Citation Nr: 21015403 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 14-08 638 DATE: March 17, 2021 ORDER Service connection for bilateral plantar fasciitis is denied. FINDINGS OF FACT 1. The Veteran had active service from July 1993 to November 2004 and from June 2007 to September 2008. 2. Plantar fasciitis was not shown in service and is not causally or etiologically related to service. CONCLUSION OF LAW Bilateral plantar fasciitis was not incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, on multiple occasions, most recently in September 2020, the Board remanded the claim on appeal for additional development. The Veteran’s case has now returned to the Board for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Board must determine the value of all pertinent lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). The evaluation of evidence generally involves three steps: competency, credibility and weighing the evidence as a whole. First, the Board must determine whether the evidence comes from a “competent” source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2) (2020). Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377, n. 4 (Fed. Cir. 2007). However, laypersons have generally been found to not be competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). As an initial matter, plantar fasciitis is not considered a chronic disorder under 38 C.F.R. § 3.309(a); as such, presumptive service connection based on continuity of symptomatology is not for application. Additionally, the Veteran has not argued that his plantar fasciitis was caused or aggravated by a service-connected disability; therefore, secondary service connection will not be addressed. However, direct service connection will be discussed. The Veteran has been diagnosed with plantar fasciitis. Specifically, multiple VA examinations and medical treatment notes, most recently in May 2019 and November 2019, respectively, diagnosed plantar fasciitis. Accordingly, a current diagnosis has been established and the first element of service connection for plantar fasciitis has been met. A review of the Veteran’s service treatment records (STRs) show that in November 1998, he complained that his left foot was burning following exposure to oil fuel following an oil spill. However, the clinician diagnosed a mild edema of his left foot rather than plantar fasciitis. The STRs further show that he reported in multiple reports of medical history between July 1992 and November 2003 that he did not then-presently or previously have foot trouble, and that multiple medical examinations over the same time frame found his feet to be clinically normal. The STRs are otherwise silent for complaints, treatment, or diagnoses of plantar fasciitis. Therefore, the medical evidence does not support an in-service incurrence of plantar fasciitis. However, in subsequent March 2014, April 2019, and July 2020 lay statements, the Veteran reported experiencing foot pain as the result of wearing steel toed flight deck boots on a daily basis throughout his many years of active military service and participating in frequent high-impact physical activity. He said that he was unable to receive treatment for his feet because of the long length of his work shifts and related inability to get to medical. He described taking Motrin in order to deal with his pain and allow him to continue performing his in-service duties. The Veteran is competent to report in-service symptoms; accordingly, resolving reasonable doubt in his favor, the second element of direct service connection- in-service incurrence- has been met. As to medical nexus, in a February 2012 lay statement, the Veteran asserted that his plantar fasciitis was the product of repeated strains from his time in the Navy that caused tiny tears in his ligaments and resulted in pain and swelling. He subsequently elaborated in March 2014, April 2019, and July 2020 statements that his plantar fasciitis emerged from his extended time in-service wearing steel toed boots and being on his feet on the flight deck onboard aircraft carriers for extended periods of time, working in rugged conditions, having to go up and down metal stairs and across nonskid decks on a daily basis, and otherwise participating in frequent high-impact physical activity. He noted that his feet swelled up significantly, requiring him to prop his feet up, and said that his condition was the result of countless hours of wear and tear over the course of his military service. The Veteran is competent to offer observations as to his symptoms, as this requires personal knowledge as it comes to him through his senses. However, he is not competent to opine as to relationship between his plantar fasciitis and his active service. See Jandreau, 492 F.3d at 1377; Woehlaert, 21 Vet. App. 456. Accordingly, the February 2012, March 2014, April 2019, and July 2020 lay statements are assigned lesser probative value. In an October 2010 treatment note, the Veteran reported that his feet were “killing [him].” He said that, while he had problems in the past, they were not as severe. He noted that he did increased walking and running and that his feet hurt more afterwards. A clinician diagnosed foot pain but did not opine as to the etiology of the condition, to include as the product of military service. In a subsequent November 2010 private medical examination, a private clinician diagnosed plantar fasciitis. The clinician noted that the Veteran had a history of painful arches in his bilateral feet. The clinician found that the Veteran’s pain started in 2009, that he was not a diabetic, and that he had hypertension. However, the private clinician similarly did not establish that the Veteran’s plantar fasciitis stemmed from his active service. More recently, in November 2018 and September 2020 VA examinations, the examiners opined that the Veteran’s plantar fasciitis was less likely than not caused by or incurred in active service. The examiners noted no documentation linking foot pain to military service. Rather, they observed that the Veteran first complained of a bilateral foot condition in October 2010 and that the clinician at the time noted that he was obese and diagnosed foot pain. The examiners said that in the years following his October 2010 foot pain, the Veteran experienced weight gain. They noted that people are at increased odds of foot pain as their body mass increases, explaining that medical literature found that obesity likely increased the stresses applied directly to the foot as a result of increased body weight. They finally offered that studies showed that overweight or obese individuals were more likely to have foot pain, flat feet, and high peak plantar pressures when walking. In light of the above, the medical evidence does not establish a causal nexus between the Veteran’s plantar fasciitis and his active service; therefore, service connection is not warranted. Competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and by STRs obtained and associated with the claims file. The VA opinion is fully responsive to the question at issue. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Here, the Board attaches greater probative weight to the clinical findings than to the lay statements that have been submitted. Based on the above, the appeal is denied. (Continued on the next page)   Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Emily Tamlyn Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Spigelman, 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.