Citation Nr: 21008762 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 16-63 156 DATE: February 18, 2021 ORDER Service connection for bilateral plantar fasciitis, to include as secondary to service-connected lumbosacral spine strain, is denied. FINDING OF FACT Bilateral plantar fasciitis was not incurred in or caused by the Veteran’s service and is not proximately due to or otherwise aggravated by the Veteran’s service-connected lumbosacral spine strain. CONCLUSION OF LAW The criteria to establish service connection for bilateral plantar fasciitis, to include as secondary to service-connected lumbosacral spine strain, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 2002 to May 2003. This matter was previously before the Board of Veterans’ Appeals (Board) in January 2020 when the issue of service connection for bilateral plantar fasciitis, to include as secondary to service-connected lumbosacral spine strain, was remanded for further development. Further development having been completed; the matter is once again before the Board. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting service, was aggravated therein. 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden, 381 F.3d at 1167; Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent". However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Certain chronic diseases are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service. 38 C.F.R. § 3.309(a). When a chronic disease is shown in service, sufficient to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). To be "shown in service," the disease identity must be established, and the diagnosis must not be subject to legitimate question. Walker v. Shinseki, 708 F.3d 1331, 1335 (Fed. Cir. 2013); see also 38 C.F.R. § 3.303(b). There is no "nexus" requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease. Walker, 708 F.3d at 1336. As noted above, a disability which is proximately due to or the result of service-connected disease or injury shall be service-connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Secondary service connection may be established by a showing that a nonservice-connected disability is caused or aggravated (chronically worsened) by a service-connected disability beyond the normal progression of the disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabriel v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Further, competency of evidence differs from the weight and credibility of evidence. Competency is a legal concept that determines whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination regarding the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). Regarding the competency of lay evidence, the Board must determine, on a case-by-case basis, whether a veteran's disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms, as symptoms require only personal knowledge of what is observed using his senses, not medical expertise. See Layno, 6 Vet. App. At 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. See Barr, 21 Vet. App. at 307 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. See Jandreau, 492 F.3d at 1377. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Service connection for bilateral plantar fasciitis, to include as secondary to service-connected lumbosacral spine strain, is denied. The Veteran contends that her bilateral plantar fasciitis is related to her active service, to include as secondary to service-connected lumbosacral spine strain. For the reasons set forth below, service connection for bilateral plantar fasciitis is not warranted on any basis. The Veteran’s service treatment records (STRs) indicate that the Veteran was evaluated for foot pain in April, May, and July of 2002. In particular, the Veteran was evaluated for plantar fasciitis in May and July 2002. In an October 2014 statement, the Veteran reported that her feet have bothered her off and on since her service, but that she did not seek treatment until roughly the past year because the pain made it difficult to walk. She stated that insoles do not work. She also stated that she has been treated with cortisone injections and shoe inserts. In a September 2015 VA examination, the examiner opined that bilateral plantar fasciitis is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner also opined that the Veteran's bilateral plantar fasciitis is less likely than not proximately due to or the result of the Veteran's service-connected lumbar spine strain. The examiner explained that, according to the Veteran, her bilateral plantar fasciitis began in approximately 2007/2008. The examiner noted that the onset was well after the Veteran was discharged from active duty in 2003. The examiner also noted that there is no support in the record that her condition occurred in-service. In an October 2015 VA addendum opinion, the examiner stated that the Veteran's foot condition had onset four or five years after discharge from service and is not secondary to a service-connected condition. The examiner opined that the Veteran’s service-connected lumbosacral spine strain did not cause her current bilateral plantar fasciitis. The examiner stated that the Veteran’s back condition is proximal to the distal foot. The examiner stated that forces are carried up the kinetic chain not down the kinetic chain. The examiner stated that the Veteran’s bilateral plantar fasciitis was not aggravated by the service-connected lumbosacral spine strain. However, the September and October 2015 VA opinions did not address evidence of plantar fasciitis contained in the Veteran’s STRs. Pursuant to the January 2020 Board remand, a new VA examination was ordered, and the examiner was asked to address whether the Veteran's bilateral plantar fasciitis was incurred in service or was caused by an in-service injury, event, or illness. If the examiner was unable to relate the Veteran’s bilateral plantar fasciitis to her service, the examiner was asked to reconcile such a finding with evidence of treatment for plantar fasciitis in the Veteran’s STRs. Finally, the examiner was asked to identify the likely etiology, to the extent possible, of the Veteran’s bilateral plantar fasciitis. The Veteran was afforded a VA examination in February 2020. The examiner noted that an in-person examination was conducted and that a review of the Veteran’s VA e-folder was completed in conjunction with the examination. The examiner noted a diagnosis of bilateral plantar fasciitis and bilateral degenerative arthritis. The examiner opined that the Veteran’s bilateral plantar fasciitis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that it is known that plantar fasciitis occurs in the arch of the foot when the fascia becomes inflamed due to wearing ill-fitting shoes and/or obesity. The examiner stated that there is no medical evidence to support a diagnosis of plantar fasciitis in-service. The examiner opined that the Veteran’s current bilateral plantar fasciitis is less likely than not related to any in-service complaint. A VA addendum opinion to the February 2020 VA examination was provided in July 2020. The examiner noted that the Veteran was seen once in-service for left foot plantar fasciitis in July 2002, but that the Veteran was not seen for any complaints of foot pain post-service until 2013, however, at that time there was no plantar fasciitis diagnosis. The examiner noted that plantar fasciitis was first diagnosed in 2014, 12 years after being evaluated in-service. The examiner stated that it is known that plantar fasciitis occurs in the arch of the foot when the fascia becomes inflamed due to wearing ill-fitting shoes and/or obesity. The examiner opined that, given that the Veteran was only seen once in-service, and there are no medical records from 2002 to 2014 which indicate that her foot complaints of plantar fasciitis were a chronic and long standing condition resulting from service, the Veteran’s current bilateral plantar fasciitis is less likely than not related to the single complaint in-service. The examiner noted that the Veteran did not have any complaints of right foot plantar fasciitis during service. Therefore, the examiner opined that the Veteran’s current bilateral plantar fasciitis is less likely than not related to the 2002 left foot complaints in-service. The examiner noted that the Veteran did not have bilateral foot degenerative joint disease (DJD) complaints in-service, which is unrelated to her plantar fasciitis, therefore, the examiner opined that it is less likely than not related to service. Another VA addendum opinion was provided later in July 2020, in which the examiner was asked to address an evaluation for a right foot ingrown toenail and athletes foot and left foot plantar fasciitis in-service in May 2002. However, the examiner stated that her pervious opinion, as outlined above, earlier in July 2020, is unchanged in light of the May and July 2002 STRs. The preponderance of the evidence is against a finding that the Veteran's bilateral plantar fasciitis was incurred in or caused by her service or is secondarily related to her service-connected lumbosacral spine strain. The probative medical evidence of record has indicated that the Veteran’s bilateral plantar fasciitis was not incurred in or caused by her service and is not a progression of her service-connected lumbosacral spine strain. The probative opinions of record do not indicate that service connection is warranted either on a direct or secondary basis. There is no other objective indication that the Veteran's bilateral plantar fasciitis is directly related to her service or secondarily related to her service-connected lumbosacral spine strain. Thus, in the absence of probative medical evidence linking the claimed condition to her service or to a service-connected disability, there is no basis to establish service connection on a direct or secondary basis, and further analysis is not necessary. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (remand is unnecessary where it "would result in this Court's unnecessarily imposing additional burdens on the [Board and the Secretary] with no benefit flowing to the Veteran."). While the Veteran believes that her bilateral plantar fasciitis is related to her service, to include service-connected lumbosacral spine strain, as a lay person, she has not shown that she has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of the Veteran's condition is not a matter capable of lay observation and requires medical expertise to determine. Accordingly, the lay evidence does not constitute competent medical evidence and therefore lacks probative value in determining whether there is a medical nexus between the Veteran's service-connected disability and her bilateral plantar fasciitis. (Continued on the next page.) The preponderance of the evidence is against the claim, and there is no doubt to be resolved. The claim is denied. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Timothy T. Emmart 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.