Citation Nr: 21075888 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 15-25 407 DATE: December 21, 2021 ORDER Entitlement to an initial rating of 30 percent, but no higher, for bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia prior to December 20, 2019 is granted, subject to the law and regulations governing the payment of monetary awards. Entitlement to a rating in excess of 30 percent from December 20, 2019 to July 4, 2021 for bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia is denied. Entitlement to a rating of 50 percent for bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia from July 5, 2021 is granted, subject to the law and regulations governing the payment of monetary awards. REMANDED Entitlement to an initial compensable rating for epididymitis is remanded. FINDINGS OF FACT 1. Prior to December 20, 2019, the Veteran's bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia was manifested by symptoms of objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. 2. From December 20, 2019 to July 4, 2021 the Veteran's bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia did not manifest in symptoms more closely approximating marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement with severe spasm of the tendon Achilles on manipulation not improved by orthopedic shoes or appliances. 3. From July 5, 2021, the Veteran's bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia did manifest in symptoms more closely approximating marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement with severe spasm of the tendon Achilles on manipulation not improved by orthopedic shoes or appliances. CONCLUSIONS OF LAW 1. Prior to December 20, 2019, the criteria for a disability rating of 30 percent, but no higher, for bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276 (2020). 2. From December 20, 2019 to July 4, 2021, the criteria for a disability rating in excess of 30 percent for bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276 (2020). 3. From July 5, 2021, the criteria for a disability rating of 50 percent for bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1990 to February 1994. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, a hearing was held before the undersigned. A transcript of the hearing is of record. The case was previously before the Board in May 2019, September 2020, and March 2021 when it was remanded for further development. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities found in 38 C.F.R. Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where entitlement to disability compensation has already been established and an increase in the assigned rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board must also consider staged ratings, which are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia The Veteran seeks an initial rating in excess of 10 percent for bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia prior to December 20, 2019 and in excess of 30 percent thereafter. The Veteran's bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5276, for acquired flatfoot. Under Diagnostic Code 5276, a 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot; 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. A maximum 50 percent rating is warranted for bilateral acquired flatfoot; 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. 38 C.F.R. § 4.71a, Diagnostic Code 5276. Although the 50 percent rating for pronounced flat feet also references "marked pronation," the criteria go on to include extreme tenderness of the plantar surfaces, "marked inward displacement and severe spasm" of the Achilles tendon on manipulation, not improved by orthopedic shoes or appliances. Id. In other words, although the rating criteria are not clearly successive in nature, marked pronation alone is not sufficient to rise to the level of a 50 percent rating because it is also contemplated by the 30 percent rating. Cf. Tatum v. Shinseki, 23 Vet. App. 152, 155-56 (2009). Further, some of the criteria for a rating of 50 percent under Diagnostic Code 5276 are in the conjunctive, using the word "and"; therefore, all such criteria must be present and 38 C.F.R. § 4.7 cannot circumvent the need to show all required criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis, to include in situations where the disability at issue is not evaluated based on range of motion measurements. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The rating criteria used to evaluate the feet were revised effective February 7, 2021. The revisions added Diagnostic Code 5269 to evaluate plantar fasciitis. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76,453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5269). From the effective date of the revisions, the Veteran could be entitled to a rating under these criteria. Diagnostic Code 5269 provides for a 30 percent rating where there is bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. Otherwise, a 10 percent rating is warranted. Note (1) provides that where there is actual loss of use of the foot, a 40 percent evaluation should be assigned. Note (2) states that if a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 or 30 percent criteria, whichever is applicable. "Loss of use of the foot" is defined as no effective function remaining other than that which would be equally well served by an amputation stump at the site of election below the knee with use of a suitable prosthetic appliance. The determination is made on the basis of the actual remaining function of balance, propulsion, etc., which could be accomplished equally well by an amputation stump with prosthesis. 38 C.F.R. § 4.63. A September 2006 private treatment record reflects the Veteran reported having pain in his heels and not being able to walk for very long when not wearing insert arch supports. Physical examination revealed collapse of the medial longitudinal arch with forefoot abduction and calcaneal eversion, left greater than right. He had lesions on both feet consistent with verrucae. The assessment was pes planus with equinus, left greater than right and verrucae, bilateral. The Veteran submitted an August 2009 independent medical examination, where an examiner stated that the Veteran's arches had fallen more, and had pain in the Achilles tendons, heels, and back of heels. There was still pain in the plantar fascia. Corns on the back of his heels have continued. The Veteran also developed abnormal motion of the metatarsal heads and hypertrophy of the left third metatarsophalangeal joint. Examination of the feet showed calluses, hypertrophy, and hyperkeratosis verruca on the back of the heel. There was tenderness of the Achilles tendon, and resulting decreased dorsiflexion and plantar flexion of the foot. There was flatness of the feet and tenderness of the calcaneus and plantar fascia. The Veteran underwent a VA examination in March 2010. The Veteran stated that he had pain that was nearly constant. He could usually walk out the intense pain after he woke up in the mornings, but with weightbearing and at the end of the day the pain is the greatest. He did not report weakness, stiffness, or swelling. He stated his feet fatigue easily but denied any lack of endurance. The Veteran had pain with rest, but pain was greatest with standing and walking. He denied functional limitations of standing and walking. He had flare-ups about 2 times a week which lasted from 1 to 1 12 hours. He was not functionally limited during a flare-up, but further weight bearing would cause increased pain. He began wearing shoe inserts around 2001, which seemed to help. The Veteran worked a desk job and did not have functional limitations at work. He also denied any limitations in daily activities such as eating, grooming, bathing, toileting, or getting dressed. He denied functional limitations with standing or walking and did not have a history of neoplasms. An examination of the feet showed no deformity, deviation, inflammation, or discoloration. There was no callus formation. There was a small lesion located on the medial edge of the left foot and the lateral edge of the right foot at the heel which was consistent with a plantar wart. There was no other calluses or other evidence of any abnormal weight bearing. There was no fungal infection. Achilles' alignment was within normal limits. There was some pain at the insertion of the Achilles to the calcaneus to palpation. No erythema or edema was present. The Veteran had bilateral pes planus. He had tenderness to palpation over the bilateral heels as well as the metatarsophalangeal joints at each of the five digits of both feet. There was normal range of motion of the feet and no change with repetition. The Veteran was able to rise to his toes. On weight bearing, papules became apparent along the medial posterior lateral aspects of both heels. The Veteran was assessed with bilateral pes planus, verruca at the bilateral heels, plantar fasciitis, bilateral small plantar spurs, DJD of the left midfoot, and piezogenic pedal pulses. Private podiatry records from January 2014 indicate that the Veteran had pain that was shooting, tender, numb, throbbing, dull, burning, and tingling. He reported pain with shoe wear, touch, walking, and weight bearing. He reported a painful right heel, pain in the plantar heel after periods of rest, prolonged standing, and weight bearing. The Veteran reported having custom orthotics which hurt his feet and did not help. The Veteran also had painful flat feet. There were palpable pedal pulses in the feet. There was no edema. Skin temperature, color, and turgor were within normal limits. There was pain to palpation of the plantar medial heel of both feet. Pain was elicited to the right and left heel with dorsiflexion of the ankle. There was excess pronation of the ankle and subtalar joints of both feet. There was semi-rigidity of the flatfeet. No crepitus was present with ankle and subtalar joint ranges of motion in the feet. There was prominence of the medial navicular on the feet. There was hypertrophy and plantar prominence of the left foot, and some fat pad atrophy. Gross muscle strength and tone appeared to be normal. Hyperkeratotic lesions were noted on the heels. Pain was elicited on side-to-side compression of lesions. There was also pain elicited with compression of the metatarsal heads. There was hyperpronation present upon weight bearing and normal angle and base of gait. There was calcaneal valgum with lateral ankle impingement upon weight bearing, too many toes sign from increased collapse of arch, and a pronated gait. The Veteran underwent a VA examination in February 2014. The Veteran complained of daily pain on the plantar aspect of the left foot and pain in the Achilles tendon, heels, and ankles, which is also worsened with weight bearing. He also complained of calluses on his feet due to abnormal weight bearing. He is limited in walking and standing for long periods. The Veteran had Morton's neuroma and metatarsalgia on the left foot. He did not have hammer toes, hallux valgus, hallux rigidus, pes cavus, malunion or nonunion of tarsal or metatarsal bones, and no other foot injuries. There was no evidence of bilateral weak foot. The Veteran used shoe inserts on a constant basis. His foot condition did not impact his ability to work. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability during flare-ups or when the joint is used repeatedly over time. The Veteran did not have flare-ups and did not describe additional limitations and the examination did not reveal additional limitation on repetitive range of motion testing. In May 2015 VA treatment records, the Veteran complained of foot pain and limited relief with shoe insoles/heel support. In October 2015, the Veteran indicated that the arch supports which were ordered for him caused a lot of pain. February 2016 records note that the supports were incorrectly made. Private treatment records from April 2016 note the Veteran's complaints of painful flat feet. Resting, restricted weight bearing, and orthotics have not helped or helped very little. There was a notable Achilles equinus deformity and a pes plano valus/flatfoot deformity noted on both feet. There was palpable soft tissue mass located on the left arch/plantar fascia. It was skin colored, well circumscribed, non-mobile, firm, non-painful and approximately 8mm in diameter. During his August 2018 hearing, the Veteran stated that his feet were in a lot of pain, and he walked with his feet turned inwards. He could not run and had pain all day. Doing yard work would make his Achilles feel like they were tearing. He stated that he moved to a desk job because of his feet. His ankles were very unstable and wobbly due to his feet. He stated his inserts, which are cork, don't really do much for his feet because they are flat. The Veteran underwent a VA examination in December 2019. He complained of constant, sharp pain 5/10, and cramps at night. He reported tenderness. He would get flare-ups when he was standing and walking for prolonged period os time. Flare-ups come every day, sharp pain 8/10, and last until he can take medication. He reported functional loss due to standing and walking for a prolonged period of time. Regarding pes planus, the Veteran had pain on use and manipulation of both feet that was accentuated on use and manipulation. There was no swelling on use and no characteristic calluses. The Veteran tried orthotics but remained symptomatic. He did not have extreme tenderness of plantar surfaces on one or both feet. The Veteran had decreased longitudinal arch height on both feet. The Veteran did not have objective evidence of marked deformity or marked pronation. The weight bearing line did not fall over or medial to the great toe. There was no lower extremity deformity other than pes planus causing alteration of the weight bearing line. There was no inward bowing of the Achilles tendon and no marked inward displacement and severe spasm of the Achilles tendon. The veteran had Morton's neuroma and metatarsalgia in the left foot. The Veteran did not have hammer toe, hallux valgus, hallux rigidus, pes cavus, malunion or nonunion of tarsal or metatarsal bones, and other foot injuries not already described. There was pain on physical examination of both feet, but it did not contribute to functional loss. The examiner indicated that pain was subjective only. There was no functional loss for the left and right lower extremities. There was no pain, weakness, fatigability, or incoordination that significantly limited functional ability during flare-ups and when the foot is used repeatedly over a period of time for both feet. There was no other functional loss. The Veteran used orthotics on a regular basis for plantar fasciitis. The functional impact was increasing pain with prolonged walking, standing, and climbing stairs. Private podiatry records from May 2020 note the Veteran complained of painful flat feet and that previous treatments have not helped or helped very little. There was pain with palpation in both arches/plantar fascia. There was a notable Achilles equinus deformity. There was pain with palpation located around the posterior area of both Achilles tendons. There was notable pain and edema in that area. There was a pes plano valus/flatfoot deformity on both feet. There was palpable soft tissue mass located on the left arch/plantar fascia. It was skin colored, well circumscribed, non-mobile, firm, non-painful and approximately 8mm in diameter. In June 2020, the Veteran stated there were no changes in his condition. The Veteran submitted a foot conditions Disability Benefits Questionnaire (DBQ) completed by a private provider dated July 5, 2021. The Veteran reported pain, and that any length of time on his feet and walking increases his pain level. He had an antalgic gait and weak stance. Flare-ups occurred several times a week, requiring 1 to 2 hours of propping up his feet for recovery. He also had functional loss and changed jobs in 2008 or 2009 to a sedentary job to avoid being on his feet and to avoid excessive pain. Regarding pes planus, the Veteran had pain on use and manipulation of both feet that was accentuated on use and manipulation. There was swelling on use and characteristic calluses. The Veteran tried arch supports but remained symptomatic. He did have extreme tenderness of plantar surfaces on both feet which were not improved by orthotic shoes or appliances. The Veteran had decreased longitudinal arch height on both feet. The Veteran had objective evidence of marked deformity or marked pronation. The weight bearing line did fall over or medial to the great toe. There was no lower extremity deformity other than pes planus causing alteration of the weight bearing line. There was inward bowing of the Achilles tendon and marked inward displacement and severe spasm of the Achilles tendon. The Veteran underwent non-surgical treatment for plantar fasciitis and symptoms were not relieved. He had functional loss due to plantar fasciitis. Due to multiple foot conditions, the Veteran was in chronic pain, sitting, standing, and walking all caused pain. The Veteran had Morton's neuroma and metatarsalgia in the left foot. The Veteran had hammer toe in both second toes, and mild or moderate symptoms of hallux valgus in the bilateral great toes. The Veteran did not have hallux rigidus, pes cavus, malunion or nonunion of tarsal or metatarsal bones, and other foot injuries not already described. There was pain on physical examination of both feet, but pain only contributed to functional loss in the left foot. Contributing factors of disability in both feet were less movement than normal, swelling, deformity, instability of station, disturbance of locomotion, interference with sitting, interference with standing, pain, fatigue, weakness, lack of endurance, incoordination, and antalgic gait. Pain, weakness, fatigability, or incoordination significantly limited functional ability during flare-ups and when the foot is used repeatedly over a period of time for both feet. He procured a sedentary job to avoid prolonged standing or walking and continued to have chronic pain at 5, whenever he is at rest or active. Activities have become somewhat limited, and the Veteran could not walk for any distance without pain flaring to 10. He has to stay off his feet for several hours to recover. This would happen multiple times a week. There was also functional loss. There was evidence of pain with passive motion, active motion, weight bearing, non-weight bearing, and on rest/non-movement. The Veteran used orthotics on a regular basis for plantar fasciitis, but they have proven ineffective. The functional impact was increasing pain with activity, reduced activity levels, fatigue, diminishing quality of life, and switching to a sedentary job to prevent pain. a) Prior to December 20, 2019 For the period prior to December 20, 2019, the Board finds that the Veteran's bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia more closely approximated severe bilateral acquired flat foot, warranting a 30 percent rating under Diagnostic Code 5276. The Veteran has consistently complained of pain on use and manipulation. There was pain, tenderness, and swelling of the feet after use. The evidence also indicated that the Veteran had calluses, corns on the back of his heels, lesions, and soft tissue masses on various parts of his feet. Additionally, the January 2014 private podiatrist found excess pronation of the ankle and subtalar joints of both feet and semi-rigidity of the flatfeet. In addition, the podiatrist noted in April 2016 that there was a notable Achilles equinus deformity and a pes plano valus/flatfoot deformity on both feet. Based on this evidence, and resolving all reasonable doubt in the Veteran's favor, the Board finds that a 30 percent rating is warranted. However, the next higher, and maximum rating of 50 percent is not demonstrated by the evidence of record. The weight of the evidence is against a finding that the Veteran's bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia was manifested by pronounced symptoms, including marked pronation, extreme tenderness of plantar surfaces of the feet, or marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is inapplicable, and the claim for a rating in excess of 30 percent prior to December 20, 2019 is denied. b) From December 20, 2019 For the period from December 20, 2019 to July 4, 2021, the Board finds that a rating in excess of the 30 percent rating already assigned is not warranted. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to standing and walking for a prolonged period of time and increasing pain with prolonged walking, standing, and climbing stairs. However, even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation reflected by the statements that he would get flare-ups of sharp pain daily when he was standing and walking for prolonged periods of time, would not result in symptoms more nearly approximating 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. However, from July 5, 2021, the Board finds that the criteria for a 50 percent rating under Diagnostic Code 5276 is warranted. The July 2021 DBQ examiner found 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. As such, a 50 percent maximum rating is warranted for this time period. From February 7, 2021, the Board has also considered whether rating under new Diagnostic Code 5269 for plantar fasciitis would be more favorable. However, the highest rating is 40 percent, which is only available if there is actual loss of use of the feet, which is not shown by the evidence of record at any time. Consequently, a 40 percent rating under Diagnostic Code 5269 is not warranted, and the Board concludes that it is more favorable to continue the Veteran's rating under Diagnostic Code 5276 from February 7, 2021. c) Other considerations The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. Here, the Veteran's bilateral plantar calluses and pes planus is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. Additionally, the evidence of record does not reflect that the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different Diagnostic Code. The Veteran has other service-connected foot disabilities, left foot Morton's neuroma, and metatarsalgia. However, the evidence of record is against a finding that the disabilities have distinct manifestations from those that are already being compensated. See 38 C.F.R. § 4.14. Specifically, while the evidence indicates that the Veteran has Morton's neuroma and metatarsalgia, a higher rating would not be possible under Diagnostic Code 5279 (metatarsalgia), as 10 percent is the maximum rating under that code and therefore does not provide an adequate basis for an increased rating. A separate compensable rating is also not warranted. Morton's neuroma and metatarsalgia are forms of foot pain. DORLAND'S ILLUSTRATED MED. DICTIONARY 1145, 1262, 1266 (32d ed. 2012). Pain in the feet and pain on use is the basis for the Veteran's assigned ratings under Diagnostic Code 5276; therefore, a separate rating under Diagnostic Code 5279 would result in impermissible pyramiding as it would also be evaluating based on foot pain. Pyramiding-the evaluation of the same disability or the same manifestation of a disability under different diagnostic codes-is to be avoided when evaluating a veteran's service-connected disability. 38 C.F.R. § 4.14. Similarly, the Board has considered whether a separate rating for plantar fasciitis is warranted from February 7, 2021. Plantar fasciitis involves inflammation of the plantar fascia and is one of the most common causes of heel pain. DORLAND'S ILLUSTRATED MED. DICTIONARY 684. As pain in the feet and pain on use is part of the basis for the Veteran's assigned rating under Diagnostic Code 5276, a separate rating under Diagnostic Code 5276 would result in impermissible pyramiding as it would also be evaluating based on foot pain, and a separate rating is not warranted. Furthermore, the July 2021 DBQ indicated that the Veteran had mild or moderate symptoms of hallux valgus in the bilateral great toes. However, to be awarded a separate compensable rating for hallux valgus under Diagnostic Code 5280, a maximum 10 percent rating is warranted for unilateral hallux valgus severe if equivalent to amputation of great toe. A maximum 10 percent rating is also warranted for unilateral hallux valgus operated with resection of metatarsal head. 38 C.F.R. § 4.71a, Diagnostic Code 5280. As there is no evidence of such symptoms or surgical procedures, a separate compensable rating under this Diagnostic Code is not warranted. The July 2021 DBQ also indicated that the Veteran had hammer toe in both second toes. However, the evidence does not demonstrate, nor has the Veteran contended, that he suffers from hammer toe of all toes, which would be required for a separate compensable rating under Diagnostic Code 5282. 38 C.F.R. § 4.71a, Diagnostic Code 5282. Also, as the evidence does not show that the Veteran has weak foot, claw foot, hallux rigidus, and malunion or nonunion of the tarsal or metatarsal bones during the appeal period, Diagnostic Codes 5277, 5278, 5281, and 5283 do not apply. Also, a rating under Diagnostic Code 5284 for foot injuries is not warranted, as the Veteran's bilateral plantar calluses and pes planus must be rated under Diagnostic Code 5276 where it is listed in the rating schedule. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015). In conclusion, for the Veteran's bilateral plantar calluses and pes planus with left foot Morton's neuroma and metatarsalgia, the Board finds that a rating of 30 percent, but no higher, is warranted prior to December 20, 2019. The preponderance of the evidence is against a rating in excess of 30 percent from December 20, 2019 to July 4, 2021. However, a higher maximum rating of 50 percent is warranted from July 5, 2021. REASONS FOR REMAND Epididymitis The Veteran is seeking a compensable rating for epididymitis. Pursuant to a prior Board remand, the Veteran was afforded a VA examination in December 2019 where the examiner indicated that the Veteran had voiding dysfunction consisting of urinary frequency and slow stream, but that voiding dysfunction was a separate and unrelated diagnosis to the Veteran's epididymitis. The Veteran submitted a June 2021 private record from Norman Urology Associates, which notes the Veteran's urinary frequency and a diagnosis of overactive bladder. It was also indicated that the Veteran urinates without obstruction or difficulty. However, the Veteran also submitted a July 2021 male reproductive organ conditions DBQ, only a month later, which indicated that the Veteran had voiding dysfunction, which was due to epididymitis, which caused daytime voiding interval less than one hour and nighttime awakening to void 3 or 4 times. The provider also stated that the Veteran had obstructed voiding, which was hesitancy, markedly slow and weak stream, and markedly decreased force of stream. The Board finds that a new VA examination is needed to clarify this conflicting information. The matters are REMANDED for the following actions: 1. Obtain the Veteran's VA treatment records for the period from March 2021 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected epididymitis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must evaluate the current severity of the Veteran's voiding dysfunction, and provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's voiding dysfunction/urinary symptomatology is caused or aggravated by his service-connected epididymitis. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bonnie Yoon, 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.