Citation Nr: 21010774 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 14-41 490 DATE: February 25, 2021 ORDER Entitlement to service connection for a left heel disability, to include as secondary to a service-connected right knee disability, is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a left heel disability at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a left heel disability, to include as secondary to a service-connected right knee disability, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1978 to October 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the matter last appeared before the Board in May 2020, at which time the issues also included claims for entitlement to service connection for a right hip condition and bilateral heels condition. The claims were remanded for further development. In a November 2020 rating decision, service connection was granted for the Veteran’s right hip disability and right foot disability (claimed as right heel condition). In a November 2020 Supplemental Statement of the Case (SSOC), service connection for a left heel condition, to include as secondary to a service-connected right knee disability, was again denied. Thus, having been granted the full benefit on appeal for the two aforementioned issues, the issue of entitlement to service connection for a left heel condition is the remaining issue before the Board. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). In order to establish service connection for a claimed disability on a direct basis, there must be competent evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established by evidencing a chronic disease in service, which requires a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required. Id. The provisions of 38 C.F.R. § 3.303(b) pertaining to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when the evidence establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition to direct service connection, a disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. Entitlement to service connection for a left heel disability, to include as secondary to a service-connected right knee disability, is denied. In all cases of establishing entitlement to service connection for a disability, the preliminary question before the Board is whether the Veteran has a current disability. After an affirmative answer to such inquiry, the next questions are then whether that disability began during service due to an event or injury and is at least as likely as not related to an in-service injury, event, or disease or secondary to the Veteran’s service-connected disability. The Board concludes that the Veteran does not have a current diagnosis related to a left heel disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). In reaching this conclusion, the Board has considered the Federal Circuit’s holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability” if it “reaches the level of a functional impairment of earning capacity.” Id. at 1367-69. Turning to the medical evidence and lay statements of record, an October 1978 report of medical for enlistment history notes the Veteran’s report of excellent health and adverse reaction to serum, drugs or medicine. An October 1978 report of medical examination for enlistment reveals normal findings upon clinical evaluation. A February 1979 service treatment record (STR) notes that the Veteran complained of left anterior tibial tenderness, left lower leg pain, numbness in lower back, and left knee tenderness. A March 1979 STR notes knees swelling bilateral. A September 1979 STR notes that the Veteran reported severe pain in knee. The note further reflects that the Veteran was seen in sick call for follow-up of left knee pain and injury sustained three nights ago while dancing. An October 2010 VA medical center (VAMC) treatment record notes the Veteran’s report of knee pain with chronic right hip and ankle pain. A November 2010 VAMC record reflects the Veteran’s report of heel pain for twenty-eight years, left greater than right; the Veteran reported that her symptoms started when she left the military, for which she never sought treatment. The record further reflects a notation of limited bilateral ankle dorsiflexion. In her November 2014 formal appeal to the Board, the Veteran stated that her February 1979 STR incorrectly noted that she complained of injuring her left knee dancing while in service, and that instead, she injured her right knee. She reported that she has suffered from this injury for many years and it has also created secondary problems with her right hip and ankle. The Veteran underwent an in-person VA foot examination in June 2019, at which time the examiner diagnosed the Veteran with only right foot plantar fasciitis. The Veteran underwent an in-person foot examination in September 2020 with a separate VA examiner. This examiner also solely diagnosed the Veteran with right foot plantar fasciitis and opined that the plantar fascitis left foot condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. The examiner rationalized that the examination revealed no findings to warrant a diagnosis of any left foot heel condition and therefore it is less likely than not that the Veteran has a left foot heel condition that was caused by or aggravated beyond its natural progression by the Veteran’s right knee disability. Then, in a December 2020 statement, the Veteran contended that she did not ask for service connection for entitlement to a left heel condition. The Veteran then concluded that she has only experienced problems and pain on her right side due to injury that occurred while in service. Although the record reflects that the Veteran sought entitlement to service connection for a bilateral heel condition in her October 2010 application for compensation and the medical record reflects notes of left knee pain, as well as left heel pain being greater than the right as noted in the November 2010 VAMC treatment record noted above, the treatment record is otherwise void of an assessment or diagnosis of a left heel disability. Her isolated lay report of the left heel pain does not support a finding that the Veteran has a current diagnosis related to a left heel disability or that she has had one at any time during the pendency of the claim. Illustratively, the Veteran’s VAMC treatment record and the VA examination reports fail to show that a left heel disability has been diagnosed at any time since the Veteran filed her claim for service connection. Further, the Veteran herself stated that she did not seek entitlement to service connection for a left heel condition and that it is only her right side in which she has experienced problems and pain due to injury in service. The Board places high probative value to the medical evidence, which lacks any indication of a current disability, and the Veteran’s recent lay statements denying any current left heel maladies. In light of the medial evidence and lay statements of record, the Board finds that the first element of establishing service connection, competent evidence of a current disability, is not met. Shedden, 381 F.3d at 1166-67. Throughout the appeal, the preponderance of the evidence is against a finding that the Veteran has had a left heel disability. The benefit of the doubt rule does not apply. Service connection for a left heel disability must be denied. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. As the preponderance of the evidence is against the appeal, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Finally, the Board acknowledges that in her December 2020 written statement, the Veteran endorsed symptoms related to her right heel condition. As the right heel disability is not currently on appeal or addressed herein, she advised that she is welcome to file a Supplemental Claim, Request for Higher Level Review or Notice of Disagreement with the rating of the November 2020 decision for the right heel disability, as explained in the November 27, 2020 notification letter provided to the Veteran. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Alli, 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.