Citation Nr: 23018917 Decision Date: 03/28/23 Archive Date: 03/28/23 DOCKET NO. 19-15 139 DATE: March 28, 2023 ORDER Entitlement to service connection for a left knee disorder is granted. Entitlement to service connection for a right heel spur is granted. Entitlement to service connection for a bilateral foot disorder, to include plantar fasciitis is granted. FINDINGS OF FACT 1. There is competent evidence of a nexus between Veteran's claimed left knee disorder and the Veteran's active service. 2. There is competent evidence of a nexus between Veteran's claimed right heel spur and the Veteran's active service. 3. There is competent evidence of a nexus between Veteran's bilateral foot disorders and the Veteran's active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left knee disability are met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for right heel spur are met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for bilateral foot disability are met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1976 to June 1980. The Veteran also served in the Army National Guard from August 1980 to August 2006. The Veteran filed his claims of service connection in August 2014. The claims were denied in a July 2015 rating decision. The Veteran disagreed with this decision in May 2016 and filed a substantive appeal in May 2019, following a March 2019 statement of the case. The claims were previously before the Board in September 2019, at which time they were remanded for additional development. Service Connection 1. Entitlement to service connection for plantar fasciitis 2. Entitlement to service connection for a left knee condition 3. Entitlement to service connection for a right heel spur The Veteran contends that his current diagnosed bilateral foot, left knee, and right heel disabilities are related to his National Guard Service, including as a result of training for service and aggravated during service. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires competent, credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus, or link, between the current disability and the in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The term "active military, naval, or air service" includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101 (21), (24). Diseases or injuries incurred or aggravated while performing ACDUTRA are eligible for service connection. 38 U.S.C. §§ 101 (24), 106, 1110, 1131. The Veteran was first treated for the current claimed conditions by a private physician in October 1998. The Veteran's VA and private treatment records show diagnoses of arthritis of the left knee, patellofemoral syndrome of the left knee, bilateral plantar fasciitis, and a right heel spur. His subsequent STRs in April 2001 and September 2005 show that he remained on a permanent profile for running related to his knee and bilateral foot conditions until separation from service. In a May 2016 statement, the Veteran stated that throughout his entire military career, including through his time in the National Guard, he was required to maintain the military physical fitness standards, which involved running on a regular basis. Each time he ran, he experienced pain. He reviewed his symptoms with the Army unit physician and had several temporary profiles until he was advised by a military doctor that he needed a permanent profile. He stated that his disorders were long term aggravations caused by the requirement to run on a regular basis to meet military standards. The Veteran also submitted a May 2016 statement from the military physician assistant who examined him between 2002 and 2006. He stated that he performed a physical examination of the Veteran and recalled that he had challenges of his feet and left knee. He then stated that "although the rigors of service were thought to be aggravating, it is noted that an LOD had not been rendered;" however, a permanent physical profile was issued directing that an alternate aerobic test was to be used for the Army physical fitness test. The Veteran underwent VA examinations in December 2019. The VA examiner confirmed the Veteran's diagnoses of right heel Achilles tendinitis, with recurrent right ankle strain; bilateral plantar fasciitis, with bilateral foot degenerative joint disease and left foot hallux valgus; and left knee degenerative joint disease, with left knee patellar tendinitis. The VA examiner opined the Veteran's claimed disabilities were at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. He provided the following rationale: The veteran is diagnosed with [right heel Achilles tendinitis, with recurrent right ankle strain; bilateral plantar fasciitis, with bilateral foot degenerative joint disease and left foot hallux valgus; and left knee degenerative joint disease, with left knee patellar tendinitis] and the veteran has had persistent and recurrent [ ] symptoms from the time of their initial development during military training in 1998 while in the Army National Guard while the veteran was in the military until the present time; with the current [ ] condition symptoms occurring in a similar location, and appearing to be of a similar nature, as the [ ] condition the veteran developed during military training in the Army National Guard; and with the current [ ] condition with similar precipitating, exacerbating, and relieving factors as the right heel condition the veteran developed during military training in the Army National Guard. The RO denied the Veteran's claims, finding that the Veteran's injuries did not occur during qualifying periods of active duty for training, or inactive duty for training; however, upon review of the record and with resolution of the doubt in favor of the Veteran, the Board finds that service connection is warranted. (Continued on the next page) The Veteran has testified and the records, including the permanent profiles, support the Veteran's claim that running for military training aggravates his left knee, right heel, and bilateral feet disorders. The Veteran has testified that he experienced pain each time he ran, and although much of his running was in preparation for active duty and military fitness, it stands to reason that prior to the permanent profile, the Veteran was required to run while on ACDUTRA. Furthermore, the VA opinion produced a positive nexus for the Veteran's left knee, right heel and ankle, and bilateral foot disorders disabilities and determined they were incurred as a result of service and exacerbated by military training. The Veteran also had a Point Credit Summary that provided he had ACDUTRA service during the time frames he was diagnosed with the claimed disorders. While the specific dates are not listed in the Point Credit Summary, his service treatment records, and permanent profiles reflect that he reported knee and foot pain during these times. The Board is cognizant of 38 U.S.C. § 1154 (a) which requires VA to give due consideration to the places, types, and circumstances of the service of a claimant. In light of the Veteran's diagnoses, the positive opinions of the December 2019 VA examiner, his consistent reporting of the aggravation of his injuries, the May 2016 statement by the military physician assistant, and the April 2001 and September 2005 permanent profiles, the Board resolves all reasonable doubt in his favor and the Board finds that the Veteran's left knee, right heel and ankle, and bilateral foot disorders are entirely consistent with his reports that they were aggravated while he was on ACDUTRA service. Therefore, service connection for left knee, right heel and ankle, and bilateral foot disorders is granted. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shana Z. Siesser, 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.