Citation Nr: 21067583 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-53 757 DATE: November 4, 2021 ORDER 1. Entitlement to an initial compensable disability rating for bilateral plantar fasciitis prior to August 14, 2015, is denied. 2. Entitlement to a disability rating of 10 percent, but not higher, for bilateral plantar fasciitis from August 14, 2015, to August 31, 2016, is granted. FINDINGS OF FACT 1. The Veteran's initial claim of entitlement to service connection for right and left foot disabilities was received on January 18, 2006. In an August 2006 rating decision, VA granted service connection for right and left foot plantar fasciitis and assigned each foot a noncompensable rating from November 19, 2005. 2. On September 1, 2016, the Veteran claimed entitlement to an increased disability rating for his bilateral plantar fasciitis. A December 2016 rating decision found clear and unmistakable error (CUE) in the prior August 2006 rating decision, which granted separate disability ratings for right and left foot plantar fasciitis, as the relevant rating criteria contemplated that bilateral plantar fasciitis would be rated as a single disability and assigned a single noncompensable disability for bilateral plantar fasciitis, effective November 19, 2005. Additionally, this rating decision granted an increased 50 percent disability rating from September 1, 2016, the date of the Veteran's increased rating claim. 3. Although the Veteran reported pain in his feet on several occasions prior to August 14, 2015, his bilateral plantar fasciitis was manifested by no worse than mild symptoms, without structural or gross deformities. 4. After affording the Veteran the benefits of the doubt, his bilateral plantar fasciitis manifested with moderate symptoms, including pain on manipulation and use of feet, which was not relieved by built-up shoe or arch support, from August 14, 2015, until August 31, 2016. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial compensable disability rating for bilateral plantar fasciitis prior to August 14, 2015, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5276. 2. The criteria for entitlement to a disability rating of 10 percent, but not higher, for bilateral plantar fasciitis from August 14, 2015, to August 31, 2016, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5276. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1986 to September 1986 and from June 2004 to November 2005. The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge (VLJ) in July 2019. This case was previously before the Board in April 2020, at which time, the Board denied the claim for an effective date prior to September 1, 2016, for the assignment of a 50 percent disability rating for bilateral plantar fasciitis. As discussed in more detail below, after reviewing the relevant evidence and contentions, the Board determines that this matter should be recharacterized as it appears on the title page of this decision based on the applicable law and facts of this case, as the finding of CUE within the 2006 rating decision caused that rating decision to not become final. The Veteran appealed the Board's April 2020 denial of his claim to the United States Court of Appeals for Veterans Claims (Court). In a June 2021 Joint Motion for Remand (Joint Motion), the Veteran and the Secretary of VA (parties) determined that the Board's denial should be vacated, and the matter was remanded for the Board to address the applicability of 38 C.F.R. § 4.59 to the Veteran's reports of pain and pain on use. The parties further agreed that the Board should address whether the Veteran's symptoms of metatarsalgia with swelling and deformity was attributable to his bilateral plantar fasciitis, and to provide an adequate statement of reasons or bases addressing the Veteran's use of shoe inserts prior to September 1, 2016. The Board shall address each of these matters below. The Veteran asserts that a compensable disability rating is warranted for bilateral plantar fasciitis prior to September 1, 2016. Specifically, he and his representative have asserted in various statements, including at the July 2019 Board hearing, a June 2021 written statement, and in the June 2021 Joint Motion, that an increased rating is warranted prior to September 1, 2016, due to the Veteran's bilateral foot pain and pain on use of the feet, the presence of metatarsalgia and swelling in the right foot, and that shoe inserts did not alleviate his symptoms. The record shows that the Veteran first submitted a claim of entitlement to service connection for right and left foot disabilities on January 18, 2006. In an August 2006 rating decision, VA granted service connection for right and left foot plantar fasciitis, each rated as noncompensable, from November 19, 2005, under DC 5299-5284, which rated the Veteran's bilateral foot disabilities by analogy as other foot injuries. See 38 C.F.R. § 4.71a, DC 5284. Thereafter, the Veteran did not submit a notice of disagreement or new and material evidence within the one-year period following notification of the decision. Years later, in September 2016, the Veteran claimed entitlement to an increased disability rating for his bilateral plantar fasciitis. A subsequent December 2016 rating decision found that there was CUE in the prior August 2006 rating decision, which granted separate disability ratings for right and left foot plantar fasciitis, as the relevant rating criteria contemplated that bilateral plantar fasciitis would be rated as a single disability and assigned a single, noncompensable disability rating for bilateral plantar fasciitis, effective November 19, 2005, under the criteria for acquired flatfoot disabilities. See 38 C.F.R. § 4.71a, DC 5276. Additionally, the rating decision granted an increased 50 percent disability rating from September 1, 2016, which was the date of the Veteran's increased rating claim. The Veteran's timely appeal followed, and he has since clarified that he is seeking at least a compensable rating for the bilateral plantar fasciitis prior to September 1, 2016, at which time he was granted increased 50 percent disability rating, and that he was not seeking a higher rating since that time. The Board notes that the Veteran's bilateral plantar fasciitis is currently rated as 30 percent disabling, effective August 24, 2017. As VA has previously found CUE in the prior August 2006 rating decision, and in order to afford the Veteran due process, the Board has herein considered whether a compensable disability rating is warranted for the Veteran's bilateral plantar fasciitis for any period on appeal prior to September 1, 2016. However, for the reasons and bases discussed below, the Board finds that the preponderance of the evidence weighs against the Veteran's claim for a compensable disability rating prior to August 14, 2015, for bilateral plantar fasciitis. Nonetheless, after affording him the benefits of the doubt, a 10 percent disability rating, but not higher, is warranted from August 14, 2015 to August 31, 2016. VA has adopted a Schedule for Rating Disabilities (Schedule) to evaluate service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R., Part IV. Disability evaluations assess the ability of the body as a whole, the psyche, or a body system or organ to function under the ordinary conditions of daily life, to include employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Id. The Schedule assigns DCs to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the claimant. 38 C.F.R. § 4.3. The Schedule recognizes that a single disability may result from more than one distinct injury or disease; however, rating the same disability or its manifestation(s) under different DCs a practice known as pyramiding is prohibited. See 38 C.F.R. § 4.14. In disability rating cases, VA assesses the level of disability from the initial grant of service connection or a year prior to the date of application for an increased rating and determines whether the level of disability warrants the assignment of different disability ratings at different times over the course of the claim, a practice known as "staged ratings." As VA has previously found CUE in the prior August 2006 rating decision, the initially-assigned rating for this disability is on appeal. Moreover, the Agency of Original Jurisdiction (AOJ) has assigned the maximum rating for this disability since September 1, 2016, which the Veteran has clarified that he is not seeking a higher rating since that time. Thus, the appeal period stems from November 19, 2005, until August 31, 2016. As noted above, during the relevant appeal period, the Veteran's service-connected bilateral plantar fasciitis is rated by analogy to acquired pes planus under DC 5276. This disability is assigned a noncompensable rating from November 19, 2005, and a 50 percent disability rating from September 1, 2016. Under DC 5276, a noncompensable disability rating is warranted for mild symptoms relieved by built-up shoe or arch support. A 10 percent disability rating is warranted for bilateral or unilateral moderate symptoms including a weightbearing line over or medial to the great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet. A 20 percent (for unilateral involvement) or 30 percent (for bilateral involvement) disability rating is warranted for severe symptoms including objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. Finally, a maximum schedular 30 percent (for unilateral involvement) or 50 percent (for bilateral involvement) disability rating is warranted for pronounced symptoms including marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. Under 38 C.F.R. § 4.45, functional loss due to weakened movement, excess fatigability, and incoordination must also be considered. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995) (holding that the criteria discussed in sections 4.40 and 4.45 are not subsumed by the DCs applicable to the affected joint). Furthermore, 38 C.F.R. § 4.59 recognizes that painful motion is an important factor of disability. Joints that are painful, unstable, or misaligned, due to healed injury, are entitled to at least the minimum compensable rating for the joint. Id. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. Id.; see Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that § 4.59 applies to all forms of painful motion of joints, and not just to arthritis). Pain that does not result in additional functional loss does not warrant a higher rating. See Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011) (holding that pain alone does not constitute function loss and is just one fact to be considered when evaluating functional impairment). A November 2005 service treatment record shows that the Veteran complained of pain in his feet. In connection with his application for service connection for the right and left foot disabilities, the Veteran asserted in a January 2006 statement that he had pain in both feet that was caused by constantly jumping out of trucks, marching, and training while in service. March 2006 VA treatment records also document the Veteran's complaint of bilateral foot pain for the past year after an injury from jumping off a truck during Army training. He described his pain as achy and noted that it hurt to walk on and caused him to limp, but denied that his foot pain required pain medication. He stated that he had seen a podiatrist and was told to put a pad underneath, which was helpful, but noted that the pain started coming back approximately one month prior. X-rays of the feet showed a calcified Lisfranc ligament on the right foot, with otherwise normal views of the bilateral foot. His symptoms were assessed as bilateral foot pain, and possible Morton's neuromas, and metatarsal arch supports were recommended. In a May 2006 VA podiatry consultation note, the Veteran reported bilateral foot pain, mostly on the right, at the plantar aspect of the third metatarsal, which was present for roughly one year. He reported that the pain was aching in nature and seemed to occur with ambulation, but also noted that the pain was relieved with increased ambulation and worsened after moments of rest. He reported outside treatment from a podiatrist who told him it was a neuroma and gave him a metatarsal pad, which helped with the pain for about two weeks but then the pain returned. Upon physical evaluation, there was no crepitus or pain with range of motion of the ankle or foot, his gait was stable and unassisted, and there were no structural deformities. There was no intermetatarsal pain, no pain with metatarsophalangeal (MTP) squeeze test, no pain along the Achilles tendon, and no pain with side-to-side compression of the calcaneus. However, there was noted pain on palpation along the plantar fascia, with maximum pain just distal to the insert. The physician diagnosed the Veteran with plantar fasciitis and discussed proper shoe gear, including the wearing of daily inserts, and was given over-the-counter inserts he was to wear daily. The physician advised the Veteran to not walk around barefoot and to ice the heel daily. The Veteran was shown the correct way of stretching and was told to perform stretching exercises multiple times a day. The physician prescribed Naprosyn medication and offered the Veteran steroid injections, which he declined at the time. The Veteran underwent a VA examination in July 2006, during which he reported a history of bilateral foot problems, right greater than left. Specifically, he noted that during training prior to deployment to Iraq, he was required to jump out of five-ton military trucks with gear on, and to jump out of the top bunk, which both resulted in foot pain. He stated that he was seen and put on a profile, but experienced pain in the arches and the ball of the feet. He saw a podiatrist when he returned from deployment and was given pads for a possible neuroma and was later diagnosed by a VA podiatrist with plantar fasciitis. He was given insoles that made his pain worse. He stated that prescription pain medication (Naprosyn) and stretching exercises had not helped and reported current daily pain in the right foot and every other day in the left. Additionally, he reported flare ups of increased pain, with no change in range of motion, and no weakness, fatigue, or incoordination. The examiner noted that x-rays performed in the last couple of months showed a right calcified lateral ligament on the right foot and a negative left foot. The examiner stated that the Veteran did not have any real flare-ups other than those noted above. Upon physical examination, the Veteran moved freely and was not in any acute distress. His posture and gait were normal, without any required assistive devices or orthotics. The examiner noted that dorsiflexion of the ankles at both feet was 10 degrees with pain on the right at the end range and no pain on the left. Plantar flexion was 55 degrees with no pain. Repetitive motion did not change the Veteran's symptoms. Bilateral feet strength, sensation, and reflexes were all normal, but there was tenderness at the insertion of the plantar fascia to the calcaneus bilaterally, greater on the right than the left. There was no edema, skin changes, or toe abnormalities, and the Veteran was not tender on manipulation of the arches, between the metatarsals, or with squeezing the metatarsals or calcaneus. Arch height and Achilles tendon angle were maintained with and without weight-bearing. There were no signs of abnormal weight bearing. There was no deformity, swelling, or erythema. There were no additional changes in active or passive range of motion during repeat motion testing and no additional losses of range of motion of the involved joints due to pain, weakness, impaired endurance, fatigue, incoordination, or flare ups. The examiner diagnosed bilateral plantar fasciitis, greater on the right than the left. VA treatment records from August 2006 document the Veteran's complaints of ongoing bilateral foot pain. Significantly, he stated that he had not tried any of the things that were suggested by his treatment providers for more than three days; the provider noted that the Veteran was wearing flip flop sandals without a supportive insert. Upon physical evaluation, there was no crepitus or pain with range of motion of the ankle or foot, his gait was stable and unassisted, and there were no structural deformities. There was no intermetatarsal pain, no pain with the MTP squeeze test, no pain along the Achilles tendon, and no pain with side-to-side compression of the calcaneus. However, there was noted pain on palpation along the plantar fascia, with maximum pain just distal to the insert with edema present. The physician diagnosed plantar fasciitis, and again discussed proper shoe gear, including the need for the Veteran to wear daily over-the-counter inserts. The physician again advised the Veteran to not walk around barefoot, to ice the heel daily, and to perform stretching exercises multiple times a day. The Veteran requested a steroid injection but it was terminated after he was unable to tolerate the injection procedure. An April 2008 VA case manager's screening note showed that the Veteran complained of foot pain, as well as neck and back pain. However, he reported in a December 2009 VA risk assessment screening note that he did not have any chronic pain or medical condition that was proving difficult to deal with. Similarly, when asked whether he had any chronic pain or medical condition that was proving difficult to deal with in a subsequent December 2009 VA mental health note, the Veteran described his feet as being cold all the time. The Board notes that the Veteran did not indicate that his feet were painful at the time. Likewise, he denied having any pain at the time of a January 2010 VA primary care nursing note. Subsequent VA treatment records from September 2012 document the Veteran's complaint of joint pain in his left foot. He denied having any swelling, weakness, limitations, or cramping of his extremities. Upon physical evaluation, there was no noted edema, and sensation was intact to the extremities and feet. However, the Veteran complained of some pain to firm palpation of the medial aspect of the left foot. In February 2014, the Veteran was seen by VA medical providers for complaints of right foot pain for the previous three months due to working long hours on his feet. He reported some left foot pain but stated that it was not as bad as the right side. He reported that he worked long hours standing up on a forklift for his job and that he had put extra padding into his shoes with little relief. He reported no trauma to the right foot, but he did have a piece of steel fall on his left foot. X-rays from several months prior were within normal limits. He reported that nothing seems to make the pain in his foot better and that standing on it makes it worse. Upon physical evaluation, there were no obvious deformities noted to the left foot, no erythema, and no edema present. He had full range of motion of the ankles. Muscle strength was normal on flexion and extension of the bilateral toes, but flexion of the toes on the right foot elicited pain. Pain was also noted on palpation of the metatarsals between the second and third toes. The physician assessed the Veteran's feet with metatarsalgia with classic presentation and severe pain with palpation of the metatarsal region between the second and third tarsal space. The Veteran was provided a cortisone and lidocaine injection. The Veteran was instructed to obtain a metatarsal pad for both feet and to return to the clinic in one month if his pain did not improve or worsened on either foot. He was prescribed muscle spasm medication due to his reports of having back spasms. During a March 2015 VA primary care annual visit, the Veteran reported that since the previous visit, he was incarcerated for domestic violence but was out of prison and working now. He reported recurrent bilateral foot pain "just like back in" February 2014 when he received foot injections with great results. The physician noted that the Veteran had used the shoe inserts but they had not helped much. He reported that his pain had lasted for one month. He rated his pain as an eight out of a possible 10, and described the pain as sharp, waxing, and waning. The pain was located in the bilateral metatarsal regions, mainly between the second and third metatarsals. The Veteran reported exercise aggravated his pain, but rest relieved his painful symptoms. Similar to the February 2014 physical evaluation, an evaluation of the Veteran's feet showed no obvious deformities in the left foot. He had full range of motion of the ankles. Muscle strength was normal on flexion and extension of the bilateral toes, but flexion of the toes on the right foot elicited pain. Pain was also noted on palpation of the metatarsals between the second and third toes, but sensation was intact in both feet. The physician again assessed the Veteran's feet with metatarsalgia with classic presentation and severe pain with palpation of the metatarsal region between the second and third tarsal space. The Veteran was again provided with a cortisone and lidocaine injection. The January 2016 VA primary care annual visit showed nearly identical physical evaluation findings as were noted in this March 2015 annual visit. In May 2015, the Veteran reported ongoing pain in his feet. It was noted that he was helped by VA vocational rehabilitation to get new boots for his plantar fasciitis. Upon follow up with VA podiatry in June 2015, the Veteran reported that his bilateral foot pain was worse at the end of the day and also noted tingling in his feet in the evenings. He reported about one week of pain relief with prior cortisone injections in his metatarsal region and noted that he had been wearing red wing shoes with inserts. Upon physical evaluation, range of motion was normal, without crepitus or pain, and there were no structural or gross deformities. The examiner documented tenderness to palpation of the second interspace bilaterally and pain with MTP lateral squeeze but no pain upon palpation of the medial aspect of the feet. In a June 2015 statement, the Veteran reported that he had serious problems with his feet and that both feet had plantar fasciitis. He asserted that his foot pain began in service and that his feet are sometimes blue in color. He reported that he received injections in his feet and that VA Vocational Rehabilitation and Employment services qualified him for specific boots. He stated that he was being seen by a pediatric and foot doctor. A VA mental health medication management note, dated August 14, 2015, shows that the Veteran complained of a lot of foot pain that tired him out. He reported that he worked at a job that required him to be on his feet all day. He stated that he received new insoles and his feet still hurt, so he knew that he needed to receive injections into his feet. He reported that a VA provider had given him shots in the past, which helped for two months. He reported that he was going to make an appointment with this VA provider. In a June 2016 VA psychology note, the Veteran noted that he was concerned with pain in his feet. Moreover, in a July 2016 VA pharmacy medication management note, the Veteran was noted to have a history of metatarsalgia and reported that his right foot was larger than the left foot. He requested that his bilateral feet be evaluated and that he receive injections in both feet. The Veteran's feet were subsequently evaluated in July 2016 by a VA physician. During the evaluation, the Veteran reported recurrent problems with metatarsalgia. A physical evaluation showed that the right foot seemed somewhat more swollen than the left foot without pitting. The second toe on the right foot was deformed and was almost a hammer toe with some deviation to the fifth toe with a lateral deviation or kink in the proximal interphalangeal (PIP) joint. As noted in the February 2014 and March 2015 VA treatment records, this physician again noted that the Veteran had metatarsalgia with the classic presentation with severe pain with palpation of the metatarsal region between the second and third tarsal space. The Veteran was again provided with a cortisone and lidocaine injection. An August 2016 VA treatment record shows that the Veteran reported that injections and shots had helped with the pain in his feet. At the July 2019 Board hearing, the Veteran's representative asserted that the Veteran should have been granted an initial compensable disability rating of 50 percent from the initially assigned effective date, as he was not asymptomatic at the time of the prior August 2006 rating decision and displayed symptomology at the time of his discharge in November 2005. The Veteran testified that his foot pain began in service and that it had gotten worse over time. He further testified that he had been wearing bilateral foot inserts since he was granted a 50 percent disability rating, or since September 1, 2016, and that the inserts did not really help alleviate his bilateral foot pain. Furthermore, the Veteran and his representative asserted that the July 2006 VA examination was inadequate because the examiner did not properly examine the Veteran's feet, simply observed the Veteran walking from one corner of the room to the other and did not refer him to a podiatrist. To the extent that the Veteran and his representative have asserted inadequacy in the prior July 2006 VA examination, the Board finds that a review pf the examiner, report does not support that allegation. Rather, the July 2006 VA examination report documents that the VA examiner reviewed the Veteran's claims file, including recent x-rays, and performed a thorough physical examination, including range of motion testing. Accordingly, the Board finds the Veteran's assertions of inadequacy are not substantiated by the detailed clinical findings in the VA examination report and properly affords the July 2006 VA examination probative weight, as well as the additional objective VA treatment records noted above. Following a review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding that the Veteran's bilateral plantar fasciitis warranted a compensable disability rating prior to August 14, 2015, at which time his symptoms increased in severity, warranting a disability rating of 10 percent from August 14, 2015, to August 31, 2016. The reasons follow. As mentioned above, the parties agreed in the June 2021 Joint Motion that the Board was required to discuss whether the Veteran's bilateral plantar fasciitis symptoms warranted a minimum compensable disability rating of 10 percent disabling after applying the provisions of 38 C.F.R. § 4.59 to the Veteran's reported pain with forward flexion and with palpation of the metatarsals between the second and third toes noted prior to September 1, 2016. The Veteran and his representative made similar contentions in June 2021 and October 2021 statements. The Board notes, however, that the evidence from the February 2014, March 2015, and January 2016 VA primary care notes states pain was elicited when the toes of the right foot were flexed forward, rather than when the right foot was in flexion. Moreover, this pain was caused by the Veteran's bilateral metatarsalgia condition, which has not been attributed to the Veteran's service-connected bilateral plantar fasciitis by a competent professional. In fact, the February 2014, March 2015, and January 2016 VA primary care notes did not discuss this service-connected disability. Rather, they discussed only the impact of, and treatment for, the Veteran's nonservice-connected bilateral metatarsalgia, which affects a distinct and separate aspect of the Veteran's foot than the plantar fasciitis disability. Furthermore, the parties within the Joint Motion cited to the July 2006 VA examination report, in which the examiner noted pain in the right foot at the end range of dorsiflexion. However, the Board finds it notable that the July 2006 examiner determined that the Veteran's dorsiflexion of the ankles at both feet was to 10 degrees. Although the examiner documented pain on the right at the end range of dorsiflexion of the ankle, rather than the foot, the examiner did not state or indicate that pain limited the Veteran's motion at that range or that he had painful motion past that range of the foot. The Board's finding that this examination report did not show the presence of painful motion in either foot is buttressed by the fact that the examiner found that the Veteran did not have any additional losses of range of motion of the involved joints due to pain, weakness, impaired endurance, fatigue, incoordination, or flare ups, or additional changes in active or passive range of motion during repeat motion testing. Thus, although the record shows that the Veteran reported pain in his bilateral foot on several occasions prior to August 14, 2015, and that this pain was attributed to his nonservice-connected metatarsalgia disability on several occasions, the evidence does not show that such pain was attributed to his bilateral plantar fasciitis or that it resulted in painful motion of either foot. See Mitchell, 25 Vet. App. 42-43; 38 C.F.R. §§ 4.40, 4.59. Additionally, in the June 2021 Joint Motion, the parties agreed that the Board must address whether the Veteran's metatarsalgia, which caused swelling and a deformed second toe in the right foot prior to September 1, 2016, was attributable to the service-connected bilateral plantar fasciitis, which would warrant a disability rating of 20 percent for unilateral involvement under the rating criteria. See 38 C.F.R. § 4.71a DC 5276. Furthermore, the parties agreed that the Board must address the evidence of record that suggested that the Veteran's symptoms did not improve with the use of inserts or pads in his shoes prior to September 1, 2016. The Veteran and his representative made nearly identical contentions in June 2021 and October 2021 statements. Although the lay and medical evidence shows the Veteran's ongoing complaints of bilateral foot pain, as well as swelling and second toe deformity on the right foot prior to September 1, 2016, there is no probative evidence of symptomatology that meets the rating criteria for an increased 10 percent disability rating under DC 5276 prior to August 14, 2015. Specifically, these right-foot symptoms have been attributed to the Veteran's metatarsalgia, which is not a service-connected disability and which affects a separate part of the foot. Furthermore, apart from the lay assertions of the Veteran and his representative, there is no competent evidence that the metatarsalgia symptoms are attributed to the service-connected bilateral plantar fasciitis, and the Veteran has not provided competent evidence of a relationship between these two disabilities. In fact, the medical evidence of record that discusses the Veteran's metatarsalgia diagnosis, as well as the right foot swelling and toe deformity symptoms, does not discuss or mention plantar fasciitis as a cause of such a disorder. Accordingly, the probative evidence of record does not show symptomatology which meets the rating criteria for an increased 10 percent disability rating under DC 5276, such as a weight-bearing line over or medial to the great toe, or inward bowing of the tendo achillis prior to August 14, 2015. Similarly, the preponderance of the evidence is against symptomatology from the Veteran's bilateral plantar fasciitis that meets the rating criteria for an increased 30 or 50 percent disability rating. As noted above, the evidence does not document structural or gross deformities prior to September 1, 2016, including marked pronation, marked inward displacement, objective evidence of marked deformity (pronation, abduction, etc.) or indication of swelling on use, with characteristic callosities that is attributed to the service-connected bilateral plantar fasciitis. Regarding the Veteran's use of shoe inserts, the Board notes that his own testimony is consistent with most of the objective treatment records, which document that he was not following through with recommended treatment procedures, including the use of bilateral inserts and rehabilitation stretching and icing, prior to August 14, 2015. Specifically, the Veteran testified at the July 2019 Board hearing that he had been utilizing bilateral foot inserts only since September 1, 2016. Although he has reported to several medical providers during the relevant time period, as noted in the June 2021 Joint Motion, that his symptoms did not improve with the use of inserts or pads in his shoes prior to August 14, 2015, this evidence does not show that his symptoms amount to an increased disability rating of 10 percent, as the preponderance of the evidence is against a finding that this disability was moderate, to include with weight-bearing line over or medial to the great toe, or inward bowing of the tendo achillis. Additionally, the Board notes that the Veteran's pain was consistently limited to tenderness at the plantar fascia, without tenderness on manipulation of the arches, between the metatarsals, or with squeezing the metatarsals or calcaneus, and the Board does not equate this limited manifestation of pain to a finding of general pain on manipulation and use of the feet prior to August 14, 2015. The Board determines that the Veteran's ongoing complaints of bilateral foot pain do not equate to accentuated pain on manipulation and use, or extreme tenderness of the plantar surfaces of both feet. However, after affording him the benefit of the doubt, the evidence shows that he his bilateral plantar fasciitis manifested with moderate symptoms, including pain on manipulation and use of feet, which was not relieved by built-up shoe or arch support, since August 14, 2015. Specifically, the August 2015 VA mental health medication management note showed that the Veteran's symptoms had worsened, as he complained of foot pain even though he was using new insoles, and this foot pain was attributed to his plantar fasciitis disability. See 38 C.F.R. §§ 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5276. Nonetheless, a disability rating in excess of 10 percent from August 14, 2015, to August 31, 2016, is not warranted as the evidence does not show severe symptoms, including objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities attributed to either unilateral or bilateral plantar fasciitis. Given the above, the Board finds that the preponderance of evidence is against a finding that a compensable disability rating is warranted prior to August 14, 2015, for the Veteran's service-connected bilateral plantar fasciitis, during which time his disability was manifested by no worse than mild symptoms. As the preponderance of the evidence is against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim is denied as to this appeal period. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). However, after resolving all doubt in the Veteran's favor, a disability rating of 10 percent, but not higher, for bilateral plantar fasciitis from August 14, 2015, to August 31, 2016, is granted. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Hodzic, 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.