Citation Nr: 21009877 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 15-08 423 DATE: February 23, 2021 ORDER Entitlement to service connection for left foot plantar fasciitis, to include as secondary to right foot plantar fasciitis, is denied. FINDING OF FACT The preponderance of the evidence is against a finding that left foot plantar fasciitis was incurred in or related to any event or injury in service and it is not related to a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for left foot plantar fasciitis, to include as secondary to right foot plantar fasciitis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Army from December 1981 to August 1984; from October 1986 to January 2005. The Board previously remanded this case for additional development in March 2019 and once again in December 2019. The matter has now returned to the Board for appellate review. Entitlement to service connection for left foot plantar fasciitis The Veteran contends that his left foot plantar fasciitis is related to his active military service. Alternatively, the Veteran asserts that his left foot plantar fasciitis is secondary to his service-connected right foot plantar fasciitis. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Secondary service connection may be warranted where a disability is proximately due to or the result of a service connected disability. 38 C.F.R. § 3.310 (a). Secondary service connection is also warranted for any permanent increase in severity (aggravation) of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (b). VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Turning to the record, the Veteran’s service treatment records (STRs) are silent for any diagnosis or treatment for left foot pain or plantar fasciitis. However, the STRs reflect that the Veteran was diagnosed with right foot plantar fasciitis while in active military service. At a general VA examination in April 2005, the examiner specifically remarked that there were no foot problems noted. In August 2012, the Veteran was afforded a VA examination in connection with his claim. A diagnosis of right foot plantar fasciitis was confirmed. However, there was no indication at the time of the examination of a diagnosis of left foot plantar fasciitis. Likewise, in an April 2013 VA examination note, the examiner explained that although the Veteran had right foot plantar fasciitis while in service, the Veteran did not then have that as a current diagnosis. Therefore, the examiner opined that the Veteran’s claimed plantar fasciitis was less likely than not the result of his active military service. Pursuant to the Board’s March 2019 remand, another VA examination was conducted in August 2019 with respect to the Veteran’s claimed plantar fasciitis. At the time of the examination, the examiner confirmed diagnoses of bilateral plantar fasciitis and bilateral degenerative arthritis. The Veteran reported his bilateral foot pain began during active military service. Further, the Veteran reported that the use of bilateral orthotics in connection with his disorder since his time in service. However, the examiner opined that it was less likely than not that the Veteran’s left foot plantar fasciitis was related to service. Specifically, the examiner found that there was no medical evidence of a chronic left foot disorder that began during the Veteran’s active military service. Additionally, in a September 2019 addendum opinion, the examiner clarified that there was no objective medical evidence that regular physical training, in the absence of a specific injury, causes and/or aggravates plantar fasciitis. In this case, the examiner noted that there was no objective evidence that the Veteran sustained an injury doing military training tasks during service. Therefore, the examiner concluded that without objective evidence of an injury or reports of left foot pain during service, it would be speculative to assign a causal relationship to military training activities. Moreover, the September 2019 examiner explained that there was no objective medical or scientific evidence that an ankle injury or pain would cause and/or aggravate plantar fasciitis. Therefore, the Veteran’s left plantar fasciitis is less likely than not due to or a result of an event, injury, or illness during the Veteran’s active military service, including the right foot pain and left ankle injury during service, as well as wear and tear due to heavy lifting and the effects of tactical road marching. Likewise, the September 2019 examiner further explained that there was no objective medical or scientific evidence that plantar fasciitis on the right side will cause and/or aggravate planter fasciitis in the opposite foot. In the absence of significant alteration to the individual’s gait pattern, the examiner opined that it is unlikely there would be any detrimental effect on the opposite uninjured foot. Also, the examiner noted that the Veteran was diagnosed with bilateral first MTPJ arthritis, which manifests as pain in the first toe during weight bearing activities. The symptoms of right plantar fasciitis or heel spur are pain and tenderness to the plantar surface of the foot; both are made worse by weight bearing activities. In January 2020, in accordance with the Board’s December 2019 remand, another VA examination was conducted. A diagnosis of bilateral plantar fasciitis was confirmed. The Veteran reported pain with weight bearing on his left foot. Further, the Veteran reported that he used orthotics for his bilateral foot disorder. The examiner found that the Veteran’s bilateral foot disorder caused the Veteran to be unable to stand or to walk for long periods of time. The examiner opined that the Veteran’s left foot plantar fasciitis was less likely than not due to his military service. Specifically, the examiner emphasized that there was no record of a significant, documented injury while in service. Moreover, the examiner found, after a review of the service treatment records, that there was no pattern of exacerbation beyond its natural progression that could be attributed to the Veteran’s service. Another VA medical opinion was obtained in June 2020. The examiner opined that the claimed left foot planar fasciitis was less likely than not proximately due to or the result of the Veteran’s right foot disabilities. The examiner explained that it was very unlikely that the Veteran’s right foot disability would cause any additional injury or strain to the left foot. Further, the examiner noted that the medical evidence did not support the plausibility that this can occur. Also, the examiner remarked that the very nature of the right foot disability would prevent the Veteran from participating in high impact activities that would cause additional injury or strain to the left foot. Moreover, the examiner found that there was no evidence that the Veteran’s right foot disability aggravated his left foot disorder beyond its natural progression; rather, the examiner opined that it is more likely than not that the Veteran’s current left foot disability is due to a post military service injury, overuse syndrome, or the natural process of aging. Based on the above evidence, the Board finds that service connection for left foot plantar fasciitis is not warranted. Service treatment records reveal that although the Veteran reported a diagnosis of plantar fasciitis during active service, this was limited to his right foot. Moreover, the medical evidence of record does not show a diagnosis of left foot plantar fasciitis until August 2019. Further, multiple VA examiners explained that it was unlikely that right foot plantar fasciitis causes or aggravates left foot plantar fasciitis. The Board acknowledges that the Veteran himself has claimed his left foot plantar fasciitis is directly related to his active service. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., foot pain; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, the Veteran’s lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). In addition, the Board notes that the Veteran has alleged that service connection for left foot plantar fasciitis is warranted due to the chronicity of symptoms since his active service. However, plantar fasciitis is not a disability listed in 38 C.F.R. § 3.309 (a) and the Veteran’s allegation of continuity does not provide a means of service connection for plantar fasciitis. 38 C.F.R. §§ 3.303 (b), 3.309(a); see Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Moreover, any reported arthritis in the right foot was first noted several years after separation from service and is not otherwise shown related to service.   Consequently, the preponderance of the evidence is against the claim, so the benefit-of-the-doubt rule is inapplicable. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, service connection for left foot plantar fasciitis is not warranted. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Scanlan, 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.