Citation Nr: 21065006 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 17-42 392 DATE: October 22, 2021 ORDER Service connection for left shoulder strain is granted. Service connection for right rotator cuff tendonitis and impingement syndrome is granted. Service connection for left knee strain is granted. Service connection for right knee strain is granted. Service connection for bilateral plantar fasciitis is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, his left shoulder strain and right rotator cuff tendonitis and impingement syndrome began during his active service. 2. Resolving reasonable doubt in the Veteran's favor, his left and right knee strains began during his active service. 3. Resolving reasonable doubt in the Veteran's favor, his bilateral plantar fasciitis began during his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for left shoulder strain and right rotator cuff tendonitis and impingement syndrome have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left and right knee strains have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1993 to April 2014. In January 2020, the Veteran testified at a hearing via videoconference before the undersigned Veterans Law Judge. In March 2020, the Board remanded the matters for further development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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). 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). The Veteran filed the current claims on appeal in June 2015. He asserts that he injured his shoulders, knees, and feet in service and has had intermittent problems since that time. At the January 2020 hearing, he acknowledged that he did not file his claims within one year of discharge from service but explained that the reason for the delay in filing was that he was in the process of finding a civilian job. Bilateral shoulder disorder The Veteran's service treatment records show complaints of right shoulder pain in November 2003 diagnosed as tendonitis. A December 2003 record also shows a diagnosis of impingement syndrome. In June 2005, he injured his left shoulder and was diagnosed with a strain. At a January 2009 examination, he reported a history of shoulder pain. The clinician noted that the shoulder problems had resolved. A May 2013 report of medical assessment for retirement purposes reflects that he intended to file claims for disability for a neck disorder, back disorder, hearing loss, and disorders associated with exposure to asbestos and lead paint. An October 2014 VA medical record, dated within one year of his discharge from service, shows complaints of bilateral shoulder pain due to in-service injuries. At a November 2015 VA examination, the Veteran reported that his shoulders continue to remain problematic with recurring pain brought on, and aggravated, by climbing up and down on trains at work. The examiner diagnosed left shoulder strain, and right impingement syndrome and rotator cuff tendonitis. In a separate opinion, the examiner noted that the Veteran's service treatment records indicate that his shoulder problems resolved and there is no mention of shoulder problems at his May 2013 separation examination. The examiner then opined that the Veteran's shoulder strains are not related to service. At the January 2020 hearing, the Veteran indicated that he has had intermittent shoulder symptoms since his in-service injuries. In a September 2020 medical opinion, a VA examiner stated that the service treatment records are silent for treatment for shoulder conditions from 2005 to release from service in 2014, including a May 2013 separation examination. The examiner further stated that the evidence does not show a shoulder condition to a compensable degree within 12 months of separation from service or chronicity of care to establish a link to service. While the Board appreciates the examiners' opinions, the Board observes that continuity of symptoms, not treatment, is required to support a claim for service connection. The Veteran is competent to give evidence on observable symptoms such as shoulder pain. Layno v. Brown, 6 Vet. App. 465 (1994). While he did not report shoulder problems at the May 2013 retirement examination, the examination appears to have been focused on disabilities for which he intended to file a VA claim. Thus, while it is probative as to the severity of existing disabilities, it does not rule out the presence of other minor but nevertheless existing disabilities. In that regard, the Veteran filed a claim within 14 months of separation from service, indicating the presence of shoulder symptoms prior to discharge, and he testified that he was unable to file an earlier claim as he was busy looking for a job. That he did not file a claim until June 2015 even for the disabilities noted at the May 2013 examination minimizes the significance of the lack of shoulder complaints at that time and can be construed as supporting his assertion of having had intermittent shoulder problems since service, albeit to a lesser degree than those noted at that examination. Moreover, an October 2014 VA medical record shows complaints of bilateral shoulder pain due to in-service injuries within one year of his discharge from service. Lastly, he is currently diagnosed with the same shoulder conditions he was diagnosed with in service. Given the above, the Board cannot find that the preponderance of the evidence is against finding that the Veteran did not have a continuity of bilateral shoulder symptoms since his in-service injuries. In light of the circumstance in this case, and resolving reasonable doubt in the Veteran's favor, the Board finds that his left and right shoulder disabilities began during active service. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, the Board concludes that service connection for left shoulder strain and right rotator cuff tendonitis and impingement syndrome is warranted. Bilateral knee disorder The Veteran's service treatment records show that in July 1993 he injured his left knee and was diagnosed with a sprain. In January 1996, he injured his right knee and was diagnosed with a sprain. He reinjured the right knee in November 1998 and was diagnosed with a medial collateral ligament (MCL) sprain. He reinjured his right knee in May 1999 and was again diagnosed with an MCL sprain. At a January 2009 examination, he reported a history of knee injuries that required the use of braces. The clinician noted that the knee problems had resolved. At a November 2015 VA examination, the Veteran reported that his knees continue to remain problematic with recurring pain in both knees. The examiner diagnosed bilateral knee strains. In a separate opinion, the examiner noted that the Veteran's service treatment records indicate that his knee problems resolved and there is no mention of knee problems at his May 2013 separation examination. The examiner then opined that the Veteran's knee strains are not related to service. VA medical records show complaints of right knee pain in December 2015 and that he underwent left knee surgery in September 2017. A June 2017 record reflects the clinician's observation that the service treatment records indicate that the Veteran's current left and right knee disorders are related to in service injuries. At the January 2020 hearing, the Veteran indicated that he has had intermittent knee symptoms since his in-service injuries. At a September 2020 VA examination, the Veteran reported persistent bilateral knee symptoms but denied ongoing treatment. The examiner noted a history of a left medial meniscus tear in September 2017. In a separate medical opinion, the examiner stated that the service treatment records document acute injuries to the knees and that conservative treatment was rendered with resolution of the injuries. The examiner noted that the service treatment records are silent for treatment for knee conditions from 2005 to release from service in 2014, including a May 2013 separation examination. The examiner stated that the evidence does not show a bilateral knee condition to a compensable degree within 12 months of separation from service or chronicity of care for a knee disorder to establish a link to service. While the Board appreciates the examiners' opinions, the Board again observes that continuity of symptoms, not treatment, is required to support a claim for service connection and the Veteran is competent to give evidence on observable symptoms such as knee pain. As the May 2013 retirement examination focused on disabilities for which he intended to file a VA claim, it again does not rule out the presence of other minor problems, including with his knees, for which he filed a claim within 14 months of separation. Again, that he did not file an earlier claim even for the disabilities noted at that examination minimizes the significance of the lack of knee complaints at that time and arguably supports his assertion of having had intermittent knee problems since the in-service injuries. Also, the November 2015 VA examination revealed the same knee conditions he was diagnosed with in service. [While the Veteran later underwent surgery for a left meniscus tear, which may or may not be associated with the strain, that is the subject of the evaluation of the disability.] Lastly, in a June 2017 VA treatment record, a clinician reviewed the service treatment records and concluded that the Veteran's current left and right knee disorders are related to in service injuries. Given the above, the Board cannot find that the preponderance of the evidence is against finding that the Veteran did not have a continuity of bilateral knee symptoms since his in-service injuries. In light of the circumstance in this case, and resolving reasonable doubt in the Veteran's favor, the Board finds that his left and right knee disabilities began during active service. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. Thus, the Board concludes that service connection for left and right knee strains is warranted. Bilateral foot disorder The Veteran's service treatment records do not show any complaints, findings, or diagnoses of foot problems. However, an October 2014 VA medical record, dated within one year of discharge from service, shows complaints of bilateral foot pain due to in-service injuries. Then, a March 2017 private treatment record shows a diagnosis of plantar fasciitis. At a November 2015 VA examination, the Veteran reported that his feet became problematic in 2014 while working as a recruiter, that he was provided with arch support inserts for his shoes, and with his daily use of arch supports his bilateral foot condition is asymptomatic. The examiner diagnosed bilateral plantar fasciitis. In a separate opinion, the examiner noted that the only mention of foot problems in the service treatment records is that of athlete's foot and there is no mention of foot problems at his May 2013 separation examination. The examiner then opined that the Veteran's bilateral plantar fasciitis was not related to service. In a June 2017 statement, the Veteran asserted that he developed foot problems in 2010, not 2014 as noted in the examination report, when he started to wear dress shoes as a recruiter. Then, at the January 2020 Board hearing, he indicated that he did not seek treatment for his feet during service as he was the only recruiter and did not want to leave his post. He also indicated that he continued to have foot symptoms since separation from service. At a September 2020 VA examination, the Veteran reported experiencing increased bilateral heel pain while working as a recruiter near the time of his separation that he attributed to wearing low quarter shoes. He indicated that while he did not seek treatment, he did have chronic pain in his feet. The examiner provided a diagnosis of bilateral plantar fasciitis. In a separate medical opinion, the examiner stated that the service treatment records do not show treatment for a foot disorder, including a May 2013 separation examination. The examiner further stated that the evidence does not show a bilateral foot disorder to a compensable degree within 12 months of separation from service or chronicity of care to establish a link to service. The examiner also noted that the cause of plantar fasciitis is often unclear and may be multifactorial, including inappropriate footwear. While the Board appreciates the examiners' opinions, the Board again observes that continuity of symptoms, not treatment, is required in a claim for service connection and the Veteran is competent to report on his foot pain. As the May 2013 retirement examination focused on disabilities for which he intended to file a claim, it again does not rule out the presence of other minor problems, including with his feet, for which he filed a claim within 14 months of separation. Again, that he did not file a claim even for the disabilities noted at that examination until that time minimizes the significance of the lack of foot complaints at that time and supports his assertion that he has had intermittent foot problems since service. Moreover, an October 2014 VA medical record shows complaints of bilateral foot pain due to in-service injuries within one year of his discharge from service. Also, the September 2020 examiner's statement that plantar fasciitis may be caused by inappropriate footwear tends to support the Veteran's assertion of developing foot problems due to wearing dress shoes as a recruiter. Lastly, while the Veteran was not diagnosed with plantar fasciitis until after discharge from service, he had the same symptoms in service as he does now that led to the diagnosis of plantar fasciitis. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Given the above, the Board cannot find that the preponderance of the evidence is against finding that the Veteran did not have a continuity of bilateral foot symptoms since service. In light of the circumstance in this case, and resolving reasonable doubt in the Veteran's favor, the Board finds that his left and right foot disabilities began during active service. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. Accordingly, the Board concludes that service connection for bilateral plantar fasciitis is warranted. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. W. Kim, 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.