Citation Nr: 25004028 Decision Date: 03/25/25 Archive Date: 03/25/25 DOCKET NO. 20-05 984 DATE: March 25, 2025 REMANDED Service connection for pes planus to include as secondary to PTSD and obesity is remanded. Service connection for plantar fasciitis to include as secondary to pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1991 to May 1998 and from January 2005 to April 2006. His service decorations include the Afghanistan Campaign Medal. These issues have a procedural history which includes a Board Decision in November 2023 and a November 2024 Order of the Court of Appeals for Veterans Claims (Court) which enacted a Joint Motion for Partial Remand (JMR) vacating the Board's Decision regarding service connection for pes planus and plantar fasciitis. Pes Planus The Veteran has sought service connection for pes planus. See May 2017 Fully Developed Claim. The record shows, and the Veteran has stated, that pes planus pre-existed the Veteran's service. See August 1991 service treatment record (STR) and August 2020 Correspondence. When a condition is noted at enlistment, service connection can only be granted based on aggravation. A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. Thus, service connection for the Veteran's conceded pre-existing pes planus cannot be granted unless the Veteran's pes planus was aggravated beyond its natural progression by the Veteran's active duty, or was aggravated beyond its natural progression by a service-connected disability. In order to support a finding of aggravation, the evidence must establish that the underlying disability underwent an increase in severity; the mere occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306(a). Here, the Veteran has stated that his service-connected posttraumatic stress disorder (PTSD) has resulted in obesity which has aggravated his pes planus beyond its natural progression. See August 2020 and January 2025 Correspondence. Although obesity, per se, is not a disease or injury for purposes of 38 U.S.C. §§ 1110 and 1131 and therefore may not be service connected on a direct or secondary basis, obesity may be an "intermediate step" between a service-connected disability and a current disability that may be connected on a secondary basis (1) if a previously service-connected disability caused him to become obese; (2) that obesity was a substantial factor in causing secondary disability; and (3) the secondary disability would not have occurred but for the obesity. See VAOPGCPREC 1-2017. The parties to the JMR indicated that the Board's November 2023 Decision failed to address whether aggravation of the Veteran's pes planus caused by obesity served to establish secondary service connection and directed the Board to address the issue. The Board notes that the standard is not merely that the Veteran's obesity aggravated his pes planus; it must be found that the Veteran's obesity was caused by his PTSD and then the issue becomes if the Veteran's pes planus was aggravated beyond its natural progression by that obesity. To date, no medical evidence of record has addressed these issues. Thus, the Board finds that remand is necessary to obtain an opinion as to whether the Veteran's PTSD stated that the Veteran's obesity was aggravated beyond its natural progression by his obesity. Plantar Fasciitis It has been established that the Veteran's plantar fasciitis is caused by his pes planus. Thus, the issue of service connection for plantar fasciitis is intertwined with the claim for pes planus. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: Obtain an opinion from a qualified examiner (an M.D., to the extent possible) regarding the Veteran's pes planus. The Board is not requesting an in-person examination of the Veteran, however, if the examiner deems it necessary to provide the opinions requested below, the RO should take appropriate action. The examiner should state: (1) Whether it is at least as likely as not (i.e., an approximate balance of negative and positive evidence) that the Veteran's service-connected PTSD caused the Veteran's obesity; or (2) Whether it is at least as likely as not (i.e., an approximate balance of negative and positive evidence) that the Veteran's service-connected PTSD aggravated the Veteran's obesity. If the examiner concludes that the Veteran's obesity was caused or aggravated his PTSD, then the examiner must address the following medical issues to the extent possible: (3) Is it at least as likely as not (i.e., an approximate balance of negative and positive evidence) that the Veteran's obesity aggravated the Veteran's pre-existing pes planus beyond its natural progression? a. If yes, identify the baseline manifestation of the severity of the Veteran's pes planus prior to aggravation; and b. the increased manifestations which, in the examiner's opinion, are due to the obesity rather than due to natural progress of the disability. A rationale for all opinions must be provided. J. JACK Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Parrish 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.