Citation Nr: 21069280 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-53 347 DATE: November 18, 2021 REMANDED Entitlement to service connection for a bilateral foot disorder, to include plantar fasciitis, heel spurs, pes planus, and metatarsalgia, is remanded. Preliminary Matters The Veteran served on active duty from August 1990 to July 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Board remanded the claim on appeal and additionally remanded the claim for service connection for headaches. Thereafter, in a July 2021 rating decision, the Agency of Original Jurisdiction granted service connection for migraine headaches. As such, that issue is no longer in appellate status. As it pertains to the issue for service connection for a bilateral foot disorder, the Board remanded the claim in order to obtain a VA medical opinion as to the etiology of the Veteran's diagnosed plantar fasciitis. The issue was readjudicated in a July 2021 supplemental statement of the case and has now been returned to the Board. The Board further notes that, while the Veteran characterized her claim as one for service connection for bilateral plantar fascitis, the Board finds that the scope of the Veteran's claim is broader and includes diagnoses of heel spurs, pes planus, and metatarsalgia. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, the issue has been broadened to include service connection for a bilateral foot disorder, to include plantar fasciitis, heel spurs, pes planus, and metatarsalgia. REASONS FOR REMAND Pursuant to the Board's March 2021 remand, VA was instructed ot obtain a medical opinion as to the etiology of the Veteran's diagnosed plantar fasciitis. Specifically, the examiner was asked to opine as to whether the Veteran's bilateral plantar fasciitis was proximately due to, caused by, or aggravated by the service-connected fibromyalgia disability. VA obtained a medical opinion in June 2021; however, the Board finds that the opinion (as it pertains to aggravation) is inadequate. In this regard, the examiner stated that the Veteran's bilateral plantar fasciitis was not aggravated by the service-connected fibromyalgia disability because there was "no causal relationship." This does not properly address the theory of aggravation. Notably, a December 2020 VA treatment record indicated that the Veteran had been diagnosed with fibromyalgia in 2016 and had "additional pain" in the hips and feet. Accordingly, a new opinion is required. Further, the Veteran's plantar fasciitis has been directly related to her heel spurs (see July 2020 VA medical opinion). However, an opinion as to whether the Veteran's heel spurs are related to service has not been obtained. As such, a remand is required to properly address the likely etiology of all of the Veteran's diagnosed foot disorders, to include whether they are related to service or secondary to the service-connected fibromyalgia disability. The matter is REMANDED for the following actions: 1. Obtain a medical opinion as to the etiology of the Veteran's bilateral foot disorders from an appropriate medical professional. A physical examination of the Veteran is not required unless deemed warranted by the examiner. The examiner must review all pertinent documents in the record. The examiner is asked to address the following: (a.) Please note that the Veteran has been diagnosed with bilateral foot plantar fasciitis, heel spurs, pes planus, and metatarsalgia. (b.) For EACH diagnosis, provide an opinion as to whether it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's foot disorder is related to service. **The Veteran asserts that she developed plantar fasciitis as a result of service in Southwest Asia. She stated that the disability resulted from wearing boots and carrying heavy rucksacks on long marches and for extended standing times. She indicated that she the painful feet began in service, and continued until it became unbearable in 2014, at which time she sought treatment. (c.) If the Veteran's disorders are not found to be directly related to service, state whether it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's foot disorder(s) is either caused or aggravated by the service-connected fibromyalgia disability. *Address the December 2020 VA treatment record noting that the Veteran had been diagnosed with fibromyalgia in 2016 and had "additional pain" in the hips and feet. *The examiner is advised that secondary service connection does NOT require "permanent" worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). (d.) All opinions should be accompanied by a clear rationale. 2. Then, readjudicate the claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.