Citation Nr: 21042583 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 19-11 902 DATE: July 13, 2021 ORDER Service connection for bilateral plantar fasciitis is granted. Service connection for bilateral heel spurs is granted. Service connection for a low back disorder is granted. FINDINGS OF FACT 1. The Veteran had active duty from November 1990 to December 1996, from July 1997 to April 2001, and from November 2007 to January 2008, with additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) in the Air Reserve and Air National Guard. 2. A foot injury was incurred during service. The current diagnosis of bilateral plantar fasciitis has been related to service. 3. Bilateral heel spurs and a low back disorder have been related to the now service-connected plantar fasciitis. CONCLUSIONS OF LAW 1. Bilateral plantar fasciitis was incurred in service. 38 U.S.C. §§ 102, 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.6, 3.159, 3.303 (2020). 2. Bilateral heel spurs are proximately due to a service-connected disability. 38 U.S.C. §§ 102, 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.6, 3.159, 3.303, 3.310 (2020). 3. A low back disorder was proximately due to a service-connected disability. 38 U.S.C. §§ 102, 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.6, 3.159, 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 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 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). In addition to the laws and regulations outlined above, active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled from a disease or injury incurred or aggravated in the line of duty, and any period of INACDUTRA during which the individual concerned was disabled from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101(21) and (24); 38 C.F.R. § 3.6(a). ACDUTRA is defined as full-time duty in the Armed Forces performed by Reserves for training purposes, and includes full-time duty performed by members of the National Guard of any State. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). Thus, service connection may be granted for a disability resulting from disease or injury incurred or aggravated while performing ACDUTRA or from an injury incurred or aggravated while performing INACDUTRA. 38 U.S.C. §§ 101(24), 106, 1110, 1131. Only "veterans" are entitled to VA compensation under 38 U.S.C. §§ 1110, 1131. See Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). To establish status as a "veteran" a claimant must serve on active duty, serve on a period of ACDUTRA and incur or aggravate an injury or disease during that period of ACDUTRA, or serve on a period of INACDUTRA and incur or aggravate an injury during that period of INACDUTRA. Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991). Certain evidentiary presumptions, such as the presumption of sound condition at entrance to service, the presumption of aggravation during service of preexisting diseases or injuries which undergo an increase in severity during service, and the presumption of service incurrence for certain diseases which manifest themselves to a degree of disability of 10 percent or more within a specified time after separation from service are provided by law to assist veterans in establishing service connection for a disability or disabilities. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.304(b), 3.306, 3.307, 3.309. These evidentiary presumptions do not extend to those who claim service connection based on a period of ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40 (2010) (presumption of soundness and presumption of aggravation not applicable to ACDUTRA); Paulson v. Brown, 7 Vet. App. 466, 470-71 (1995) (Board did not err in not applying presumptions of sound condition and aggravation to claim where appellant served only on ACDUTRA and had not established any service-connected disabilities from that period). However, for those who have achieved "veteran" status through a prior period of service and claim a disability incurred only during a later period of ACDUTRA, the presumption of soundness applies only when the veteran has been "examined, accepted, and enrolled for service" and where that examination revealed no "defects, infirmities, or disorders." Smith, 24 Vet. App. at 40. Bilateral Plantar Fasciitis Turning to the evidence, the first element of service connection a current disability is met, as a November 2017 VA examiner diagnosed the Veteran with plantar fasciitis in the right foot in 2012, and the left foot in 2013. Private medical records and service treatment records (STRs) also show a diagnosis of and treatment for bilateral plantar fasciitis, first noted in 2012. As such, the first element is met. Next, the second element an in-service incurrence is not shown by the medical evidence. The service treatment records (STRs) associated with his periods of active duty were silent for a diagnosis of, treatment for, or complaints of plantar fasciitis or symptomatic feet. However, the Veteran claims that during a fitness test in 2010, as a member of the Michigan Air National Guard, he injured his feet. As a full-time employee working at an Air Force Base while in the National Guard, characterizing what his service record shows to be a few days of monthly service as either active duty, ACDUTRA, or INACDUTRA service is unclear. The individual days shown as active duty used for physical training align most clearly with INACDUTRA. Further, at the January 2021 Board hearing, the Veteran stated during a fitness test he believed occurred in 2010 he noticed pain, which increased the next day. During the November 2017 VA examination, he also stated that his foot pain began in 2010 during physical training. He related that he did not go see a podiatrist until 2012, which is reflected in private medical records. Specifically, October 2012 private medical records indicated that after orthopedic taping, it was the first relief the Veteran had experienced in two years, dating the onset of pain to 2010, consistent with his testimony. Additionally, once he started seeing the podiatrist in 2012, he was excused from running and fitness multiple times per his physician's recommendations. Collectively, although documentation of the injury itself is not of record, the Veteran has consistently alleged the same date range of his injury and is competent to state his feet began hurting while running during physical training. As such, the second element of service connection has been met. As to a medical nexus, a November 2017 VA examiner found that it was as likely as not that bilateral plantar fasciitis was caused by an injury in service. The examiner reasoned that after review of the STRs, physical evidence, X-ray evidence, and the Veteran's statements, which included the discussion of the onset of symptoms, that bilateral plantar fasciitis was as likely as not related to service. Although the November 2017 VA examiner's opinion does not discuss INACDUTRA or ACDUTRA service, it is based on the injury as relayed by the Veteran and is thus adequate. There is no contradictory medical opinion. As such, the third element is met, and service connection is granted. Bilateral Heel Spurs During the development of the claim for bilateral plantar fasciitis, a separate diagnosis for injuries of the feet was identified, and a medical nexus opinion was provided relating these separate diagnoses to service. The original claim is thus broadened to encompass all bilateral foot disorders. Turning to the evidence, the first element of service connection on a secondary basis a current disability is met, as a November 2017 VA examiner diagnosed the Veteran with bilateral heel spurs. The second element a service-connected disability is also met, as he is now service connected for bilateral plantar fasciitis. As to a medical nexus, the November 2017 VA examiner found that the Veteran's heel spurs were as likely as not secondary to bilateral plantar fasciitis. The examiner reason that heel spurs were frequently associated with plantar fasciitis, which was a painful inflammation to the fibrous band of connective tissue that ran along the bottom of the foot and connected the heel bone to the ball of the foot. This opinion referenced physiological evidence and there is no contradictory medical opinion. As such, the third element is met, and service connection for bilateral heel spurs is granted. Low Back Disorder The Veteran claims he has a low back disorder caused by service, specifically due to his bilateral plantar fasciitis. Turning to the evidence, the first element of service connection on a secondary basis a current disability is met, as a November 2017 VA examiner diagnosed the Veteran with intervertebral disc syndrome (IVDS), sciatica, and associated diagnostic records revealed mild bilateral L5-S1 facet osteoarthritis. The second element a service-connected disability is also met as he is now service connected for bilateral plantar fasciitis. As to a medical nexus, the November 2017 VA examiner found it to be as likely as not that the Veteran's current spine disabilities were caused by plantar fasciitis. The examiner reasoned that plantar fasciitis impacted the Veteran's gait and put biomechanical strain on his lumbar spine. Specifically, the Veteran's job during service, diagnosis of plantar fasciitis, and history of disc herniation caused the examiner to find that the wear and tear of his back by his body mechanics coupled with an antalgic gain created by plantar fasciitis both at least as likely as not contributed to the current back disorder. While an injury to his back would be required for service connection during a period of INACDUTRA service on a direct basis, secondary service connection requires that a disability be proximately due to or aggravated beyond its normal course by a service-connected disability. Here, the examiner has clearly indicated that the antalgic gait contributed to the development of his back disorder. Thus, this is sufficient as a medical nexus on a secondary basis, the third element is met, and the claim for service connection for a low back disorder is granted. 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, 369-370 (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). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brendan A. Evans, 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.