PLANTAR FASCIITIS

TANYA SMITH · 2026 · Case ID: A26031277

GRANTED

Summary

The Veteran served from July 1984 to June 1990, with subsequent periods of service in 2001 and 2004. The Veteran sought service connection for bilateral plantar fasciitis and a bilateral ankle disability, claiming they were secondary to his already service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine. The Veteran also sought service connection for thyroid nodules with a multinodular goiter, asserting exposure to ionizing radiation during service. The Board reviewed evidence including August 2019 VA examinations and treatment notes from the Veteran's treating VA physician. The treating physician opined that the foot and ankle injuries were more likely than not secondary to and worsened by the service-connected back injuries. While a VA examiner's opinion was less favorable, the Board found the treating physician's opinion equally probative, resolving doubt in the Veteran's favor and granting service connection for the plantar fasciitis and ankle disability. For the thyroid condition, the Board noted the Veteran's diagnosis and the absence of further development regarding radiation exposure after a January 2018 risk sheet. However, letters from the Acting Director of VA Health Eligibility Center in March and April 2019 stated the Veteran was determined to have been exposed to ionizing radiation. The Board found this evidence favorable and, combined with a private medical opinion linking radiation exposure to thyroid nodules, granted service connection for the thyroid condition.

Rationale

Treating physician opined injuries secondary to back condition; Record in relative equipoise; Benefit of the doubt resolved in Veteran's favor

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200501-87354

Full Decision Text

Citation Nr: A26031277
Decision Date: 04/06/26 Archive Date: 04/06/26

DOCKET NO. 200501-87354
DATE: April 6, 2026

ORDER

Entitlement to service connection for bilateral plantar fasciitis, as secondary to service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine, is granted.

Entitlement to service connection for a bilateral ankle disability, as secondary to service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine, is granted.

Entitlement to service connection for thyroid nodules with a multinodular goiter is granted.

FINDINGS OF FACT

1. The Veteran's bilateral plantar fasciitis is caused by his service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine.

2. The Veteran's bilateral ankle disability is caused by his service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine.

3. The Veteran's thyroid nodules with a multinodular goiter are causally or etiologically due to his time in service.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral plantar fasciitis, as secondary to service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for a bilateral ankle disability, as secondary to service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for thyroid nodules with a multinodular goiter are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from July 1984 to June 1990, September 2001 to September 2001, and January 2004 to September 2004.

The rating decision on appeal was issued in September 2019 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the May 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in July 2024. Therefore, the Board may only consider the evidence of record at the time of the September 2019 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

1. Entitlement to service connection for bilateral plantar fasciitis.

2. Entitlement to service connection for a bilateral ankle disability.

The Veteran seeks entitlement to service connection for bilateral plantar fasciitis and a bilateral ankle disability. He asserts his disabilities are secondary to his service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine. See July 2024 BVA Hearing Transcript, page 4.

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 4 (1990). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value.

When there is an approximate balance of positive and negative evidence
evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 4 (1990). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

As service connection for bilateral plantar fasciitis and a bilateral ankle disability are being granted on a secondary basis based on causation, there is no need to discuss entitlement to service connection on a direct basis or any other basis.

Service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310.

The Veteran has current diagnoses of bilateral plantar fasciitis and bilateral ankle strains. See August 2019 VA examinations.

The Veteran is service connected for intervertebral disc syndrome with degenerative arthritis of the lumbar spine. See August 2010 and April 2019 rating decisions.

The key question at issue is whether the Veteran's bilateral plantar fasciitis and bilateral ankle disability are caused or aggravated by the Veteran's service-connected intervertebral disc syndrome with degenerative arthritis of the lumbar spine.

The Veteran's treating VA physician included an opinion in VA treatment notes in July 2019, prior to the filing of the Veteran's claims. The physician opined that the Veteran's bilateral "foot and ankle injuries are more likely than not secondary to and worsened by" the Veteran's service-connected back injuries and sciatic nerve injuries.

The Board acknowledges that VA medical opinions were obtained in August 2019, at which time the VA examiner opined that the Veteran's bilateral foot and ankle conditions were less likely than not secondary to his lumbar spine disability. However, the Board finds the VA treating physician's medical opinion is at least as probative and persuasive as the VA opinion. In light of the discussion above, the record is at least in relative equipoise. As such, the Veteran's service-connection claims for bilateral plantar fasciitis and a bilateral ankle disability are granted. In so finding, all reasonable doubt has been resolved in favor of the Veteran.

3. Entitlement to service connection for thyroid nodules.

The Veteran seeks entitlement to service connection for thyroid nodules. He asserts he was exposed to ionizing radiation during service.

The Veteran has a current diagnosis of thyroid nodules with a multinodular goiter. See August 2019 VA examination.

The Board notes that the Veteran's claim was deferred in December 2017 for "radiation development." The Veteran completed a Radiation Risk Activity Sheet in January 2018. The claims file then does not include any evidence of further development related to determining whether the Veteran was exposed to ionizing radiation. Importantly, however, the Veteran submitted copies of letters he received in March 2019 and April 2019 from the Acting Director of VA Health Eligibility Center which stated the Veteran was "determined to have been exposed to ionizing radiation while in the military." The Board finds no adequate basis to reject the evidence of record that is favorable to the Veteran, based on a lack of credibility or probative value. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998). As such, the Board finds the Veteran was exposed to ionizing radiation while in service.

Service connection for claims based on exposure to ionizing radiation in service can be established in any of three different ways. See Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are diseases that are presumptively service connected in radiation-exposed veterans under 38 U.S.C. § 1112(c) and 38 C.F.R. § 3.309(d). Second, service connection can be established under 38 C.F.R. § 3.303(d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311 if the condition at issue is a radiogenic disease. Third, direct service connection can be established under 38 C.F.R. § 3.303(d) by showing that the disease was incurred in or aggravated by service without regard to the statutory presumptions. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994).

Importantly, diseases presumptively service connected for radiation-exposed veterans under the provisions of 38 U.S.C. § 1112(c) and 38 C.F.R. § 3.309(d)(2) include thyroid cancer but do not include thyroid nodules or goiter. 38 U.S.C. § 1112(c)(2); 38 C.F.R. § 3.309(d).

If a claimant does not qualify as a radiation-exposed veteran under 38 C.F.R. § 3.309(d)(3) and/or is not diagnosed with one of the presumptive conditions listed in 38 C.F.R. § 3.309(d)(2), the Veteran may still benefit from the special development procedures provided in 38 C.F.R. § 3.311 if the Veteran suffers from a radiogenic disease and claims exposure to ionizing radiation in service.

Regulation 38 C.F.R. § 3.311 establishes a procedural framework for developing and considering claims for service connection for radiogenic diseases. It does not provide a presumption of service connection.

Under 38 C.F.R. § 3.311, radiogenic disease means a disease that may be induced by ionizing radiation. Importantly, it does not include thyroid nodules or goiter. 38 C.F.R. § 3.311(b)(2).

Here, the Board notes that the Veteran submitted a positive medical opinion in April 2019, from a diabetes and endocrinology physician. The physician explained that the Veteran was being treated for a multinodular goiter and according to the records, the Veteran was exposed to ionizing radiation during service. The physician noted that radiation exposure is a well-known risk factor for thyroid nodules, so radiation exposure is at least a partial cause of the Veteran's thyroid nodules. The physician noted that while the Veteran does not currently have thyroid cancer, he will require lifelong monitoring with thyroid ultrasounds and biopsies to make sure the thyroid nodules do not grow or experience any changes.

The Board finds the April 2019 opinion is sufficient to substantiate the claim. Given the evidence of record, the Board finds that the evidence supports the establishment of service connection for thyroid nodules with multinodular goiter. The Veteran has a post-service diagnosis, in-service exposure to ionizing radiation, and a medical opinion that relates his post-service diagnosis to his exposure in service. The appeal is granted.

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L. Andersen, 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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