and finds the Veteran's obstructive sleep apnea began during his service, the in-service and nexus elements are demonstrated, and service connection is warranted. See Holton, 557 F.3d at 1366. 3. Service connection for left shoulder disability After reviewing the record, the Board finds the criteria for service connection for a left shoulder disability have been met. 38 C.F.R. § 3.303. The evidence shows a current disability. A VA treatment record from September 2014 notes left shoulder impingement, AC (acromioclavicular) degenerative joint disease and supraspinatus tear with retraction. A November 2014 treatment record shows the assessment of left shoulder pain, age-appropriate changes and supraspinotous tendinosis. Treatment records continued to show pain with some limitation of motion of the left shoulder. Thus, the evidence shows a current disability, and the first element of service connection is established. See Holton, 557 F.3d at 1366. Next, the Veteran is service connected for residuals of left ankle sprain. He has reported experiencing a fall in 2014 where he landed on and injured his left shoulder. He asserted that he fell because his service-connected left ankle buckled and gave-way. In a July 2015 statement, the Veteran's nurse aid confirmed witnessing the fall on the left side. VA treatment records also show treatment for the left shoulder after a fall in May 2014. In an August 2015 letter, Dr. P.G.P. agreed with the Veteran's theory on the cause of the fall and explained that limited range of motion in an ankle joint could easily cause an imbalance of forces in the lower extremities and torso, which could cause a shift in the center of gravity of an individual to such an extent that it might cause the individual to fall. Dr. P.G.P. further noted that the Veteran has no other risk factors for falling, and a traumatic injury to a shoulder commonly results in the onset of degenerative osteoarthritis. He concluded that it is at least as likely as not that Veteran's service-connected left ankle was the cause of his fall and injury to the left shoulder that led to the degenerative osteoarthritis. Again, the Board sees no reason to doubt the credibility of the lay reports of the fall. The opinion by Dr. P.G.P. includes a detailed explanation of how the service-connected left ankle disability resulted in left shoulder degenerative arthritis. As this opinion is probative and there are no other opinions of record on the etiology of the Veteran's left shoulder disability, the Board relies on Dr. P.G.P.'s opinion. The Board concludes that the Veteran's left shoulder degenerative arthritis was caused by trauma from a fall that resulted from his service-connected left ankle disability. Service connection for the left shoulder is warranted on a secondary basis. See Allen, 7 Vet. App. at 448-49. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.P. Armstrong 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.