BILATERAL FOOT DISABILITY, INCLUDING PLANTAR FASCIITIS

LUKE PELICAN · 2026 · Case ID: A26005954

MIXED

Summary

The veteran, who served in the Army and Navy from January 1975 to July 1994, appeals the denial of service connection for a bilateral foot disability, including plantar fasciitis, and a cervical spine disability. The Board found that the veteran's claims for bilateral ankle, knee, wrist, elbow, and shoulder strains were granted on a direct basis, attributing them to in-service injuries from parachuting, physical training, and other duties. The Board found the private medical opinion from Dr. N.P.D. highly probative, linking these strains to the arduous tasks of service and citing medical literature. Unfavorable VA opinions were discounted for failing to adequately address the veteran's lay statements and in-service events. The Board also granted service connection for the ankle and knee strains on a secondary basis to the veteran's already service-connected lumbar spine disability, finding the private opinion persuasive in establishing this causal link. However, the claim for cervical spine disability was denied, as the Board found the VA medical opinion persuasive, concluding the current degenerative changes were more consistent with post-service activities and not likely related to service, despite the veteran's lay assertions. The Board remanded claims for bilateral foot disability, higher ratings for lumbar spine disability, lumbar radiculopathy, and GERD due to AOJ errors in evidence consideration and inadequate VA examinations regarding secondary causation and medication effects.

Service Branch

ARMY/NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250127-513486

Full Decision Text

Citation Nr: A26005954
Decision Date: 01/22/26 Archive Date: 01/22/26

DOCKET NO. 250127-513486
DATE: January 22, 2026

ORDER

Readjudication of the claim of entitlement to service connection for a bilateral foot disability, to include plantar fasciitis, and to include as secondary to service-connected degenerative disc disease, other than intervertebral disc syndrome, with degenerative arthritis and spinal stenosis ("lumbar spine disability"), is warranted.

Entitlement to service connection for left ankle strain, as secondary to the service-connected lumbar spine disability, is granted.

Entitlement to service connection for right ankle strain, as secondary to the service-connected lumbar spine disability, is granted.

Entitlement to service connection for left knee strain, as secondary to the service-connected lumbar spine disability, is granted.

Entitlement to service connection for right knee strain, as secondary to the service-connected lumbar spine disability, is granted.

Entitlement to service connection for left wrist strain is granted.

Entitlement to service connection for right wrist strain is granted.

Entitlement to service connection for left elbow strain is granted.

Entitlement to service connection for right elbow strain is granted.

Entitlement to service connection for left shoulder strain is granted.

Entitlement to service connection for right shoulder strain is granted.

Entitlement to service connection for a cervical spine (neck) disability, to include degenerative arthritis and spinal stenosis, is denied.

REMANDED

Entitlement to service connection for a bilateral foot disability, to include plantar fasciitis, and to include as secondary to the service-connected lumbar spine disability, is remanded.

Entitlement to a rating above 20 percent for the service-connected lumbar spine disability is remanded.

Entitlement to a rating above 10 percent for right lower extremity lumbar radiculopathy, sciatic nerve, is remanded.

Entitlement to a rating above 10 percent for gastroesophageal reflux disease (GERD) is remanded.

FINDINGS OF FACT

1. The Department of Veterans Affairs (VA) received new and relevant evidence in support of the appellant's supplemental claim of entitlement to service connection for a bilateral foot disability, to include plantar fasciitis.

2. The appellant's left ankle strain was caused by his service-connected lumbar spine disability.

3. The appellant's right ankle strain was caused by his service-connected lumbar spine disability.

4. The appellant's left knee strain was caused by his service-connected lumbar spine disability.

5. The appellant's right knee strain was caused by his service-connected lumbar spine disability.

6. The appellant's left wrist strain was caused by service.

7. The appellant's right wrist strain was caused by service.

8. The appellant's left elbow strain was caused by service.

9. The appellant's right elbow strain was caused by service.

10. The appellant's left shoulder strain was caused by service.

11. The appellant's right shoulder strain was caused by service.

12. The appellant's cervical spine disability was not incurred in or caused by service, and it did not manifest within one year after separation.

CONCLUSIONS OF LAW

1. The criteria for readjudication of the claim of entitlement to service connection for a bilateral foot disability, to include plantar fasciitis, are met. 38 U.S.C. §§ 5104C, 5108; 38 C.F.R. §§ 3.156, 3.2500, 3.2501.

2. The criteria for entitlement to service connection for left ankle strain, as secondary to the service-connected lumbar spine disability, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for entitlement to service connection for right ankle strain, as secondary to the service-connected lumbar spine disability, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for entitlement to service connection for left knee strain, as secondary to the service-connected lumbar spine disability, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for entitlement to service connection for right knee strain, as secondary to the service-connected lumbar spine disability, are met. 38 U.S.C. §§ 1110, 1131, 510
. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

6. The criteria for entitlement to service connection for left wrist strain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

7. The criteria for entitlement to service connection for right wrist strain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

8. The criteria for entitlement to service connection for left elbow strain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

9. The criteria for entitlement to service connection for right elbow strain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

10. The criteria for entitlement to service connection for left shoulder strain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

11. The criteria for entitlement to service connection for right shoulder strain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

12. The criteria for entitlement to service connection for a cervical spine disability, to include degenerative arthritis and spinal stenosis, are not met. 38 U.S.C. §§ 1110, 112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant served on active duty in the Army from January 1975 to November 1984, and in the Navy from November 1984 to July 1994. He is the recipient of the Air Medal, Parachute Badge and the Army Aviator Badge, among others.

Procedural History

These matters come before the Board of Veterans' Appeals (Board) on appeal from (1) an April 2024 higher-level review (HLR) of December 2023 and April 2024 rating decisions, and (2) a December 2024 HLR of the April 2024 rating decision, all of which were issued by VA's Veterans Benefits Administration, the agency of original jurisdiction (AOJ). VA timely received the appellant's January 2025 notice of disagreement (NOD), via VA Form 10182, for the April 2024 and December 2024 HLR decisions. The appellant selected the Board's Direct Review docket.

Recharacterization of Issues on Appeal

The AOJ characterized the appellant's claims, in part, as entitlement to service connection for (1) bilateral plantar fasciitis and (2) a cervical condition with pain. However, pursuant to Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Board has recharacterized these claims as entitlement to service connection for (1) bilateral foot disability, to include plantar fasciitis, and (2) a cervical spine disability, to include degenerative arthritis and spinal stenosis, respectively. In Clemons v. Shinseki, the United States Court of Appeals for Veterans Claims (CAVC) held that, in determining the scope of a claim, the Board must consider the claimant's description of the claim, symptoms described, and the information submitted or developed in support
plantar fasciitis and (2) a cervical condition with pain. However, pursuant to Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Board has recharacterized these claims as entitlement to service connection for (1) bilateral foot disability, to include plantar fasciitis, and (2) a cervical spine disability, to include degenerative arthritis and spinal stenosis, respectively. In Clemons v. Shinseki, the United States Court of Appeals for Veterans Claims (CAVC) held that, in determining the scope of a claim, the Board must consider the claimant's description of the claim, symptoms described, and the information submitted or developed in support of the claim. Id. at 5. Accordingly, the Board has classified the issues as listed above to account for the totality of the appellant's associated symptoms.

Applicable Evidence Window

As the appellant has selected the Direct Review docket, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issues on appeal. See 38 C.F.R. §§ 20.300(a), 301. The Board will not consider evidence received after the AOJ decision unless the claimant files a timely request for a Board hearing or an opportunity to submit additional evidence on the NOD (VA Form 10182). 38 C.F.R. § 20.301. The appellant has not filed such a request.

If additional evidence was submitted after the AOJ decision, the Board will not consider it. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. See also Cook v. McDonough, 36 Vet. App. 175 (2023).

However, the Board is remanding the claims of entitlement to service connection for a bilateral foot disability, entitlement to a rating above 20 percent for a lumbar spine disability, entitlement to rating above 10 percent for right lower extremity lumbar radiculopathy, sciatic nerve, and entitlement to a rating above 10 percent for GERD. As those claims are remanded herein, any evidence the Board could not consider will be considered by the AOJ on remand. 38 C.F.R. § 3.103(c)(2)(ii).

1. Readjudication of the claim of entitlement to service connection for a bilateral foot disability is warranted.

First, the appellant requests readjudication of his previously denied claim of entitlement to service connection for a bilateral foot disability, to include plantar fasciitis. He attributes this disability to various in-service injuries, including from parachute landings and physical training. He has also presented medical evidence suggesting that his foot problems may be related to his service-connected lumbar spine disability.

Applicable Law

Under the Appeals Modernization Act (AMA), when a claim has been previously disallowed, it may not be readjudicated upon the same factual basis, unless the claimant submits a supplemental claim along with new and relevant evidence. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. §§ 3.156(d), 3.2501. New evidence is evidence that was "not previously part of the actual record before agency adjudicators." 38 C.F.R. § 3.2501. Relevant evidence is evidence that "tends to prove or disprove a matter at issue in a claim" and includes evidence that raises a theory of entitlement that was not previously addressed. Id.

Analysis

The AOJ originally denied entitlement to service connection for a bilateral foot disability in a September 2022 rating decision. There, the AOJ favorably found that the appellant had been diagnosed with plantar fasciitis. However, the AOJ denied the claim because the evidence at the time "[did] not show an event, disease or injury in service." Rating Decision, September 3, 2022.

In August 2023, the appellant submitted a supplemental claim for the foot disability, along with a written statement about his in-service injuries. See VA Form 20-0995, Decision Review Request: Supplemental Claim, August 4, 2023. In the statement, he indicated that his current foot problems are related to hard ground landings from parachute jumps, wearing poor, military-issue footwear, and "constant" running and walking during service. He stated that "[walking] long distances
had been diagnosed with plantar fasciitis. However, the AOJ denied the claim because the evidence at the time "[did] not show an event, disease or injury in service." Rating Decision, September 3, 2022.

In August 2023, the appellant submitted a supplemental claim for the foot disability, along with a written statement about his in-service injuries. See VA Form 20-0995, Decision Review Request: Supplemental Claim, August 4, 2023. In the statement, he indicated that his current foot problems are related to hard ground landings from parachute jumps, wearing poor, military-issue footwear, and "constant" running and walking during service. He stated that "[walking] long distances in the field with full gear over rough terrain" and long runs would make his feet hurt. See VA Form 21-4138, Statement in Support of Claim, May 10, 2023.

Additionally, the appellant submitted a private medical report from "Dr. N.P.D." with the August 2023 supplemental claim. Although Dr. N.P.D. did not express a specific medical opinion on the nature and etiology of the claimed foot disability, Dr. N.P.D. indicated that the appellant's now-service-connected lumbar spine disability "has caused imbalanced stress on joints to support the body's movements," including the midfoot joints. See Private Medical Evaluation Report, Dr. N.P.D., M.D., June 16, 2023.

The April 2024 rating decision continued the previous denial of entitlement to service connection for a bilateral foot disability "because the evidence submitted is not new and relevant." Rating Decision, April 4, 2024. In the April 2024 HLR decision on appeal, the AOJ likewise found that the evidence submitted in support of the supplemental claim was not relevant "because it does not prove or disprove a matter at issue[.]" Id., April 19, 2024.

The Board finds that the appellant submitted new and relevant evidence in support of his supplemental claim for a bilateral foot disability. The May 2023 lay statement, which was not before the AOJ at the time of the original denial, tends to prove a matter at issue-i.e., that the appellant injured his feet during service. The June 2023 private medical report was not before the AOJ at the time of the original denial either. The private medical report reasonably raises a theory of entitlement that was not previously addressed: service connection on a secondary basis, i.e., as secondary to the service-connected lumbar spine disability. Accordingly, the evidence is new and relevant, and readjudication is warranted. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. §§ 3.156(d), 3.2501.

Service Connection

Next, the appellant maintains he is entitled to service connection for disabilities of his ankles, knees, wrists, elbows, shoulders, and cervical spine (neck).

Applicable Law

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). The United States Court of Appeals for the Federal Circuit clarified the standard for secondary service connection in Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023), finding that secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Id. Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364.

Certain chronic diseases, including arthritis, may be presumed to
.R. § 3.310(a)-(b). The United States Court of Appeals for the Federal Circuit clarified the standard for secondary service connection in Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023), finding that secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Id. Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364.

Certain chronic diseases, including arthritis, may be presumed to have been incurred or aggravated during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). To establish service connection on this basis, there must be evidence of a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307), and subsequent manifestations of the same chronic disease; or if the fact of chronicity in service is not adequately supported, by evidence of continuity of symptomatology after service. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Under 38 U.S.C. § 1154, consideration is to be accorded the time, place, and circumstances of service. Where an appellant is seeking service connection for any disability, due consideration shall be given to the places, types, and circumstances of such service as shown by the appellant's service record, the official history of each organization in which the appellant served, medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154 (a)(1). In this regard, the Board observes the appellant's personnel records indicate he served five years and five months as an infantryman during which time he was awarded the parachute badge, and three years and ten months as a TOW Cobra pilot and scout pilot. The analysis that follows has taken these records into account.

2. Entitlement to service connection for bilateral ankle strain and bilateral knee strain, as secondary to service-connected lumbar spine disability, is granted.

The appellant submitted medical evidence that his service-connected lumbar spine disability caused his current ankle and knee problems. The Board finds that he is entitled to service connection on a secondary basis.

The most probative evidence of record comes from Dr. N.P.D.'s June 2023 private medical report. Dr. N.P.D. opined that the appellant's current bilateral ankle strain is likely due, in part, to his persistent lumbar pain. Dr. N.P.D. cited medical literature on the relationship between podiatrical deviations and chronic low back pain as support for this opinion. According to Dr. N.P.D., studies have shown that pelvic tilt can affect an individual's gait, producing instability and strain. See Private Medical Evaluation Report, Dr. N.P.D., M.D., June 16, 2023.

Similarly, Dr. N.P.D. opined that the appellant's current bilateral knee strain is likely due, in part, to his degenerative disc disease of the spine. Citing medical literature on the relationship between knee and low back pain, Dr. N.P.D. explained that that the appellant's low back pain "has caused imbalanced stress on joints to support the body's movements," including the knees. Dr. N.P.D. pointed out that this increased stress can lead to accelerated degeneration of those joints or exacerbation of a preexisting condition. Id.

The Board finds Dr. N.P.D.'s opinions highly probative, as they contain "factually accurate, fully articulated, sound reasoning" for the conclusion that the appellant's current ankle and knee problems are likely related to his service-connected lumbar spine disability. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). These opinions are based on Dr. N.P.D.'s review of the claims file, including the appellant's medical records, as well as relevant medical literature.

The record also contains unfavorable VA medical opinions for the appellant's current ankle and knee disabilities. However, these opinions do not contradict Dr. N.P.D.'s conclusions with respect to secondary service connection, as the VA opinions only address "direct" service connection. See VA Medical Opinions, April 2, 2024, & August 16, 2022. The VA medical opinions do not address whether, but for the appellant's service-connected lumbar spine disabilities, he would not have the current ankle
22 Vet. App. 295, 304 (2008). These opinions are based on Dr. N.P.D.'s review of the claims file, including the appellant's medical records, as well as relevant medical literature.

The record also contains unfavorable VA medical opinions for the appellant's current ankle and knee disabilities. However, these opinions do not contradict Dr. N.P.D.'s conclusions with respect to secondary service connection, as the VA opinions only address "direct" service connection. See VA Medical Opinions, April 2, 2024, & August 16, 2022. The VA medical opinions do not address whether, but for the appellant's service-connected lumbar spine disabilities, he would not have the current ankle or knee disabilities. Nor do the VA medical opinions address whether the appellant's current ankle or knee disabilities would be less severe and result in less functional impairment but for his service-connected lumbar spine disabilities. Spicer, 61 F.4th at 1365.

Resolving any reasonable doubt in the appellant's favor, the Board therefore finds that his bilateral ankle strain and bilateral knee strain were caused by the service-connected lumbar spine disability. Lynch v. McDonough, 21 F.4th 776, 781-82 (2021). Entitlement to service connection is granted.

3. Entitlement to service connection for left wrist strain is granted.

The appellant attributes his left wrist disability to parachuting, physical training and other in-service injuries. See e.g., VA Form 21-4138, Statement in Support of Claim, May 10, 2023. The Board finds that he is entitled to service connection on a direct basis.

In June 2023, Dr. N.P.D. opined that the appellant's current bilateral wrist strain was likely due to the "arduous tasks and physical demands" of his service as a helicopter pilot and airborne infantryman, including parachute jumps. Dr. N.P.D. explained that the appellant's duties included lifting heavy equipment and machinery, he sustained "numerous" musculoskeletal injuries in service, and he did not have any wrist ailments before service. Dr. N.P.D. cited medical literature on parachuting injuries as support for this conclusion. See Private Medical Evaluation Report, Dr. N.P.D., M.D., June 16, 2023.

The Board finds Dr. N.P.D.'s opinion highly probative, as it contains "factually accurate, fully articulated, sound reasoning" for the conclusion that the appellant's left wrist disability is likely related to service. See Nieves-Rodriguez, 22 Vet. App. at 304. This opinion is based on Dr. N.P.D.'s review of the claims file, as well as relevant medical literature.

On the other hand, the record contains two unfavorable VA medical opinions. The August 2022 and April 2024 VA opinions both indicate that the appellant's current left wrist disability was not likely incurred in or caused by service. Both VA opinions contain similar, inadequate medical rationales. Essentially, the two VA clinicians relied on a lack of documentation of wrist complaints in the appellant's medical records to conclude that the current disability is more likely related to post-service occupational or recreational activities. See VA Medical Opinions, April 2, 2024, & August 16, 2022. However, the VA clinicians did not adequately address the appellant's reports about his in-service strains due to parachuting activities and physical training. See Miller v. Wilkie, 32 Vet. App. 249, 260 (2020) ("The examiner must address the veteran's lay statements to provide the Board with an adequate medical opinion."); Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (a medical opinion is inadequate if it does not consider a veteran's reports of symptoms and history). As such, the VA opinions carry limited probative weight compared to Dr. N.P.D.'s opinion.

Resolving any reasonable doubt in the appellant's favor, the Board finds that his left wrist strain was caused by service. Lynch, 21 F.4th at 781-82. Entitlement to service connection is granted.

4. Entitlement to service connection for right wrist strain is granted.

The appellant attributes his right wrist disability to parachuting, physical training and other in-service injuries as well. See e.g., VA Form 21-4138, Statement in Support of Claim, May 10, 2023. The Board finds that he is entitled to service connection on a direct basis.

As discussed above, Dr. N.P.D. linked the appellant's current bilateral wrist strain to the "arduous tasks and physical demands" of his service. The private opinion is highly probative because it contains "factually accurate, fully articulated, sound reasoning"
21 F.4th at 781-82. Entitlement to service connection is granted.

4. Entitlement to service connection for right wrist strain is granted.

As discussed above, Dr. N.P.D. linked the appellant's current bilateral wrist strain to the "arduous tasks and physical demands" of his service. The private opinion is highly probative because it contains "factually accurate, fully articulated, sound reasoning" for this conclusion, based on Dr. N.P.D.'s review of the claims file and relevant medical literature. See Nieves-Rodriguez, 22 Vet. App. at 304.

The record also contains an unfavorable August 2022 VA opinion, which indicates that the current right wrist disability was more likely incurred after service. See VA Medical Opinion, August 16, 2022. But again, the VA opinion is improperly based on lack of documentation of wrist complaints in the appellant's medical records. The VA clinician did not adequately address the appellant's reports about his in-service injuries noted above. Miller, 32 Vet. App. at 260; Dalton, 21 Vet. App. at 39. The VA opinion carries little probative weight.

Resolving any reasonable doubt in the appellant's favor, the Board finds that his right wrist strain was caused by service. Lynch, 21 F.4th at 781-82. Entitlement to service connection is granted.

5. Entitlement to service connection for bilateral elbow strain and bilateral shoulder strain is granted.

The appellant also attributes his elbow and shoulder disabilities to various in-service injuries, including from parachuting, physical training, and falling down in a classroom in the early 1990s. See e.g., VA Form 21-4138, Statement in Support of Claim, May 10, 2023. The Board finds that he is entitled to service connection on a direct basis.

In June 2023, Dr. N.P.D. opined that the appellant's current bilateral elbow strain was likely due to the "arduous tasks and physical demands" of his service as a helicopter pilot and airborne infantryman, including parachute jumps. Dr. N.P.D. explained that the appellant's duties included lifting heavy equipment and machinery, he sustained "numerous" musculoskeletal injuries in service, and he did not have any elbow ailments before service. Dr. N.P.D. also cited medical literature on parachuting injuries as support for this conclusion. See Private Medical Evaluation Report, Dr. N.P.D., M.D., June 16, 2023.

Similarly, Dr. N.P.D. opined that the appellant's current bilateral shoulder strain was likely due to the physical demands of service. Dr. N.P.D. explained that the appellant's shoulder pain reportedly started in or around 1991, when he tripped over some wires and dislocated his left shoulder. Dr. N.P.D. also explained that the appellant sustained other musculoskeletal injuries, including bilateral shoulder strains, as a helicopter pilot and airborne infantryman. Again, Dr. N.P.D. cited medical literature on parachuting injuries in support of his conclusions. Id.

The Board finds Dr. NP.D.'s opinions highly probative, as they contain "factually accurate, fully articulated, sound reasoning" for the conclusion that the appellant's elbow and shoulder disabilities are likely related to service. See Nieves-Rodriguez, 22 Vet. App. at 304. The opinions are based on the Dr. N.P.D.'s review of the claims file, as well as relevant medical literature.

On the other hand, the record contains unfavorable VA medical opinions for the appellant's current elbow and shoulder disabilities. The August 2022 VA opinions indicate that the current (1) bilateral elbow and (2) right shoulder disabilities were not likely incurred in or caused by service. The April 2024 VA opinion indicates the current left elbow disability was not likely incurred in or caused by service. See VA Medical Opinions, April 2, 2024, & August 16, 2022. But in each case, the VA clinicians improperly relied on a lack of medical documentation of elbow/shoulder complaints to conclude that the current disabilities are more likely related to post-service occupational or recreational activities. The VA clinicians did not adequately address the appellant's reports about his in-service duties, and thus, the opinions carry little probative weight. Miller, 32 Vet. App. at 260; Dalton, 21 Vet. App. at 39.

Meanwhile, the September 202
or caused by service. The April 2024 VA opinion indicates the current left elbow disability was not likely incurred in or caused by service. See VA Medical Opinions, April 2, 2024, & August 16, 2022. But in each case, the VA clinicians improperly relied on a lack of medical documentation of elbow/shoulder complaints to conclude that the current disabilities are more likely related to post-service occupational or recreational activities. The VA clinicians did not adequately address the appellant's reports about his in-service duties, and thus, the opinions carry little probative weight. Miller, 32 Vet. App. at 260; Dalton, 21 Vet. App. at 39.

Meanwhile, the September 2022 and April 2024 VA opinions indicate that the appellant's current left shoulder disability was not likely incurred in or caused by service. Here, the VA clinicians acknowledged that the appellant injured his left shoulder in 1991, as noted in his service treatment records. However, because there are no other complaints in the service treatment records after 1991, the VA clinicians concluded that the current disability was more likely due to a post-service injury. See VA Medical Opinions, April 2, 2024, & August 16, 2022. Again, though, the VA opinions are largely based on a lack of medical documentation. Unlike Dr. N.D.P., the VA clinicians did not adequately address the appellant's reports of ongoing left shoulder pain since the early 1990s. As a result, these VA opinions have limited probative value.

Accordingly, resolving any reasonable doubt in his favor, the Board finds that the appellant's bilateral elbow strain and bilateral shoulder strain were caused by service. Lynch, 21 F.4th at 781-82. Entitlement to service connection is granted.

4. Entitlement to service connection for a cervical spine disability is denied.

The appellant attributes his cervical spine disability to parachuting activities, daily physical training, and other demands of service. He asserts that he started having neck pain years after separation, either in 2000 or "around 2006." See VA Cervical Spine (Neck) Conditions Examination Report, March 29, 2024; VA Form 21-4138, Statement in Support of Claim, May 10, 2023.

After careful review, the Board finds that the appellant is not entitled to service connection for the cervical spine disability.

In this case, the AOJ favorably found that the appellant had been diagnosed with a disability: degenerative arthritis and spinal stenosis. Rating Decision, April 19, 2024. This favorable finding is binding on the Board. 38 C.F.R. § 3.104(c).

The most probative evidence of record persuasively shows that the appellant's current cervical spine disability is not the result of service. This evidence comes from the March 2024 VA examination. During the examination, the appellant reported that the onset of his current disability was in 2000. He reported ongoing symptoms of decreased range of motion and intermittent neck pain/cervicalgia since onset. He indicated that his duties as a paratrooper, "with 50+ jumps," and a helicopter pilot contributed to his disability. He denied receiving treatment for neck symptoms during service. VA Examination Report, supra.

After examining the appellant and reviewing the claims file, the VA clinician opined that the current cervical spine disability was not likely incurred in or caused by service. The VA clinician considered the appellant's reports about his duties during service. However, the VA clinician concluded that the current disability is more consistent with post-active duty occupational and recreational duties, based in part on imaging from 2022. The VA clinician explained that cervical spine degeneration caused by in-service injury 30-plus years ago "would more likely than not have resulted in a more progressed state of arthritis than that seen on [the] imaging in 2022." VA Medical Opinion, April 2, 2024; see also Private Imaging Report, T.I.P., Dr. M.M., March 8, 2022.

The Board finds the VA medical opinion highly probative, as it contains "factually accurate, fully articulated, sound reasoning" for the conclusion that the appellant's current neck problems are not likely related to service. See Nieves-Rodriguez, 22 Vet. App. at 304. Notably, the VA clinician adequately addressed the appellant's lay statements about his neck problems and provided a medical reason for rejecting the appellant's contention that his duties in service represented the onset of the currently diagnosed disability. See Miller, 32 Vet. App. at 260.

The VA medical opinion is not contradicted by any other competent evidence in the record. Dr. N.P.D.'s medical report does not
, 2022.

The VA medical opinion is not contradicted by any other competent evidence in the record. Dr. N.P.D.'s medical report does not address the appellant's neck problems, and the record contains no other favorable medical opinions about the etiology of the cervical spine disability. See Private Medical Evaluation Report, Dr. N.P.D., M.D., June 16, 2023. While the appellant believes the disability is related to service, he is not competent to provide an opinion about the etiology of his current diagnosis. The issue is medically complex, as it requires knowledge of anatomical relationships, pathology, and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the appellant to offer such an opinion because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

Moreover, the appellant is not entitled to service connection for arthritis on a presumptive basis, or based on continuity of symptomatology. The appellant has provided conflicting accounts about the onset of his current symptoms. According to his May 2023 statement, his neck pain "started around 2006," i.e., 12 years after separation from active service. VA Form 21-4138, supra. During the VA examination, though, he reported that the onset occurred in 2000, about six years after separation. VA Examination Report, supra. Either way, the appellant asserts that his symptoms started well after the one-year presumptive period for chronic diseases like arthritis. 38 C.F.R. §§ 3.307(a)(3). He does not assert, and the other evidence does not demonstrate, that he has experienced the same symptoms since service (or since the one-year presumptive period). See Walker, 708 F.3d at 1340.

In sum, the evidence is persuasively against finding that the appellant's cervical spine disability was incurred in or caused by service, or that it manifested within one year after separation. Thus, the benefit-of-the-doubt rule is not applicable in this instance. Lynch, 21 F.4th at 781-82. Entitlement to service connection is denied.

REASONS FOR REMAND

The Board must remand the remaining claims on appeal to the AOJ.

Under the AMA, VA's duty to assist ends when VA issues the notice of decision on a claim or returned claim and does not recommence unless a supplemental claim is submitted, or a claim is returned to the AOJ for correction of an error. 38 U.S.C. § 5103A(e); 38 C.F.R. § 3.159(c). Given the limitations of when the duty to assist applies, remand by the Board in the AMA is proper for correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors); and (2) AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a).

While additional delay is regrettable, remand is necessary in order to correct the errors discussed below.

1. Entitlement to service connection for a bilateral foot disability is remanded.

As explained above, the record contains new and relevant evidence with respect to the appellant's supplemental claim of entitlement to service connection for a bilateral foot disability, to include plantar fasciitis. However, the AOJ continued the previous denial because it found that the evidence was not new and relevant. As the AOJ erred by failing to readjudicate the claim on the merits, remand is appropriate. On remand, the AOJ must readjudicate the claim on the merits in the first instance. See Hickson v. Shinseki, 23 Vet. App. 394, 399 (2010) (when the Board reopens a claim after the AOJ did not, the matter generally must be returned to the AOJ for consideration of the new evidence submitted and the merits in the first instance "so as to preserve for that claimant the one review on appeal" as provided by 38 U.S.C. § 7104); see also Smith v. Wilkie, 32 Vet. App. 332, 337 (2020) (the Board is "obligated to ensure that it provides to appellants fair process in the adjudication of their claims").

Additionally, the Board finds that the AOJ erred by not obtaining a VA medical opinion regarding secondary service connection.

A VA examination or medical opinion is necessary when the record contains the following: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or that certain diseases manifested during an applicable presumptive period, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.519(c)(4); see McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).

The third requirement for a VA examination or medical opinion is "a low threshold." McLendon, 20 Vet. App. at 81. It requires the showing of "some causal connection" between a claimant's disability and their military service. The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. Id.

The requirements for a VA opinion on secondary service connection were satisfied at the time of the decision on appeal. Dr. N.P.D.'s June 2023 private medical report suggests a possible relationship between the appellant's current foot problems and his service-connected lumbar spine disability. As discussed above, Dr. N.P.D. indicated that the appellant's low back pain "has caused imbalanced stress on joints to support the body's movements," including the midfoot joints. See Private Medical Evaluation Report, Dr. N.P.D., M.D., June 16, 2023. However, Dr. N.P.D. did not express a specific opinion on the nature or etiology of the claimed foot disability, so the private medical report is not sufficient to decide the claim.

The Board will therefore remand the issue to the AOJ for initial consideration on the merits, and to obtain a VA medical opinion regarding secondary service connection.

2. Entitlement to higher ratings for lumbar spine disability, right lower extremity lumbar radiculopathy, & GERD is remanded.

Finally, the appellant asserts that he is entitled to a rating above 20 percent for the service-connected lumbar spine disability, a rating above 10 percent for service-connected right lower extremity lumbar radiculopathy (sciatic nerve), and a rating above 10 percent for service-connected GERD.

The Board finds that remand is necessary because the AOJ relied on inadequate VA examinations to evaluate these disabilities. See e.g., Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes the effort to provide a VA examination, it must ensure that the examination is adequate).

In Ingram v. Collins, 38 Vet. App. 130 (2025), the CAVC recently clarified that when evaluating certain disabilities, the beneficial effects of medications must be discounted where the applicable diagnostic code does not reference medication as a factor in evaluation. See also Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

Here, the appellant's lumbar spine disability and associated
is necessary because the AOJ relied on inadequate VA examinations to evaluate these disabilities. See e.g., Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes the effort to provide a VA examination, it must ensure that the examination is adequate).

Here, the appellant's lumbar spine disability and associated radiculopathy are currently rated under Diagnostic Codes 5242 and 8520, respectively. These diagnostic codes do not reference medication as a factor in evaluating the disabilities, and as such, Ingram is for application. See 38 C.F.R. §§ 4.71a, Diagnostic Code 5242 (General Rating Formula for Diseases & Injuries of the Spine), 4.124a, Diagnostic Code 8520 (paralysis of the sciatic nerve).

Meanwhile, the appellant's GERD is rated, by analogy, under the diagnostic code for hiatal hernia. Id. § 4.114, Diagnostic Code 7346 (2023). VA recently amended the criteria for rating digestive system disabilities, including GERD, effective May 19, 2024. See Schedule for Rating Disabilities: The Digestive System, 89 Fed. Reg. 19375 (March 20, 2024) (codified at 38 C.F.R. § 4.114). However, the AOJ issued the decision on appeal in April 2024, before these amendments went into effect. See Rating Decision, April 19, 2024. The pre-amendment criteria, which were in effect at the time of the AOJ decision on appeal, are still applicable in this case. See 38 U.S.C. § 5110(g); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). These pre-amendment criteria did not reference medication as a factor in evaluating hiatal hernia. VA must therefore discount the ameliorating effects of any medication for the appellant's GERD as well. Jones, 26 Vet. App. at 63.

During his March 2024 VA examination, the appellant indicated that he treated his lumbar spine disability and right lower extremity lumbar radiculopathy with nonsteroid anti-inflammatory drugs (NSAIDS) and/or Lortab. However, the VA examination reports do not discuss the ameliorating effects (if any) of this medication. See VA Thoracolumbar Spine (Back) & Peripheral Nerve Conditions Examination Reports, March 29, 2024. As such, the AOJ must provide an adequate VA examination to determine the severity of the appellant's lumbar spine disability and associated radiculopathy without consideration of the ameliorating effects of medication. Ingram, supra; Jones, 26 Vet. App. at 63.

Similarly, at his September 2022 and September 2023 VA examinations, the appellant indicated that he treated his GERD with over-the-counter medications like Nexium, Rolaids, and/or Pepcid AC. But again, the VA examination reports do not discuss the ameliorating effects (if any) of this medication. See VA Esophageal Conditions Examination Reports, September 19, 2023, & September 14, 2022. So, on remand, the AOJ must also provide an adequate VA examination to determine the severity of the appellant's GERD without consideration of the ameliorating effects of medication. Jones, 26 Vet. App. at 63.

The matters are REMANDED for the following actions:

1. Obtain an addendum medical opinion on the nature and etiology of the appellant's bilateral foot disability, to include plantar fasciitis. The VA clinician must review the claims file and a complete copy of this remand in conjunction with rendering any opinion. This review should be noted in the examination report. If the clinician determines that a new examination or any testing is necessary, it should be ordered.

The clinician is requested to provide opinions responsive to the following:

(a.) State whether, but for the appellant's service-connected lumbar spine disability, he would not have a current bilateral foot disability (to include plantar fasciitis).

(b.) State whether the appellant's bilateral foot disability (to include plantar fasciitis) would be less severe and result in less functional impairment but for the appellant's service-connected lumbar spine disability.

If
ar fasciitis. The VA clinician must review the claims file and a complete copy of this remand in conjunction with rendering any opinion. This review should be noted in the examination report. If the clinician determines that a new examination or any testing is necessary, it should be ordered.

The clinician is requested to provide opinions responsive to the following:

(a.) State whether, but for the appellant's service-connected lumbar spine disability, he would not have a current bilateral foot disability (to include plantar fasciitis).

If the clinician opines that the bilateral foot disability (to include plantar fasciitis) would result in less functional impairment but for the lumbar spine disability, the clinician must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the primary service-connected disability.

2. Schedule a VA examination to determine severity of the appellant's service-connected lumbar spine disability, right lower extremity lumbar radiculopathy, and GERD. The VA clinician should provide a full description of the disability and report all signs and symptoms necessary for evaluating the disabilities under the rating criteria.

The VA clinician is asked to consider the following:

(a.) Medications are not contemplated by the applicable rating criteria in this case. As such, the VA clinician must assess the effects of any medications taken by the appellant for his lumbar spine disability, right lower extremity lumbar radiculopathy, and GERD, and determine the severity of the symptoms in the absence of said medications. Specifically, the VA clinician should clarify the extent to which the appellant's medications for these disabilities improved his ability to function. In other words, the VA clinician's assessments of functional impairment should be based on the degree of impairment in the absence of medications.

(b.) If it is not possible to provide a specific measurement or opinion without speculation, the VA clinician must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the clinician (does not have the knowledge or training).

(c.) A rationale for all opinions expressed should be provided as the Board is precluded from making medical findings. A discussion of the facts and the medical principles involved will be of considerable assistance to the Board, including citation to any supporting medical treatises.

3. Thereafter, please readjudicate the claims.

Luke Pelican

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board D.Z. Wall, 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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