PLANTAR FASCIITIS

KRISTY L. ZADORA · 2025 · Case ID: A25052146

MIXED

Summary

The veteran, who served from March 2001 to November 2019, appeals a September 2021 rating decision concerning bilateral plantar fasciitis, hypertension, and erectile dysfunction. The Board granted an initial 30 percent rating for bilateral plantar fasciitis with degenerative changes and sesamoid fracture residuals, finding the criteria met based on pain on use and manipulation, accentuated pain, indication of swelling on use, and characteristic calluses, consistent with the August 2020 VA examination. The Board denied an increased rating for plantar fasciitis, as the evidence did not support marked pronation, extreme tenderness, or other severe symptoms required for higher evaluations. Service connection for hypertension was denied because the veteran's blood pressure readings and treatment history did not meet the criteria for a compensable rating, specifically lacking consistent diastolic pressure of 100 or more or systolic pressure of 160 or more, and not requiring continuous medication. The claim for service connection for erectile dysfunction as secondary to PTSD, persistent depressive disorder, insomnia disorder, and alcohol use disorder was denied due to the lack of a current diagnosis of erectile dysfunction in the record, rendering the nexus element unmet. The Board noted that while the veteran is competent to report symptoms, a diagnosis of erectile dysfunction requires medical expertise, which was not provided by the veteran's lay assertions.

Rationale

Pain on use of the feet bilaterally; Pain on manipulation of the feet bilaterally; Indication of swelling on use bilaterally; Characteristic calluses on the right side

Special Benefit

NO SPECIAL BENEFIT

Docket No.

220914-277844

Full Decision Text

Citation Nr: A25052146
Decision Date: 06/13/25 Archive Date: 06/13/25

DOCKET NO. 220914-277844
DATE: June 13, 2025

ORDER

Entitlement to an initial 30 percent rating for bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals is granted.

Entitlement to an initial compensable rating for hypertension is denied.

Entitlement to service connection for erectile dysfunction, to include as secondary to service connected posttraumatic stress disorder (PTSD), persistent depressive disorder, insomnia disorder and alcohol use disorder in early remission, is denied.

FINDINGS OF FACT

1. Throughout the period on appeal, the Veteran's bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals have more nearly approximated pain on use of the feet without relief from an orthotic device, pain on manipulation, indication of swelling on use and characteristic callosities without manifested as pronounced, marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement or severe spasm of the tendo-Achilles on manipulation, was not improved by orthopedic shoes or appliances or performed surgical treatment or recommended surgical treatment.

2. Throughout the appeal period, the Veteran's hypertension has not required continuous medication for control and no evidence of diastolic pressure of predominantly 100 or more, a history of diastolic pressure of predominantly 100 or more nor by systolic pressure of predominantly 160 or more.

3. At no time during the pendency of the claim does the Veteran have a diagnosis of erectile dysfunction, and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim.

CONCLUSIONS OF LAW

1. The criteria for an initial 30 percent rating for bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.20, 4.27, 4.71a, Diagnostic Codes 5299-5269, 5276.

2. The criteria for an initial compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.104, Diagnostic Code 7101.

3. The criteria for service connection for erectile dysfunction, to include as secondary to service connected PTSD, persistent depressive disorder, insomnia disorder and alcohol use disorder in early remission, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 2001 to November 2019.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2021 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The rating decision constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In August 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of August 2020 (erectile dysfunction) and July 2021 (bilateral feet and hypertension) decisions. In September 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior August 2020 and July 2021 decisions. Therefore, the Board may only consider the evidence of record at the time of the August 2020 and July 2021 decisions.

In the September 2022 Form 10182, Decision Review Request: Board Appeal, that is on appeal the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the September 2022 VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the
the Board may only consider the evidence of record at the time of the August 2020 and July 2021 decisions.

In the September 2022 Form 10182, Decision Review Request: Board Appeal, that is on appeal the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the September 2022 VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). In this case, a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2) as it is more than one year from the date that the AOJ mailed notice of the decision on appeal, and it is more than 60 days of the date that the Board received the September 2022 VA Form 10182. Therefore, the Board shall proceed with adjudication.

Increased Rating Criteria

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3.

Separate evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). VA's determination of the present level of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased-rating claim has been pending. Hart v. Nicholson, 21 Vet. App. 505, 509 (2007).

The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall
Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.").]

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims.

Additionally, the Board has considered whether an inferred claim for a total disability based upon individual unemployability (TDIU) has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). A June 2022 rating decision awarded a TDIU based on the effects of his service connected posttraumatic stress disorder (PTSD), effective July 10, 2020. The Veteran has not alleged, and the record does not establish, that the Veteran was unable to secure and follow substantially gainful employment due to his bilateral plantar fasciitis and hypertension. As such, the Board finds that a claim for a TDIU is not raised in connection with the instant appeals. See Rice v. Shinseki, supra.

VA's duty to maximize benefits requires it to assess all of a claimant's service connected disabilities to determine whether any combination of the disabilities establishes eligibility for special monthly compensation under 38 U.S.C. § 1114(s). See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). In Bradley, the Court held that 38 U.S.C. § 1114(s) permits a TDIU rating based on a single disability to satisfy the statutory requirement of a "total" rating. When a veteran is awarded TDIU based on a single disability and receives schedular disability ratings for other conditions, special monthly compensation based on the statutory housebound criteria may be awarded so long as the same disability is not counted twice, i.e., as a basis for TDIU and as a separate disability rated 60 percent or more disabling. See 75 Fed. Reg. 11,229, 11,230; Summary of Precedent Opinions of the
. App. 280, 294 (2008). In Bradley, the Court held that 38 U.S.C. § 1114(s) permits a TDIU rating based on a single disability to satisfy the statutory requirement of a "total" rating. When a veteran is awarded TDIU based on a single disability and receives schedular disability ratings for other conditions, special monthly compensation based on the statutory housebound criteria may be awarded so long as the same disability is not counted twice, i.e., as a basis for TDIU and as a separate disability rated 60 percent or more disabling. See 75 Fed. Reg. 11,229, 11,230; Summary of Precedent Opinions of the VA General Counsel (March 10, 2010) (withdrawing VAOPGCPREC 6-1999 in light of Bradley, 22 Vet. App. at 280).

A veteran with a 100 percent schedular rating for a single service-connected disability could also obtain a TDIU on a single separate disability (though not on multiple service-connected disabilities), in order to meet the special monthly compensation requirements (100 percent rating plus 60 percent rating). A TDIU could meet the special monthly compensation requirements by either: a) increasing a single disability rating of less than 60 percent to at least 60 percent (in a case where a separate 100 percent rating is already established), or b) increasing a single disability that is less than 100 percent to a "total" (100 percent) rating, in a case where there is already established a combination of other ratings that meet the separate 60 percent rating requirement for special monthly compensation. See Buie at 249-50. The Veteran is already in receipt of the special monthly compensation under 38 U.S.C. § 1114(s) beginning on April 22, 2021. Therefore, special monthly compensation under 38 U.S.C. § 1114(s) for statutory housebound benefits is not warranted.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (2021).

1. Entitlement to an initial 30 percent rating for bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals is granted.

The Veteran contends that a rating in excess of 10 percent is warranted for his bilateral plantar fasciitis. He provides no specific argument in support of his appeal. See September 2022 VA Form 10182.

The Veteran's bilateral plantar fasciitis has been rated as 10 percent disabling under Diagnostic Codes 5299-5276 and was recharacterized as under Diagnostic Code 5299-5269 in July 2021. 38 C.F.R. § 4.27 provides that unlisted disabilities requiring rating by analogy will be coded with the first two numbers of the schedule provisions for the most closely related body part and "99." 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 evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.20.

During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020).

Under Diagnostic Code 5276, a 10 percent rating is warranted for flatfoot, acquired, moderate; weight-bearing line over or medial to the great toe, inward bowing of the tendo-Achilles, pain on manipulation and use of the feet, bilateral or unilateral. A 30 percent rating is assigned respectively for severe bilateral acquired flatfoot, with objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities (a 20 percent rating is warranted when these symptoms are unilateral). A 50 percent rating is assigned for pronounced bilateral acquired flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achillis on manipulation, not improved by orthopedic shoes or appliances (a 30 percent rating is warranted when these symptoms are unilateral). This Diagnostic Code was unchanged in the revisions to the rating schedule.

Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "pronounced"
is assigned respectively for severe bilateral acquired flatfoot, with objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities (a 20 percent rating is warranted when these symptoms are unilateral). A 50 percent rating is assigned for pronounced bilateral acquired flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achillis on manipulation, not improved by orthopedic shoes or appliances (a 30 percent rating is warranted when these symptoms are unilateral). This Diagnostic Code was unchanged in the revisions to the rating schedule.

Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "pronounced" or "marked". Use of such terminology by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

"Marked," as an adjective, is defined as "having a distinctive or emphasized character." Marked, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/severe, Definition 2 (last visited Nov. 15, 2023).

"Pronounced," as an adjective, is defined as "very noticeable." Pronounced, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/pronounced, (last visited Nov. 15, 2023).

Under Diagnostic Code 5269, effective February 7, 2021, a 10 percent rating is warranted for unilateral or bilateral plantar fasciitis. A 20 percent rating is warranted for unilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. A 30 percent rating is warranted for bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. Note 1 provides that 40 percent rating is warranted for plantar fasciitis with actual loss of use of the foot. Note 2 states that if the veteran has been recommended for surgical intervention, but is not a surgical candidate, then the veteran's plantar fasciitis shall be evaluated under the 20 percent or 30 percent criteria, whichever is applicable. 38 C.F.R. § 4.71a, Code 5269.

During the pendency of this appeal, VA issued revised schedular criteria for rating musculoskeletal disabilities, including some of the diagnostic codes for rating shoulder disabilities under 38 C.F.R. § 4.71a, which became effective February 7, 2021. However, consideration under the revised schedular criteria should not be undertaken before such criteria became effective. The effective date rule contained in 38 U.S.C. § 5110(g) prevents the application of a later, liberalizing law to a claim prior to the effective date of the liberalizing law. That is, for any date prior to February 7, 2021, neither the AOJ nor the Board could apply the revised rating schedule.

Where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the Veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. As such, VA must consider the claims pursuant to the former and revised regulations during the course of this appeal. See VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997).

The Veteran underwent a VA examination in April 2019. The examiner noted the Veteran had pain in bilateral feet, pain accentuated on use, no swelling or characteristic callouses. The Veteran uses arch supports bilaterally; no tenderness of plantar surfaces; no decreased longitudinal arch height of the feet; no objective evidence of marked deformity; no marked pronation; no weight-bearing line fall over or medial to the great toe; no extremity deformity; no inward bowing of the Achilles tendon; no marked inward displacement and severe spasm of the Achilles tendon on manipulation. The Veteran reports pain to the feet only during use. No functional loss of either extremity attributable to claimed conditions. There is no pain, weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the foot is used repeatedly over a period of time. No other functional loss during flare-ups or when the foot is used repeatedly over a period of time. There was no tenderness to palpation, joint effusion, deformity, swelling, warmth, malalignment, weakness, abnormal motion, guarding, laxity, joint prostheses, or instability in the joints examined. Bilateral X-ray shows no fracture, dislocation or aggressive bone lesion. There is minimal degenerative changes at the interphalangeal joint of the great toe. There is no focal soft tissue abnormality. No joint effusion.

During August 2020 VA examination, plantar fasciitis and degenerative arthritis was diagnosed. The Veteran reported numbness to lateral side of right foot with tingling. Sharp pain anterior portion of bilateral heels with walking, does not radiate. The Veteran feels pain in his feet in the morning when he wakes up and is aggravated when bearing weight on his feet for too long. He is unable to bear weight on feet without supportive shoes. Current treatment includes custom inserts, night splints, over the counter Ibuprofen, frozen water bottle every morning, stretching daily. He reports functional impairment in that he avoids prolonged walking and standing, running, sports, playing with his kids, and taking them for walks or to the park. Physical examination revealed pain on use of the feet; pain on manipulation of the feet; pain accentuated on manipulation; swelling on use; right foot characteristic calluses; the Veteran uses arch supports. The Veteran wears arch support inserts because of bilateral plantar fasciitis, not his arthritis or previous sesamoid fracture of right foot that is now healed. Pain on weight-bearing; pain on nonweight-bearing, swelling, interference with standing, lack of endurance. He has constant use of arch support inserts. The examiner noted that due to degenerative changes in bilateral feet and plantar fasciitis, the Veteran has difficulty keeping up with kids to take care of them, cannot do chores that require him to be on his feet for long periods of time, cannot play with the kids, has to sit often. The Veteran avoids prolonged walking or standing, running, sports, taking kids for walks or to the park. The Veteran is unaffected by healed sesamoid fracture of right foot.

Further review of the record shows that the Veteran receives VA treatment providers for various disabilities, to include his bilateral plantar fasciitis. However, there is no indication from the treatment notes of record that the Veteran has reported bilateral pes planus symptoms that are worse nor are manifestly different than those reported at above-mentioned VA examinations.

2. Based on the foregoing, the Board finds that a 30 percent rating for bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals is warranted. In this regard, a higher rating requires severe, objective evidence of marked deformity, pain on manipulation, use accentuated, indication of swelling on use, characteristic callouses, pronounced, marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement or severe spasm of the tendo-Achilles on manipulation, was not improved by orthopedic shoes or appliances or performed surgical treatment or recommended surgical treatment. Here, the record reflects that the Veteran had pain on use of the feet bilaterally, pain on manipulation of the feet bilaterally, indication of swelling on use bilaterally and characteristic calluses on the right side as found in the August 2020 examination. Such warrants a 30 percent rating throughout the appeal period.. A rating in excess of 30 percent is not warranted as the record does not reflect, and the Veteran has not alleged, marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation and was not improved by orthopedic shoes or appliances. The April
opedic shoes or appliances or performed surgical treatment or recommended surgical treatment. Here, the record reflects that the Veteran had pain on use of the feet bilaterally, pain on manipulation of the feet bilaterally, indication of swelling on use bilaterally and characteristic calluses on the right side as found in the August 2020 examination. Such warrants a 30 percent rating throughout the appeal period.. A rating in excess of 30 percent is not warranted as the record does not reflect, and the Veteran has not alleged, marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation and was not improved by orthopedic shoes or appliances. The April 2019 and October 2020 VA examinations found that the Veteran did not have extreme tenderness of the plantar surfaces on one or both feet or marked inward displacement and severe spasm of the Achilles' tendon on manipulation of one or both feet. The Veteran reported using arch supports with both sides relieved in the April 2019 October 2020 VA examinations. Therefore, a rating in excess of 30 percent is not warranted for the Veteran's bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals.

The Board has considered whether Diagnostic Code 5284 (for other foot injuries) is applicable to this case. With respect to Diagnostic Code 5284, which pertains to other foot injuries, the Court has held that when a condition is specifically listed in the rating schedule, it may not be rated by analogy. See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015); see also Suttmann v. Brown, 5 Vet. App. 127, 134 (1993) (providing that "[a]n analogous rating... may be assigned only where the service-connected condition is 'unlisted.'"). In Copeland, the Court explicitly rejected the appellant's argument that to rate his disability under Diagnostic Code 5284 for other foot injuries would not be rating by analogy. Rather, the Court held that to do so would ignore the plain meaning of the term "other," and would make the remaining foot-related Diagnostic Codes redundant. As the Veteran's bilateral plantar fasciitis is specifically listed in the rating schedule under Diagnostic Code 5276, Diagnostic Code 5284 is inapplicable and higher or separate ratings are not warranted under such criteria.

The Board has considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and DeLuca v. Brown, 8 Vet. App. 202 (1995) but finds that increased rating is not warranted during the period on appeal on the basis of functional loss due to pain in this case, as those symptoms are already contemplated by the assigned ratings. To the extent the Veteran has otherwise reported experiencing flare-ups, the basis for the current ratings includes the pain and impairment experienced during those flare-ups.

The Board has also considered whether a separate or higher rating for the Veteran's bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals is warranted under various other diagnostic codes. See Schafrath v. Derwinski, supra. The record does not support, and the Veteran has not alleged, weak foot, claw foot, anterior metatarsalgia, hallux valgus, hallux rigidus, hammer toe or malunion of the tarsal or metatarsal bones. Therefore, a higher or separate rating under Diagnostic Codes 5277, 5278, 5279, 5280, 5281, 5283 or 5283 is not warranted.

In assessing the severity of the Veteran's bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals, the Board has given due consideration to the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings involve medical findings that are within the province and purview of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the Veteran's lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher ratings pursuant to any applicable criteria at any point pertinent to the appeals. While the Veteran is competent to report
See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings involve medical findings that are within the province and purview of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the Veteran's lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher ratings pursuant to any applicable criteria at any point pertinent to the appeals. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his pes planus and/or plantar fasciitis with degenerative arthritis according to the appropriate diagnostic codes. Layno v. Brown, supra.

The Board has also considered whether a staged rating under Fenderson v. West, supra, is appropriate for the Veteran's service connected bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals; however, the Board finds that his symptomatology referable to such disabilities have been stable throughout each period on appeal. The Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the higher rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017).

Accordingly, the Board finds that a 30 percent rating for bilateral plantar fasciitis with degenerative changes at the interphalangeal joint of the great toe and sesamoid fracture right foot residuals is warranted. To that extent, the appeal is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

3. Entitlement to an initial compensable rating for hypertension is denied.

The Veteran generally seeks an initial higher compensable rating for his hypertension. See September 2022 VA Form 10182. He provides no specific argument in support of this appeal.

Under Diagnostic Code 7101, a 10 percent rating is assigned for hypertension with diastolic pressure (bottom number) predominantly 100 or more, or systolic pressure (top number) predominantly 160 or more. A 10 percent rating also is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is assigned for hypertension with diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent rating is assigned for hypertension with diastolic pressure predominantly 120 or more. The maximum 60 percent rating is assigned for hypertension with diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104.

There are three notes to 38 C.F.R. § 4.104, Diagnostic Code 7101. Note (1) provides that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure (i.e., bottom number) is predominantly 90 mm or greater, and isolated systolic hypertension means the systolic blood pressure (i.e., top number) is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. Note (2) requires the evaluation of hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation. Note (3) states that hypertension should be evaluated separately from hypertensive heart disease and other types of heart disease.

The Board notes that the use of medications is explicitly contemplated in Diagnostic Code 7101 and that the Court has held that the Board did not err in failing to discount the ameliorative effects of blood pressure medication as the plain language of Diagnostic Code 7101 contemplates the effects of medications. McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016).

Turning to the evidence, the Veteran was afforded an Integrated Disability Evaluation System (IDES) examination in April 2019. At that time, the Veteran's treatment plan did not include taking continuous medication for hypertension. His blood pressure readings taken on that day were as follows: 145/103; 130/98; 124/88; a second round revealed 142/99; 138/
7101 and that the Court has held that the Board did not err in failing to discount the ameliorative effects of blood pressure medication as the plain language of Diagnostic Code 7101 contemplates the effects of medications. McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016).

Turning to the evidence, the Veteran was afforded an Integrated Disability Evaluation System (IDES) examination in April 2019. At that time, the Veteran's treatment plan did not include taking continuous medication for hypertension. His blood pressure readings taken on that day were as follows: 145/103; 130/98; 124/88; a second round revealed 142/99; 138/100; 122/90. The Veteran did not have a history of a diastolic blood pressure elevation to predominantly 100 or more. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The VA examiner noted the Veteran's hypertension did not impact his ability to work.

An August 2020 VA examination report documents the Veteran was not on continuous medication for hypertension. Blood pressure readings taken that day revealed: 138/84; 140/90; 140/88. No other pertinent findings were shown.

A June 2021 VA examination report documents the Veteran was not on continuous medication for hypertension. Blood pressure readings taken that day revealed: 142/82; 140/80; 144/80.

Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported hypertension symptoms, to include blood pressure readings, that are worse than those noted above.

Based on the foregoing, the Board finds that an initial compensable rating for the Veteran's hypertension is not warranted. In this regard, the Board notes that diastolic pressure has never been shown to be 100 or more, or systolic pressure that was predominantly 160 or more. In addition, the Veteran's hypertension has not required continuous medication. As noted, evidence shows diastolic pressures to be consistently less than 100 and systolic pressures to be consistently less than 160. Therefore, an initial compensable rating for hypertension is not warranted.

The Board acknowledges the Veteran's assertions that his hypertension is more severe than evaluated. The Veteran is competent to report his symptoms. See e.g., Layno v. Brown, supra and Grottveit v. Brown, supra. The Board finds, however, that the statements of the Veteran and clinical evidence demonstrates that the criteria for a compensable rating have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his hypertension. However, these records do not address the specific rating criteria necessary to substantiate a higher rating. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, supra. As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal.

The Board also observes that the Veteran, while competent to report his observable symptoms, he is not competent to report that his hypertension is of sufficient severity to warrant a higher rating under VA's tables for rating such disabilities because such an opinion requires medical expertise which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (2007). Even after considering any contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher rating are not met. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007).

Consideration has been given to assigning a staged rating. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson v. West, supra. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra.

Accordingly, the Board finds that a compensable rating for hypertension is not warranted. The appeal is denied. 38 U.S.C
impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007).

Accordingly, the Board finds that a compensable rating for hypertension is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

Service Connection Criteria

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may 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). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, supra. Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id. see also Davidson v. Shinseki, supra.

Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability").

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

4. Entitlement to service connection for erectile dysfunction
7), the Court held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

4. Entitlement to service connection for erectile dysfunction as secondary to PTSD, persistent depressive disorder, insomnia disorder and alcohol use disorder in early remission is denied.

The Veteran contends that he has erectile dysfunction that is secondary to a service connected PTSD. See June 2020 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ). A September 2021 rating decision made favorable findings that new and relevant evidence had been received to reconsider the claim, that the claimed primary disability is service connected and that the evidence shows that a qualifying event, injury or disease had its onset in service as the Veteran reported erectile dysfunction on the April 2019 pre-discharge examination report; the Board is bound by these favorable findings.

The pertinent evidence consists of an April 2019 IDES VA examination. The Veteran reported that he has erectile dysfunction. Physical examination reveals normal penis, testes, and epididymis. The examiner noted that examination showed no evidence of epididymitis, no edema, no redness, no pain on palpation of scrotal region, no penile discharge, no evidence of warts, sores, or open wounds. The examiner indicated that although the Veteran is claiming erectile dysfunction, there is lack of supportive clinical evidence to warrant a diagnosis. The symptoms given associated with claimed condition and notated in the history portion of this record it is more likely than not, the Veteran does not have erectile dysfunction with no visits with his medical provider or ancillary services associated with this claim and no evidence of losing workdays in the past year associated with this claim. The examiner noted that the Veteran states he is able to start and complete sexual intercourse without medication and the IDES examination was unremarkable and there is no evidence of specific pathology, which may contribute the onset of erectile dysfunction.

As the record does not reflect a current diagnosis of erectile dysfunction, the cornerstone element of service connection has not been met, and service connection is not warranted. Brammer v. Derwinski, supra. Pertinent evidence does not indicate the Veteran complained of, or was treated for, erectile dysfunction nor does it document diagnosis of erectile dysfunction. The Board acknowledges the Court's holding in Saunders but does not find a basis for determining that there is erectile dysfunction that results in functional impairment. See Saunders v. Wilkie, supra. In addition, the record does not reflect, and the Veteran did not allege, that he suffered from impairment of earning capacity due to his erectile dysfunction that is of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020).

The Board notes that the Veteran is competent to report his own symptoms or matters within his personal knowledge. See Jandreau v. Nicholson, supra. In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, supra. The matter, however; of a medical diagnosis for a disability not capable of lay observation, such as that of erectile dysfunction, is a matter within the province of trained medical professionals. See Jones v. Brown, supra. In the instant case, there is no suggestion that the Veteran has developed an expertise in the diagnosis of erectile dysfunction. Therefore, as they do not have the appropriate medical training and expertise to competently diagnose erectile dysfunction, the lay assertions in this regard have no probative value. Jandreau v. Nicholson, supra; see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).

The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1110. Thus, where, as here, the probative evidence indicates that the Veteran does not have current diagnosis of erectile dysfunction for the entire appeal period, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, supra.

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Jandreau v. Nicholson, supra; see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).

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In summary, the controlling question in this case is answered in the negative. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, supra. Therefore, as the evidence of record shows that the Veteran does not have current diagnoses of erectile dysfunction, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection).

In light of the foregoing, the Board finds that service connection for erectile dysfunction as secondary to service connected PTSD, persistent depressive disorder, insomnia disorder and alcohol use disorder in early remission is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. McPhaull, 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.

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