Citation Nr: 21009488 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 20-30 303A DATE: February 22, 2021 REMANDED Entitlement to an effective date prior to December 11, 2017 for the award of service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an initial disability rating in excess of 30 percent for PTSD is remanded. Entitlement to service connection for a bilateral foot disability, to include plantar fasciitis and as due to an undiagnosed illness, is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from May 2002 to May 2005 and from August 2009 to February 2010, including service in Southwest Asia. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for PTSD, evaluated at 30 percent, effective December 11, 2017, and denied service connection for plantar fasciitis. After reviewing the contentions and evidence of record, and in order to contemplate all of the Veteran’s foot symptoms, the Board has recharacterized the Veteran’s claim as one for a bilateral foot disability. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The issue of unemployability has been raised by the record as part of the Veteran’s increased rating claim; therefore, the issue of entitlement to a TDIU is added to the instant appeal. See Rice v. Shinseki, 22 Vet. App. 447, 453, 54 (2009). 1. Entitlement to an effective date prior to December 11, 2017 for the award of service connection for PTSD is remanded. By way of a June 2019 notice of disagreement (NOD), the Veteran timely appealed the issue of entitlement to an effective date prior to December 11, 2017 for the award of service connection for PTSD. However, the RO did not address the claim of entitlement to an earlier effective date in the October 2020 Statement of the Case (SOC). As such, remand is required to ensure that proper appellate procedures are followed. See Manlincon v. West, 12 Vet. App. 238 (1999). 2. Entitlement to an initial disability rating in excess of 30 percent for PTSD is remanded. A determination with respect to the claim for an earlier effective date for the award of service connection for PTSD may affect the adjudication of the claim for an increased rating for PTSD, as it may alter the period on appeal. Therefore, the Board finds the increased rating claim is inextricably intertwined with the effective date claim. As such, the claim for an increased rating for PTSD must be remanded. Harris v. Derwinski, 1 Vet. App. 180 (1991). 3. Entitlement to service connection for a bilateral foot disability, to include plantar fasciitis and as due to an undiagnosed illness, is remanded. The Veteran asserts he is entitled to service connection for a bilateral foot disability, to include plantar fasciitis. The Board finds that additional development is necessary prior to appellate consideration of this claim. In May 2018, the Veteran was provided a VA examination to determine the nature and etiology of his claimed bilateral foot disability. After an in-person examination of the Veteran and review of his claims file, the VA examiner opined that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness, reasoning, that without knowing exactly how much walking, running, or use of was done while in the service, it was difficult to tell if the condition was aggravated by his service. In an October 2020 VA examination report, the examiner opined that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness, finding that right and left foot plantar fasciitis clearly and unmistakably existed prior to service with no evidence of any aggravation beyond natural progression by an in-service injury, event, or illness. The Board finds the May 2018 and October 2020 VA medical opinions are inadequate. Both the May 2018 and October 2020 VA examiners failed to provide an adequate rationale for their finding that the Veteran’s bilateral foot disability, to include plantar fasciitis, clearly and unmistakably existed prior to service. While mild asymptomatic pes planus was noted on service entrance in an August 2001 Report of Medical Examination, there is no mention of plantar fasciitis. Because the RO only requested an opinion as to aggravation of a preexisting condition, it appears that the May 2018 and October 2020 VA examiners merely adopted the phrasing from the RO’s request. Thus, it is unclear whether the examiners separately found that the Veteran’s bilateral foot disability clearly and unmistakably existed prior to service. To the extent that the VA examiners did reach this conclusion, the opinions are conclusory and are not supported by adequate rationale. Therefore, the Board finds that a remand is warranted for a new VA examination and medical opinion. The Board notes that in the Veteran’s June 2019 NOD, the Veteran asserted entitlement to service connection for a bilateral foot disability on a presumptive basis due to his service in Southwest Asia. Upon remand, the examiner should provide an opinion as to whether the symptoms reported by the Veteran are symptoms of a diagnosable disorder, a manifestation of undiagnosed illness, a chronic multi-symptom illness with partially understood etiology and pathophysiology, or a medically unexplained chronic multi-symptom illness. 4. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is remanded. In a March 2019 VA Form 21-4138 (Statement in Support of Claim), the Veteran reported that his PTSD has caused him to miss work more frequently and contends entitlement to TDIU in the June 2019 NOD. As discussed above, the Board finds that TDIU has been raised by the record pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453, 54 (2009). Entitlement to TDIU has not been adjudicated by the RO; thus, remand is warranted. Accordingly, the matters are REMANDED for the following actions: 1. Issue a statement of the case with respect to the June 2018 rating decision and June 2019 notice of disagreement regarding the issue of entitlement to an earlier effective date for the award of service connection for PTSD. 2. Provide proper notice to the Veteran regarding the evidence and information necessary to substantiate a TDIU claim and request that he complete and return VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability). 3. Obtain the Veteran’s VA treatment records from March 2020 to present. 4. Schedule the Veteran for a VA examination with an appropriate clinician as to the nature and etiology of the Veteran’s bilateral foot disability. The examiner must review the claims file. The examiner should identify each diagnosed foot disability, to include plantar fasciitis and pes planus. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: For each identified foot disability, to include plantar fasciitis and pes planus, did the disability clearly and unmistakably (undebatable) preexist the Veteran’s service? If the examiner finds it did clearly and unmistakably preexist service, was it clearly and unmistakably not aggravated by service? If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not related to service, including the Veteran’s lay statements pertaining the rigors of service, such as pushing heavy pallets and being on his feet for long periods of time. If a diagnosis cannot be rendered that account for the Veteran’s reported foot symptoms, the VA examiner is asked to state whether the Veteran’s reported symptoms are symptoms of a diagnosable disorder, a manifestation of undiagnosed illness, a chronic multi-symptom illness with partially understood etiology and pathophysiology, or a medically unexplained chronic multi-symptom illness. If either the etiology or pathophysiology is inconclusive, the examiner should state so. These opinions must be based on the individual Veteran’s circumstances rather than the illnesses as they are understood in the general public. Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 5. After completing the above, and any other development as may be indicated, the Veteran’s claims of entitlement to an increased rating for PTSD, service connection for a bilateral foot disability, and TDIU should be readjudicated based on the entirety of the evidence. If the claims remain denied, the Veteran and his representative should be issued a supplemental statement of the case (SSOC). (Continued on next page)   An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. Stephanie M. Owen Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. M. Gill, 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.