Citation Nr: 22013591 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 17-01 546 DATE: March 10, 2022 ORDER Service connection for coronary artery disease (CAD) is denied. REMANDED Entitlement to service connection for bilateral pes planus is remanded. Entitlement to service connection for bilateral plantar fasciitis is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for right shin splints is remanded. Entitlement to service connection for left shin splints is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a lumbar spine disorder is remanded. FINDING OF FACT The weight of the evidence is against a finding that any coronary artery disease (CAD) is due to or the result of the Veteran's active service. CONCLUSION OF LAW The criteria for service connection for CAD have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1985 to November 1988. This case is before the Board of Veterans' Appeals (Board) on appeal from a July 2013 Department of Veterans Affairs (VA) rating decision. In connection with this appeal, the Veteran testified at a hearing before the undersigned Veterans Law Judge in March 2021. A transcript of that hearing is of record. Service connection is warranted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. To substantiate a claim of service connection there must be competent evidence showing: (1) the existence of a claimed disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal relationship between the present claimed disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases may be presumed to be service connected if manifested as chronic in service or to a compensable degree within a specified period after service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). For chronic disease listed in 38 C.F.R. § 3.309(a) service connection may be established by showing continuity of symptomatology. See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). The Veteran asserted that his CAD was due to his active service. At the March 2021 Board hearing, he testified that he was diagnosed with CAD in 2012, but he had heartburn in service. The Veteran's service treatment records (STRs) from his active service do not show any symptoms, complaints, or treatment for CAD or any heart disorder during his active service. He had normal examinations of his heart at his June 1985 entrance physical, a May 1986 physical, a November 1986 physical, and his September 1988 separation physical. In addition, in medical questionnaires completed in conjunction with these physicals, he specifically denied having any pain or pressure in the chest, palpation or pounding heart, or high or low blood pressure. His STRs do not show any complaints or treatment for heartburn (which is not a symptom of a heart disorder). Finally, his STRs show that he had normal blood pressure readings throughout his active service. The Veteran's reserve service STRs show that he continued to have a normal examination of his heart at a June 1990 physical, and he continued to deny having any pain or pressure in the chest, palpation or pounding heart, or high or low blood pressure in an accompanying medical questionnaire. As such, the Veteran's STRs do not show that he was diagnosed with CAD or any heart disorder during his active service or within one year of separation from active service. The Veteran's medical records show that the first evidence of a diagnosis of CAD is in September 2012, over twenty years after his separation from active service. Finally, there is also no competent medical opinion of record which even suggests that the Veteran's CAD might be related to his active service. Consideration has been given to the Veteran's assertion that his CAD is due to his active service. He is clearly competent to report symptoms of CAD. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, while the Veteran may describe symptoms, he lacks the medical training or qualification either to diagnose CAD or to relate it to his active service. Id. Accordingly, the criteria for service connection for CAD have not been met, and the claim is denied. REASONS FOR REMAND Regarding the Veteran's service connection claim for bilateral pes planus, at his June 1986 entrance physical, he was noted to have asymptomatic pes planus. As such the Veteran is not due the presumption of soundness. See 38 U.S.C. § 1111. During military service, he was treated for foot pain in March 1986. In a May 1986 medical questionnaire, he reported having foot trouble. He again treated for foot pain in September 1986. In a November 1986 medical questionnaire, he continued to report having foot trouble. Finally, at his September 1988 separation physical, he reported having foot trouble and that his pes planus was painful at times. The Veteran was afforded a VA examination for his pes planus in June 2013. In July 2013, a VA examiner reviewed the Veteran's claims file and opined that the Veteran's pes planus was less likely than not aggravated by his active service. The examiner reported that there were no specific injuries noted in service. However, the Veteran's STRs show he treated for complaints of foot trouble throughout his active service. As such, a remand is necessary to afford the Veteran a new VA examination for his bilateral pes planus. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). Regarding the Veteran's service connection claims for bilateral plantar fasciitis, bilateral ankle disorders, bilateral shin splints, bilateral knee disorders, and a lumbar spine disorder, his STRs show he reported having leg and feet injuries in March 1986 and had pain during the previous eight weeks. At a May 1986 physical, he reported having swollen or painful joints, cramps in his legs, and foot trouble. He complained of feet pain in September 1986. He sprained his right ankle in October 1986. At a November 1986 physical, he again reported having foot trouble. He was treated for right foot plantar fasciitis in November 1987. He complained of right knee pain in January 1988. At his September 1988 separation physical, he reported that he had cramps in his legs, recurrent back pain, and foot trouble. He reported that he was involved in a motor vehicle accident during his active service. The Veteran's reserve service STRs show that he had a back spasm in November 1989. The Veteran was afforded a VA examination for his bilateral plantar fasciitis, bilateral ankle disorders, bilateral shin splints, bilateral knee disorders, and a lumbar spine disorder in June 2013. Unfortunately, the VA examiner did not discuss the Veteran's STRs showing complaints and treatment during his active service. At the March 2021 Board hearing, the Veteran testified that he was required to perform a lot of heavy work during his active service. He testified he was involved in a motor vehicle accident during his active service. He testified that his bilateral pes planus aggravated all of these conditions. As such, a remand is necessary to afford the Veteran new VA examinations for his bilateral plantar fasciitis, bilateral ankle disorders, bilateral shin splints, bilateral knee disorders, and lumbar spine disorder. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his bilateral pes planus. After review of the claims file, particularly the Veteran's service treatment records, and examination of the Veteran, the examiner should opine whether the Veteran's pes planuswhich pre-existed service as it was noted on entrance to servicewas at least as likely as not (50 percent or greater probability) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran's military service. In so discussing, the examiner should specifically address the Veteran's several complaints throughout service of foot pain and problems. The examiner should provide a detailed rationale for all conclusions reached. 2. Schedule the Veteran for a VA examination to determine the etiology of any bilateral plantar fasciitis, bilateral ankle disorders, bilateral shin splints, bilateral knee disorders, and lumbar spine disorder. After examination of the Veteran and review of the claims file, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral plantar fasciitis, bilateral ankle disorders, bilateral shin splints, bilateral knee disorders, and/or lumbar spine disorder began during military service or are otherwise the result thereof. In so discussing the examiner should specifically address the Veteran's complaints and treatment for his feet, ankles, legs, knees, and lumbar spine during his active service, including being involved in a motor vehicle accident and performing heavy work. For any disorder noted above that is not found to be directly related to military service, the examiner should opine whether any of those disorders are at least as likely as not (a) caused by; or (b) aggravated (i.e, worsened by) the Veteran's claimed bilateral pes planus. The examiner should provide a detailed rationale for all conclusions reached. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berryman, 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.