BONE NEOPLASM BENIGN

Summary

The veteran, an Army veteran who served from June 1993 to December 1995, appeals the denial of service connection for a right heel spur. The veteran contends the heel spur is a result of his in-service plantar fasciitis. The Board noted that the March 2021 rating decision was an initial decision, making the Appeals Modernization Act applicable. The veteran initially elected a hearing but later withdrew the request, limiting the Board's review to evidence of record at the time of the March 2021 decision or submitted within 90 days of the hearing withdrawal. The Board is bound by favorable findings from the agency of original jurisdiction (AOJ), which had found a current diagnosis of right heel spur and an in-service event of plantar fasciitis. A July 2019 VA examination found the heel condition less likely than not related to service, with no in-service documentation and no causal link between the plantar fasciitis and the current heel spur. However, a February 2025 private physician opinion linked the heel spur to the in-service plantar fasciitis, noting the strong association between chronic inflammation from plantar fasciitis and calcaneal bone spurs, concluding it was highly likely incurred due to service. The Board found the evidence weighed equally for and against service connection. Applying the benefit of the doubt doctrine, the Board found the veteran entitled to service connection for the right heel spur.

Rationale

Favorable findings from AOJ regarding current diagnosis and in-service plantar fasciitis; Conflicting opinions: VA exam found less likely than not related; private physician found highly likely caused by service; Board applied benefit of the doubt due to balanced evidence

Full Decision Text

Citation Nr: A26031702
Decision Date: 04/07/26	Archive Date: 04/07/26

DOCKET NO. 210614-165686
DATE: April 7, 2026

ORDER

Entitlement to service connection for right heel spur is granted. 

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, the Veteran's right heel spur is at least as likely as not related to the Veteran's in-service plantar fasciitis.

CONCLUSION OF LAW

The criteria for service connection for right heel spur are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from June 1993 to December 1995.

The rating decision on appeal was issued in March 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In the June 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On November 29, 2024,, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the March 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

1. Entitlement to service connection for right heel spur is granted. 

The Veteran contends he is entitled to service connection for right heel spurs as a result on his in-service plantar fasciitis. See August 2019 Veteran Statement. 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, space, or air 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 pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. §3.303 (d). 

Establishing service connection generally requires (1) evidence of a current disability; (2) medical or lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) 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). 

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).  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.  Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted).  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.  For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability.  Id. 

Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (
 caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain.  Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted).  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.  For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability.  Id. 

Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson reports a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. In fact, competent medical evidence is not necessarily required when the determinative issue involves medical etiology or medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). 

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.§5107(b); 38 C.F.R. § 3.102. 

Under the AMA, the Board is bound by favorable findings by the AOJ in the absence of evidence of clear and unmistakable error. See 38 C.F.R. § 3.104(c). There is no dispute that the Veteran has a current diagnosis of right heel spur. In the March 2021 rating decision, the AOJ made favorable findings regarding the Veteran's current right heel spur diagnosis. The AOJ also found the Veteran had an in-service event or injury based on his in-service treatment for plantar fasciitis. The Board is bound by these favorable findings. See 38 C.F.R. § 3.104(c).

Here, the Veteran was afforded a VA examination in July 2019 regarding his right heel spur. The July 2019 VA examiner found the Veteran's right heel condition was less likely than not related to his military service as there was no documentation of the condition in his service treatment records. The July 2019 examiner also found the Veteran's in-service plantar fasciitis did not cause his current right foot heel spur. 

The Veteran submitted a February 2025 private physician opinion which found the Veteran's right heel spur was more likely than not caused by his in-service plantar fasciitis. The examiner noted Plantar ligament are linked to heel injuries such as heel spurs. Plantar fasciitis, a common cause of heel pain, is strongly associated with the development of calcaneal bone spurs due to chronic inflammation and repetitive traction on the plantar fascia. The examiner concluded that it was highly likely that the Veteran's right heel spur condition was incurred or due to service. 

The Board finds the evidence weighs equally in favor and against the Veteran's right heel spur being caused by his in-service plantar fasciitis. Because the evidence is balanced, the Board must weight the evidence in favor of the Veteran.  38 U.S.C.§5107(b); 38 C.F.R. § 3.102. Therefore, the Board finds the Veteran is entitled to service connection for his right heel spur. 

 

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Tiffany P. Elling

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.