Citation Nr: 21066239 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 19-24 258 DATE: October 29, 2021 ORDER Entitlement to service connection for bilateral plantar fasciitis is granted. Entitlement to service connection for arthritis, bilateral feet is granted. FINDINGS OF FACT 1. The Veteran has a current diagnosis of bilateral plantar fasciitis. 2. The Veteran has a current diagnosis of arthritis, bilateral feet. 3. The Veteran's pes planus and arthritis of the feet are at least as likely as not related to his military service to include more than 13,000 hours of flying time as a loadmaster on C-130 aircraft during active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 2. The criteria for entitlement to service connection for arthritis, bilateral feet have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran is retired and had active service from August 1980 to July 1984; April 1985 to August 1985; December 1990 to August 1991; October 14, 2001 to October 17, 2001; March 3, 2003 to April 30, 2004; and July 1, 2005 to November 30, 2012. 1. Entitlement to service connection for bilateral plantar fasciitis 2. Entitlement to service connection for arthritis, bilateral feet The Veteran contends that he developed foot problems during active service that were documented at his retirement medical examination in 2012 as flat feet. After a thorough review of the evidence and resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran has the current diagnosed feet conditions of bilateral plantar fasciitis and bilateral arthritis that are related to active service and accordingly entitlement to service connection is warranted. Service connection may be granted for a 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 generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran had a VA examination in September 2016 that showed a current diagnosis of plantar fasciitis and arthritis in the bilateral feet. Accordingly, the Veteran has met the first Shedden criteria. The Veteran's service personnel records show that the Veteran is retired, having service between active duty and inactive duty over the course of 33 years, to include 13,250 hours as a loadmaster on C-130 aircraft. The Veteran contends that this work as a loadmaster in active service was the reason for developing foot pain. Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The Federal Circuit has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran does not have medical training and accordingly, his lay assertion that the etiology of a plantar fasciitis or arthritis diagnosis is not competent medical evidence. However, the Veteran is competent to report his experiences and history of work and symptoms such as foot pain. In the July 2021 Board hearing, the Veteran stated that a couple years before he retired, he had asked his superior to assign a different type of boot to attempt to alleviate foot pain, which his superior approved. The Veteran also stated that since a couple years prior to service and continuing until the present, he had tried various home remedies for his foot pain such as ice bottles, over the counter creams, orthotics, etc. The Veteran had a VA examination in September 2016. The report reflects that the Veteran stated he had increasing foot pain that he did not list on his medical examinations until leaving the service in 2012 and that he had orthotics made after service separation. The examiner took X-rays of the feet and diagnosed bilateral arthritis in the feet and bilateral plantar fasciitis. The examiner provided an opinion that the Veteran's current foot conditions were not at least as likely as not related to active service. The examiner also explained that the Veteran's 2012 retirement medical examination showed a notation of flat foot, but that such a diagnosis was probably incorrect as the Veteran at the present examination did not show signs of flat feet, to include what is seen in the X-rays. The examiner provided the rationale that the Veteran did not have treatments or complaints for foot pain in the STRs (service treatment records) until the retirement physical and that the present condition was in the mild stage. "The etiology of this condition is NOT [sic] clearly understood and is probably multi-factorial in nature. Weight gain, occupation-related activity, anatomical variations, poor biomechanics, overexertion, and inadequate footwear are contributing factors." The examiner went on the state that in approximately 85 percent of plantar fasciitis cases, the etiology is unknown. The examiner then highlighted that the Veteran was currently obese with a BMI of 31. At the time of the September 2016 VA examination, the records reflect that the Veteran weighed 230 pounds. The RO requested an addendum medical opinion that was issued May 2017. The examiner reiterated that the Veteran does not meet the medical criteria for flat feet based on his medical examination and X-rays. The examiner noted that "bilateral degenerative arthritis can be medically linked to plantar fasciitis." The examiner noted the "greatest risk factors" in the development of plantar fasciitis based on medical studies included obesity or sudden weight gain, and occupations that require prolonged weight-bearing. The examiner then wrote, "Bilateral PF is medically linked to the in-service degenerative arthritis... The Veteran has been obese most of his military career. He is now 54 years old and has a BMI which exceeds 31." In response, the Veteran provided copies of physical fitness testing reports documenting that in 2004, he weighed 190 pounds (BMI 26.5), in 2005, weighed 202 pounds (BMI 28.2), and in 2006, weighed 196 (BMI 27.3.) The RO obtained another addendum medical opinion in July 2019. The examiner in that report stated that there was no objective evidence that the Veteran had complaints of plantar fasciitis until three years after separation. The examiner reiterated his opinion that the plantar fasciitis was not at least as likely as not incurred in or caused by service. The examiner opined that the Veteran's degenerative arthritis was less likely than not incurred in or caused by claimed in-service injury, event, or illness, based on lack of objective evidence in the STR. "The Rater, now, is asking the examiner to make an opinion based on a non- existent bilateral fasciitis for a secondary service connection." It is unclear what the examiner is referencing here, as the Veteran has a current diagnosis of plantar fasciitis, that this examiner previously diagnosed. By the medical examiner's own opinion, the "greatest risk factors" for the development of plantar fasciitis include obesity or sudden weigh gain, then goes on to say that the Veteran was "obese most of his military career." The examiner's opinion also notes one of the "greatest risk factors" as occupations involving prolonged weight bearing. As a loadmaster, whose tasks included loading and unloading cargo from C-130 aircraft, and with 13,000 plus hours of flight time, and to consider the Veteran's lay statements regarding his experiences in his performance of his duties, it is reasonable to consider that such duties for that extensive number of hours involved prolonged weight bearing. The examiner also notes that "degenerative arthritis can be medically linked to plantar fasciitis," although does not explain whether arthritis develops as a result of plantar fasciitis, or whether the two conditions develop coincident to each other. Nonetheless, the 2016 VA examination X-rays of the right foot include a notation of "minimal calcifications are noted in the tibiofibular ligament on the basis of old trauma," without further explanation of the age of this trauma. At this point, the Board notes that the Veteran had been retired from service for four years. The examiner also noted in his opinion that, "the etiology of [plantar fasciitis] is NOT [sic] clearly understood and is probably multi-factorial in nature." The Board will resolve reasonable doubt in favor of the Veteran in finding that the Veteran's bilateral plantar fasciitis and bilateral foot arthritis developed coincident to service and that he has experienced symptoms since service separation, including foot pain with evidence during the appeal period of treatment for plantar fasciitis and bilateral foot arthritis diagnosed by X-ray. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, the appeal for entitlement to service connection for bilateral plantar fasciitis and bilateral arthritis, feet, is granted. With regard to effective date, the Board notes that the notice letter related to the original rating decision of October 2016 was dated October 11, 2016. The Veteran submitted a new claim in January 2017. However, in response, the RO mailed a notification letter dated February 8, 2017 containing erroneous information, specifically, that the one-year period to appeal the original October 2016 rating decision had expired. The Veteran submitted a notice of disagreement in September 2017, which is still within the one-year time frame to appeal the first October 2016 rating decision. The RO should consider this information when assigning the effective dates for the issues herein. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Miller, 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.