Citation Nr: 21014062 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-99 784A DATE: March 11, 2021 ORDER Service connection for bilateral plantar fasciitis is denied. REMANDED Entitlement to service connection for bilateral restless leg syndrome and/or peripheral polyneuropathy is remanded. FINDING OF FACT The Veteran’s bilateral plantar fasciitis did not have its onset in, and is not otherwise related to, his military service. CONCLUSION OF LAW The criteria for service connection for bilateral plantar fasciitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Army from October 1958 to October 1960. Unfortunately, he died in September 2019. The appellant is his widow and has been properly substituted in these claims. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in April 2012 by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were last before the Board in December 2020, at which time they were remanded to obtain an addendum report which addressed the Veteran’s lay statements regarding his disabilities. To the extent that the resulting December 2020 addendum opinion addressed the Veteran’s bilateral plantar fasciitis, the Board finds that there was substantial compliance with its remand directives and appellate review of the matter is appropriate. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303 (a). Service connection may also 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 during service. 38 C.F.R. § 3.303 (d). Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.303 (a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The absence of any one element will result in denial of service connection. 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). The Veteran’s service treatment records show that, upon separation in July 1960, he reported experiencing “foot trouble” and fallen arches. The Veteran was provided a VA examination in September 2019 in connection with his claim. At that time, the examiner concluded that it was less likely than not that the Veteran’s bilateral plantar fasciitis was due to or caused by his military service. He explained that while the Veteran’s separation examination showed fallen arches, there was no record of any plantar fasciitis during service. The Board found this opinion to be inadequate and subsequently, in December 2020, it remanded the claim to obtain an addendum opinion which directly addressed the Veteran’s reports of cramps in his legs with prolonged walking and standing, worse in the summer, on the July 1960 separation report of medical history. The examiner was asked to opine whether bilateral plantar fasciitis was at least as likely as not related to an in-service injury, event, or disease, including poor posture, and training with combat boots and equipment “that was very strenuous on the body.” Subsequently, in a December 2020 addendum opinion, the September 2019 examiner concluded that the Veteran’s bilateral plantar fasciitis was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, he acknowledged the Veteran’s documented “foot trouble” and reports of fallen arches. He explained that fallen arches are not plantar fasciitis. Further, plantar fasciitis does not cause leg cramping, and combat boots do not cause plantar fasciitis. If this had been the case, the Veteran’s condition would have manifested during, or shortly after, service. Rather, he was diagnosed with plantar fasciitis decades after service and decades after he stopped wearing combat boots. Thus, it was highly unlikely that the combat boots caused plantar fasciitis. Based on this evidence, the Board finds that the claim must be denied. The Board affords much probative weight to the December 2020 VA addendum report. The examiner provided a rationale, relying on and citing to the records reviewed. Moreover, the examiner offered a clear conclusion with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). Notably, there is no medical opinion of record to the contrary. The Board acknowledges the appellant’s belief, and that of the Veteran when alive, that the Veteran’s plantar fasciitis developed due to service. However, the Board finds that such assertions provide no persuasive evidence in support of the claim. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that they observed and which is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The matter of the etiology of the foot disability at issue here is one within the province of trained professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the appellant and the Veteran are shown to be laypersons without the appropriate training and expertise, they are not competent to render a probative opinion as to the medical matter upon which this claim turns. While it is in error to categorically reject layperson nexus evidence as incompetent, the Board may consider the facts of a particular case to determine the layperson’s competence. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). One factor to consider is the complexity of the question to be determined. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Here, the matter of whether the Veteran’s plantar fasciitis is etiologically related to his military service is not a matter within the realm of knowledge of a layperson; rather, such is a complex question that requires education, training and expertise. Id. Hence, the lay assertions in this regard have no probative value. For these reasons, the claim for service connection for plantar fascitis must be denied. In reaching its conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert, supra. The claim is denied. REASONS FOR REMAND Entitlement to service connection for bilateral restless leg syndrome and/or peripheral polyneuropathy is remanded. As noted supra, in December 2020, the Board remanded the issue of service connection for bilateral restless leg syndrome and/or peripheral polyneuropathy and directed that an addendum opinion be obtained in which the examiner directly addressed the Veteran’s reports of cramps in his legs with prolonged walking and standing, worse in the summer, on the July 1960 separation report of medical history. The examiner was asked to opine whether polyneuropathy and restless leg syndrome were at least as likely as not related to an in-service injury, event, or disease, including poor posture, and training with combat boots and equipment “that was very strenuous on the body.” At that time, the Board specifically directed that the opinions may not be based solely on a lack of documented in-service treatment. Subsequently, in a December 2020 addendum opinion, the September 2019 examiner reiterated that the Veteran’s bilateral restless leg syndrome was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In support of his conclusion, the examiner again rationalized that there is no evidence in the Veteran’s file that he was diagnosed with polyneuropathy or restless leg syndrome during service. He noted that the July 1960 separation examination only noted the Veteran’s fallen arches. The examiner further indicated that there was no evidence that the Veteran sought medical care for the condition post-service and there was no medical evidence to support a claim that wearing combat boots and equipment caused polyneuropathy. The examiner noted that polyneuropathy is due to chemotherapy and restless leg syndrome is thought to be due to an imbalance in neurotransmitters in the brain. Unfortunately, the Board finds that the September 2019 examiner again failed to address the Veteran’s lay statements, as instructed by the December 2020 Board remand. Illustratively, the provided rationale disregards the Veteran’s complaints of cramps in his legs and foot trouble, and again indicates that because the contemporaneous medical records or lack of documented treatment closer to service reflects that he was diagnosed after service, there cannot then be a causal relationship to his current disabilities and his statements of training with combat boots and equipment being very strenuous on the body in service. Hence, the Board finds that the December 2020 addendum opinion is not in compliance with its remand instructions and is thus inadequate. Although it regrets the delay, it finds that another remand for an addendum opinion is required. The matters are REMANDED for the following action: Obtain an addendum opinion from an examiner, other than the one who provided the September 2019/December 2020 opinions if possible, to determine the nature and etiology of the Veteran’s diagnosed polyneuropathy and restless leg syndrome. The selected examiner is asked to opine whether polyneuropathy and restless leg syndrome were at least as likely as not (that is, a 50 percent chance or greater) related to an in-service injury, event, or disease, including poor posture, and training with combat boots and equipment “that was very strenuous on the body.” The examiner is asked to specifically address the Veteran’s complaints of cramps in his legs with prolonged walking and standing, worse in the summer, on the July 1960 separation report of medical history. The examiner is reminded that opinions based solely on the lack of documented treatment in service is inadequate. A complete and detailed rationale for all opinions proffered is required. JEREMY J. OLSEN Acting 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.