Citation Nr: 21005641 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 15-45 811 DATE: February 2, 2021 ORDER Entitlement to service connection for a left foot disorder, to include pes planus and plantar fasciitis is denied. Entitlement to an initial rating in excess of 10 percent for right foot disorder, to include pes planus and plantar fasciitis prior to June 20, 2013 is denied. Entitlement to an increased rating to 20 percent, but not greater, for right foot disorder, including pes planus with plantar fasciitis as of June 20, 2013 is granted. FINDINGS OF FACT 1. The Veteran failed, without a showing of good cause, to appear for his scheduled Department of Veterans Affairs (VA) examination in connection with his claims for service connection of left foot disorder, including pes planus and plantar fasciitis and for a compensable rating for right foot disorder, including pes planus and plantar fasciitis. 2. There is no competent medical opinion of record that the Veteran’s left foot disorder, including pes planus and plantar fasciitis was aggravated beyond its natural progression as a result of service. 3. Prior to June 20, 2013, the Veteran’s right foot pes planus with plantar fasciitis most closely approximated a moderate disability with pain upon use that was not relieved by arch supports. 4. From June 20, 2013, the Veteran’s right foot pes planus with plantar fasciitis most closely approximated a severe disability with symptoms including objective evidence of marked pronation, accentuated pain on use and callosities. CONCLUSIONS OF LAW 1. The criteria for service connection for a left foot disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310, 3.655(b) (2019). 2. The criteria for entitlement to an increased initial rating in excess of 10 percent for right foot disorder, including pes planus and plantar fasciitis prior to June 20, 2013 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5276 (2019). 3. The criteria for entitlement to rating of 20 percent for right foot disorder, including pes planus and plantar fasciitis, is met from June 20, 2013. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5276 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty in the U.S. Army from June 1988 to March 1997; January 2007 to January 2008; July 2008 to May 2009 and from August 2009 to August 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the record. In September 2018, the Board remanded the Veteran’s claims for service connection for left foot pain and for initial compensable rating for right foot plantar fasciitis for further development. The Board is proceeding with adjudication of the claims given substantial compliance by the RO with the remand directives. After review of the evidence of record, the Board has re-characterized the issues to left foot disorder, including pes planus and plantar fasciitis, and right foot disorder including pes planus and plantar fasciitis, as reflected above to address most fully the benefits sought by the Veteran on appeal. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Entitlement to service connection for left foot disorder including pes planus and plantar fasciitis The Veteran contends that his left foot pain was incurred in, aggravated by, or otherwise attributable to his active duty service. Service Connection Claim Service connection may be established for disability resulting from personal injury or disease contracted in line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in line of duty. 38 U.S.C. §§ 1110, 1131. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing 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 present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A veteran is presumed to have been in sound condition when examined, accepted and enrolled in service, except for defects noted at the time of entrance, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. §§ 1111, 1132. According to 38 C.F.R. § 3.304(b), the term "noted" denotes only conditions that are recorded in examination reports. A history of pre-service existence of conditions recorded at the time of examination does not constitute a notation of such conditions but will be considered together with all other material evidence in determinations as to inception. 38 C.F.R. § 3.304(b)(1); Crowe v. Brown, 7 Vet. App. 238 (1994). If a preexisting disability is noted upon entry into service, the Veteran may not bring a claim for service connection for that disability on a direct-incurrence basis, only instead a claim for aggravation of the disability during or as a result of his service. But in this circumstance, the provisions of 38 C.F.R. § 1153 apply and the Veteran has the burden of establishing aggravation. See Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). A preexisting disease will be considered to have been aggravated by military service when there is an increase in disability during such service, unless there is a specific finding that the increase is due to the natural progression of the disease. The presumption of aggravation applies only when pre-service disability increases in severity during service. Beverly v. Brown, 9 Vet. App. 402, 405 (1996). Mere temporary or intermittent flare-ups of a preexisting injury or disease are insufficient to be considered aggravation unless the underlying condition, as contrasted to symptoms, is worsened. Jensen v. Brown, 4 Vet. App. 304, 306 - 07 (1993). Clear and unmistakable evidence is required to rebut the presumption of aggravation when the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306(b). A claimant is not required to show that the disease or injury increased in severity during service before VA's duty under this rebuttal standard attaches. Cotant v. Principi, 17 Vet. App. 116 (2003). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306; Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002) (holding that evidence of a temporary flare-up, without more, does not satisfy the level of proof required of a non-combat Veteran to establish an increase in disability). Independent medical evidence generally is needed to support a finding that the pre-existing disability increased in severity during service beyond its natural progression. See Paulson v. Brown, 7 Vet. App. 466, 470-471 (1995). The presumption of aggravation applies where there was a worsening of the disability in service, regardless of whether the degree of worsening was enough to warrant compensation. Browder v. Derwinski, 1 Vet. App. 204, 206-207 (1991). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step process. First, the Board must determine whether the evidence comes from a competent source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence considering the entirety of the record. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-512 (1995) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. Layno v. Brown, 6 Vet. App. 465 (1994). In ascertaining the competency of lay evidence, the Courts have generally held that a layperson is not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183 (1997); see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). In certain instances, however, lay evidence has been found to be competent regarding a disease with "unique and readily identifiable features" that is "capable of lay observation." See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (where the Court held that a medical opinion was not required to prove nexus between service connected mental disability and drowning which caused Veteran's death). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses.  38 C.F.R. § 3.159(a)(1). The standard of proof to be applied affords a claimant the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Turning to the evidence of record in this matter, the Veteran’s service treatment records reflect asymptomatic mild pes planus on his November 1987 entrance examination. In June 1988 the Veteran was treated for bilateral foot pain of 4-days duration with no history of injury. Mild pain in the Veteran’s arches was noted upon examination and the Veteran was diagnosed with overuse syndrome. Between June 1988 through August 2009, there are numerous reports of medical history which reflect that the Veteran denied any pain, injury or treatment of the feet with the exception of a December 1996 Report of Medical History for his flight medic examination in which the Veteran endorsed foot trouble without further comment. In October 2004 the Veteran denied having a medical condition that would prevent him from walking 12 miles in combat boots or 6 miles with a 40-pound rucksack. In a January 2011 Report of Medical History prepared for Medical Board review, the Veteran endorsed foot trouble noting pain in his arches from “time to time.” The examining physician documented tenderness on palpation of the feet including the left foot instep, plantar surface and foot pain, soft tissue. In June 2011 the Veteran was seen for a medication refill for foot condition. A pain level of 3/10 was endorsed by the Veteran for his left foot arch. In a July 2011 Report of Medical Assessment, the Veteran endorsed a question regarding any injury for which he had not sought medical care while on active duty and explained that this endorsement referred to foot pain. VA treatment records reflect that in May 2012, the Veteran received a VA miscellaneous foot examination. The Veteran gave a history of plantar fasciitis diagnosed in the military which had required more supportive soles in his military boots. At the time of the examination the Veteran complained of fascial pain after activity and constant arch pain. The examiner noted bilateral pain with palpation at the insertion of the plantar fascia. In a June 2013 VA podiatry consultation, the Veteran provided a history of bilateral heel pain, right worse than the left, which started in jump school and was aggravated by jumps. On that date, the assessment was talar tilt with maximum pronation in stance position with pain upon palpation of the plantar fascia. In July 2013, after review of the entire claims file, a VA examiner offered an opinion that the Veteran had complaints consistent with plantar fasciitis while in the military in 2011 and his foot pain complaints were consistent with plantar fasciitis upon separation from the military in August 2011. The examiner found that the Veteran’s right foot pain was due to plantar fasciitis that was more likely than not due to, caused by or incurred in military service but did not address the left foot in her nexus opinion. In a July 2013 rating decision, the RO denied service connection for left foot pain indicating that left foot plantar fasciitis was not diagnosed until May 2012. The Veteran filed a timely appeal for service connection of left foot pain. The Veteran received temporary orthotics and several rounds of very painful steroid injections in the bottom of both feet and eventually, custom-fitted orthotics in 2014. The Veteran testified in September 2017 at a Board hearing regarding pain and deformities in both of his feet. He indicated that when his problems began when he was 17 years old, he did not know that he could have persisted and received more treatment than over-the-counter pain medication. The Veteran testified that he had had a lot of problems with his feet in Hawaii from 1988 to 1991 when he was in the light infantry. He has “extremely flat feet” with pain that varied in severity depending on his activities and footwear. His pain increased when he was required to wear hard-bottomed flat shoes for work after service. He testified to significant pain where his arch should be as well as other deformities in his foot including calcifications (sic). He further testified that he was advised by a VA treating podiatrist that with orthotics early on he may not have progressed to the issues that he now has in both of his feet. A March 2018 orthotic consult reflects an order for 2 rigid full-length foot orthotics with 4 degrees of motion. In September 2018 the Board remanded the claim for service connection for left foot pain for a VA examination due to the inherent ambiguity as to whether the July 2013 examiner’s nexus opinion included the left foot. An examination was scheduled for July 29, 2019 on which date the file was updated with a note indicating that the Veteran declined to attend. After the Veteran failed to attend his July 2019 examination, the RO issued a March 2020 rating decision and Supplemental Statement of the Case denying the claim for lack of competent evidence of a nexus between the Veteran’s claimed disability and service. In addition, in both statements, the RO requested that the Veteran notify the RO when he was ready to report for an examination, or if he preferred to submit a disability benefits questionnaire (DBQ) completed and signed by a health care provider. VA regulations provide that when a claimant fails to report for a necessary medical examination in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied. 38 C.F.R. § 3.655(b). Of note, the Veteran was participating in the claim development process and receiving treatment from the VA during this period; in November 2018 the Veteran submitted DBQs prepared by private providers regarding other disabilities to the VA and received new foot orthotics. In June and July 2019, the Veteran was accessing health care services at the VA. The Board noted that the Veteran had not disputed the report in the March 2020 Supplemental Statement of the Case that he failed to report for his examination, asserted that he did not receive notice of any examination, provided other good cause for failing to report, or indicated that he wanted to reschedule the examinations. For these reasons, the Board finds that the provisions of 38 C.F.R. § 3.655(b) apply in this case and the claim will be rated based upon the evidence of record. The Board observes that the Veteran's bilateral mild asymptomatic pes planus was noted on his service enlistment clinical examination in November 1987 and over the period of 24 years prior to separation from service, he sought treatment in 1988 for bilateral foot pain, complained during a VA examination in June 2007 of left foot pain associated with an examination for left leg pain, and in a Medical Board examination in 2011 for foot pain complained of arch pain off and on. The VA treatment records reflect the Veteran’s lay report to a treating podiatrist of a long history of bilateral heel pain that started in jump school in the military and was aggravated with jumps. The first element of service connection for the Veteran’s left foot has been met with the Veteran’s current diagnoses and treatment of bilateral pes planus with plantar fasciitis. Regarding the second element of direct service connection, while the Board notes that there is evidence of foot pain and plantar fasciitis for both feet in May 2012, an x-ray was ordered for right heel pain solely. Otherwise there is scant evidence regarding a permanent aggravation of the Veteran’s bilateral pes planus as the Veteran denied any problems with his feet in multiple reports of medical history and denied any difficulties that would preclude his performing a 12-mile march in boots in 2004 in service. The Veteran’s testimony, however, is alternately that the pain in his feet was ongoing in service from the time of basic training or, that the pain began in jump school and was aggravated by jumps. The primary distinction between the right foot, which is now service-connected, and the left foot, is that there is a July 2013 VA opinion supporting an increase in severity beyond the natural progression of pes planus with respect to the right foot and that the VA providers found that x-rays were indicated for severe right heel pain, but not for left heel pain, in May 2012 and June 2013. To the extent that there was an attempt to remedy the deficiency of the lack of evidence or competent medical opinion regarding an increase in severity beyond its natural progression for left foot pain in service with the scheduled July 2019 VA examination and medical opinion, it was thwarted by the Veteran's failure to attend or request rescheduling of the examination. The Board is mindful of the Veteran's assertions regarding his pes planus condition and the onset of his present left foot disorder during active duty service. Falzone, supra. However, since the issue on appeal is medically complex, rather than simple, there must be competent medical evidence supporting the notion of permanent aggravation, as opposed to intermittent, self-limited flare-ups of the pre-existing disability in service. Independent medical evidence generally is needed to support a finding that the pre-existing disability increased in severity during service beyond its natural progression. See Paulson at 470-417. Accordingly, the preponderance of the evidence of record is against the Veteran's claim for service connection for a left foot disorder. As such, the benefit of the doubt doctrine is not for application, and service connection must be denied. Gilbert, supra. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. If there is a question as to which evaluation to apply to the Veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of his disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Rating Criteria for the Foot Diagnostic Code 5276 pertains to acquired flat foot (or pes planus) and provides that mild disability of the foot with symptoms that are relieved by built-up shoe or arch support will be assigned a non-compensable rating. Moderate disability, with the weight-bearing line over or medial to the great toe, inward bowing of the Tendo Achillis, pain on manipulation and use of the feet, bilateral or unilateral, will be assigned a 10 percent rating. Severe disability, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use of accentuated, indication of swelling on use, and characteristic callosities, will be assigned a 20 percent rating where it is unilateral and a 30 percent rating where it is bilateral. Pronounced disability, with 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, warrants a 30 percent rating where it is unilateral and a 50 percent rating where it is bilateral. 38 C.F.R. § 4.71a. Diagnostic Code 5284, for "other foot injuries" provides for a rating of 10 percent for moderate disability, 20 percent for moderately severe disability, 30 percent for severe disability, and 40 percent for actual loss of use of the foot. See 38 C.F.R. § 4.71a. VA General Counsel stated that this is a more general diagnostic code under which a variety of foot injuries may be rated. See VAOPGCPREC 9-98. Entitlement to increased initial rating in excess of 10 percent for right foot disorder, including pes planus with plantar fasciitis as of June 20, 2013 The Veteran contends in his August 2013 Notice of Disagreement (NOD) that his right foot symptoms were entitled to a disability rating of 10 percent. The Board has a duty to maximize benefits based on the presumption that a veteran is seeking the maximum benefit allowed under the law. Morgan v. Wilkie, 31 Vet. App. 162, 167 (2019). But that duty is cabined where an appellant expresses a clear intent to limit the scope of his appeal. AB v. Brown, 6 Vet. App. 35, 38-39 (1993) (finding that if "there is not clearly expressed intent to limit the appeal," VA is "required to consider entitlement to all available ratings for that condition"). As noted above, when a Veteran fails to appear for a scheduled VA examination for an increased rating claim without a showing of good cause, the law provides for a denial of the claim except in instances of an initial rating claim. For an initial rating claim, the case shall be rated on the evidence of record rather than denied, because an initial rating claim is an original compensation claim under 38 C.F.R. § 3.655(b). See Turk v. Peake, 21 Vet. App. 565 (2008). Turning to the evidence of record, on May 22, 2012, the Veteran was afforded a VA examination for foot, miscellaneous. The VA examiner diagnosed mild bilateral pes planus with bilateral plantar fasciitis which elicited pain upon palpation of the plantar fascia. X-rays performed on that day for severe right heel pain revealed no bony or joint abnormality. The examiner noted that there was no functional loss as a result of these findings. After the Veteran failed to attend a scheduled July 2019 examination, the RO issued a March 2020 rating decision in which a 10 percent disability rating for right foot plantar fasciitis was granted effective August 3, 2011, the day after discharge from active duty, given competent and credible lay evidence of ongoing pain in the right foot at that time. The RO indicated that the decision favorably resolved the issue on appeal as it was a full grant of the benefit sought. Accordingly, the Board concludes that the most probative evidence of record indicates that from August 3, 2011 to June 20, 2013, a rating in excess of 10 percent for the Veteran’s right foot disorder was not warranted. Entitlement to increased initial rating in excess of 10 percent for right foot disorder, including pes planus with plantar fasciitis from June 20, 2013 On May 10, 2013, right foot x-ray revealed narrowing of the joint space between the talus and the tarsal navicular bone with moderate pes planus. On June 20, 2013 during a podiatry visit, the VA podiatrist noted a long history of heel pain that was worse on the right. Upon examination, bilateral pes planus with talar tilt and maximum pronation in stance position was noted as well as pain with palpation of the lateral fascia. The Board notes that on June 20, 2013, podiatry examination and x-ray findings demonstrated maximum pronation with moderate pes planus which are findings that warrant a higher disability rating of 20 percent for one foot given the objective evidence of marked deformity (pronation, abduction, etc.) and pain on manipulation. In addition, the Veteran offered credible testimony of accentuated pain on use and characteristic callosities. On July 12, 2013, the Veteran was afforded a medical opinion by a VA examiner after review of the entire claims file. The examiner noted that the Veteran was diagnosed with plantar fasciitis and pes planus in June 2013 and that the right foot plantar fasciitis was as likely as not due to, caused by or incurred in military service. The Board notes that the Veteran was diagnosed in May 2012 with pes planus during the prior VA examination. In a November 2014 podiatry visit, the clinician noted that the Veteran’s pain was better following a cortisone injection although his new orthotics received in July 2014 were still too uncomfortable to wear. Upon examination, the podiatrist’s remarks regarding tenderness on palpation are noted. In his September 2017 hearing, the Veteran testified that he had “extremely flat feet” with pain that varied in severity depending on his activities and footwear. His pain increased when he was required to wear hard-bottomed flat shoes for work which began after a period of unemployment following his separation from service. The testified to significant pain where his arch should be as well as other deformities in his foot including calcifications (sic). As noted, there has not been an updated VA examination. The evidence of record indicates that the Veteran received new orthotics in March 2018 which suggests that the orthotics are beneficial in relieving the Veteran’s symptoms. The Board accepts the Veteran’s testimony regarding “calcifications” as characteristic callosities, a symptom consistent with a 20 percent rating. The orthotic technicians noted in 2014 that adapting to orthotics takes time with gradual increase in daily wearing times to avoid initial discomfort. Based on the forgoing, the Board finds that an increased rating of 20 percent under Diagnostic Code 5276 is warranted for the right foot from June 20, 2013 when the Veteran’s podiatrist documented the foot deformity of maximum pronation in stance position in addition to foot pain in the arch and heel that increased with use. As noted above, to warrant a 30 percent rating for a pronounced unilateral foot disability, the Veteran would have to demonstrate 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. The pain the Veteran has described and the functional limitation of difficulty with prolonged walking and standing, particularly before receipt of his custom orthotics, is contemplated by the criteria for a severe disability under Diagnostic Code 5276. A 2018 note indicates that the Veteran was being fitted for replacement orthotics. As the Veteran appears to be receiving benefit from orthotics, and extreme tenderness of the plantar surface of the feet nor severe spasm of the Tendo Achillis on manipulation have not been documented, this level of foot disability is not evident in the record. Thus, in conclusion, the Board finds that Diagnostic Code 5276 is the most appropriate code under which to rate the Veteran's pes planus with right foot plantar fasciitis. Under that code, the evidence of record indicates that from June 20, 2013, the Veteran’s right foot disorder symptoms were commensurate with a rating of not more than 20 percent for pes planus with plantar fasciitis. Accordingly, the Board finds that the evidence of record warrants an increased disability rating of 20 percent, but not greater, from June 20, 2013. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Denise Adams Hill, Associate 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.