Citation Nr: A25038245 Decision Date: 04/25/25 Archive Date: 04/25/25 DOCKET NO. 210720-391918 DATE: April 25, 2025 ORDER A 30 percent rating for bilateral plantar fasciitis (claimed as knot on bottom, bilateral feet) from January 2, 2020, is granted. FINDING OF FACT Resolving all reasonable doubt in the appellant's favor, the Board finds that from January 2, 2020, the Veteran's service-connected bilateral pes planus resulted in symptoms including pain on manipulation, indication of swelling on use of the feet, and characteristic callouses on the left side. CONCLUSION OF LAW From January 2, 2020, the criteria for a 30 percent rating for bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Codes 5299-5276. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1984 to April 1988. In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the appellant elected the Evidence Submission option; therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the appellant or his or her representative with the VA Form 10182 or within 90 days of receipt of the VA Form 10182. 38 C.F.R. § 20.303. The Veteran died in January 2023, and in November 2023 the Veteran's spouse was substituted to continue the Veteran's appeal. Entitlement to a rating in excess of 10 percent for bilateral plantar fasciitis from January 2, 2020. In a May 2021 rating decision, the Veteran was granted an increased rating for bilateral plantar fasciitis to 30 percent, effective September 18, 2008, and 10 percent disabling from January 2, 2020. See May 2021 rating decision. The Veteran contends that he is entitled to a rating in excess of 10 percent from January 2, 2020. See July 2021 VA Form 10182, NOD. In this case, the hyphenated code indicates that the Veteran's disability is evaluated as pes planus found under Diagnostic Codes 5299-5276. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be "built-up" as follows: the first two digits will be selected from that part of the schedule most closely identifying the part, or system of the body involved, in this case, the musculoskeletal system, and the last two digits will be "99" for all unlisted conditions. Then, the disability is rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. 38 C.F.R. §§ 4.20, 4.27. Importantly, during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71(a) were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. The Board notes that prior to February 7, 2021, there was no specific code for plantar fasciitis. Therefore, Diagnostic Code 5276 was used; however, the Board must determine which diagnostic code is more appropriate given the Veteran's symptomatology from February 7, 2021. The Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to the regulatory change, plantar fasciitis was rated by analogy and did not have a listed diagnostic code. As of February 7, 2021, under the amended criteria, the Diagnostic Code 5269 was created to rate plantar fasciitis. Under Diagnostic Code 5269, a 10 percent is assigned for bilateral or unilateral; a 20 percent is assigned for unilateral no relief from both non-surgical and surgical treatment; and a 30 percent is assigned for bilateral no relief from both non-surgical and surgical treatment. Note 1 states that actual loss of use of the foot should be rated as 40 percent. Note 2 states that if the veteran has been recommended for surgical intervention, but is not a surgical candidate, then it should be evaluated under the 20 percent or 30 percent criteria, whichever is applicable. Under Diagnostic Code 5276, a 526910 percent is assigned for moderate acquired flatfoot with weight -bearing line over or medial to great toe, inward bowing of the tendo achilles, pain on manipulation and use of the feet, bilateral or unilateral; a 20 percent is assigned for severe acquired flatfoot that is unilateral with objective evidence of marked deformity (pronation, abduction.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities; a 30 percent is assigned for severe acquired flatfoot that is unilateral with objective evidence of marked deformity (pronation, abduction.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities; a 30 percent is assigned for unilateral pronounced acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achilles on manipulation, not improved by orthopedic shoes or appliance; and a 50 percent is assigned for bilateral pronounced acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achilles on manipulation, not improved by orthopedic shoes or appliance. 38 C.F.R. § 4.71 (a), Diagnostic Code 5276. Additionally, the Board notes that words such as "mild," "moderate," "marked," "severe," and "pronounced" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. "Mild" is defined as not severe. "Moderate" is defined as tending toward the mean or average amount or dimension. "Marked" is defined as having a distinctive or emphasized character. "Severe" is defined as very painful or harmful or of a great degree. "Pronounced" is defined as strongly marked. Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed May 25, 2023). The use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 U.S.C. § 7104(a); 38 C.F.R. §§ 4.2, 4.6. Turning to the available medical evidence, in January 2020 the Veteran underwent a VA examination. The Veteran was diagnosed as having bilateral flat foot (pes planus), hallux valgus, degenerative arthritis, and bilateral plantar fibromatosis. The Board notes that the January 2020 VA examiner noted the Veteran had surgery for his bilateral hallux valgus in 1987 (tarsal osteotomy/metatarsal head osteotomy (equivalent to metatarsal head resection). However, the January 2016 VA examiner noted that the Veteran's hallux valgus surgery was unrelated to the Veteran's bilateral plantar fasciitis. Specifically, he noted that the Veteran's previous surgery was performed for hallux valgus. He noted that degenerative changes were seen in the metatarsophalangeal joint of the left foot and clinically, masses were felt in the arch of both feet. There were plantar spurs on both sides. The Veteran reported that his bilateral plantar fasciitis caused pain in both arches and "more so on the balls" of his feet. Additionally, he reported that his feet swell at the end of the day. It was noted that pain could be exacerbated by physical activity including walking, running, walking up inclines, walking down inclines, pushing a brake pedal, standing for more than 5 minutes, and climbing ladders. The Veteran described the pain as 7 out of 10. Bilateral orthotics were used but the Veteran reported extreme tenderness of plantar surfaces on one or both feet. The January 2020 VA examiner noted that the Veteran's fibromatosis is less likely than not to have been incurred in and caused by service. He noted that is easily distinguished from plantar fasciitis. He noted that the cause is unknown but thought to be genetic. Further, he opined that the Veteran's plantar fibromatosis or Dupuytren's disease resulted from any plantar fasciitis as it is known or thought to be genetic. See January 2020 VA examination. The Board notes the issue of entitlement to service connection for plantar fibromatosis is not before the Board and the available information does not support a separate rating for plantar fibromatosis. The Veteran reported decreased longitudinal arch height of one or both feet on weight-bearing. The Veteran reported pain in both feet which was accentuated on use, along with pain on manipulation of the feet which was also accentuated on manipulation. Bilateral arch supports were used but the Veteran reported extreme tenderness of plantar surfaces on one or both feet, as well as bilateral decreased longitudinal arch height of one or both on weight-bearing. There was no objective evidence of marked deformity of one or both feet nor were there marked pronation of one or both feet. The examiner noted the Veteran had mild to moderate symptoms due to hallux valgus. The Veteran had surgery for tarsal osteotomy/metatarsal head osteotomy (equivalent to metatarsal head resection) on both feet. Additionally, the examiner noted the Veteran was also diagnosed with bilateral plantar fibromatosis that was moderately severe in the right foot, severe in the left foot. The examiner noted the foot condition required arch supports, custom orthotic inserts or shoe modifications. The Veteran's foot condition was noted to chronically compromise weight bearing. The Veteran had functional loss and limitation of motion described as: pain on movement, pain on weight-bearing, swelling, disturbance of locomotion, interference with standing, and lack of endurance. The examiner described it as the Veteran had a 35-45 percent and greater than 60 percent loss of motion in the right and left feet respectively. The examiner noted that this was an estimate only and not based on an actual physical evaluation following repetition "over time" and during a "flareup." The Veteran's left foot was characteristic of callouses. The Veteran required the regular use of an assistive device. The Board finds that the evidence more closely approximates a 30 percent disability rating for the Veteran's bilateral pes planus disability from January 2, 2020, is warranted. While the Veteran experienced some relief from his orthopedic appliances, he reported foot pain and soreness with physical activity. Thus, resolving all reasonable doubt on this point in the Veteran's favor, the Board finds that he has in fact experienced pain on manipulation and use accentuated, bilateral functional loss due to pain, during flare-ups, pain with walking, running, standing for more than 5 minutes. The Veteran experienced extreme tenderness on both surfaces of both feet. The Veteran's weight-bearing line did not fall over or medial to the great toe and he did not have inward bowing of the achilles tendon. The Board acknowledges that the Veteran has reported and the record has shown swelling on use or characteristic calluses only on the left foot. However, the assignment of the appropriate disability rating for the Veteran's disability rating is within the Board's discretion, and the Board finds here that the Veteran's symptomatology more closely approximates that of severe bilateral pes planus, impacting his ability to walk and stand for prolonged periods of time, as well as to climb ladders and run. The Board finds that a higher, 50 percent disability rating is not warranted. At the January 2020 VA examination, there was no objective evidence of marked deformity of one or both feet. Additionally, marked inward displacement and severe spasm of the tendo Achilles on manipulation have not been asserted or shown throughout the appeal period. While extreme tenderness of plantar surfaces of the feet was noted at the January 2020 VA examination, they were improved by orthopedic shoes or appliances. Finally, while the Veteran's orthotics did not completely alleviate his condition, the Board finds that he did experience some relief in the severity of his bilateral foot pain with their use. Thus, the Board finds that the evidence does not reflect no improvement on use of orthopedic shoes or appliances such that a higher, 50 percent disability rating is warranted. In summary, entitlement to a 30 percent for bilateral pes planus is granted from January 2, 2020. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jordan, J 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.