BVA9503533 DOCKET NO. 93- 09 909 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUE Entitlement to service connection for a bilateral foot deformity, variously diagnosed as pes cavus, heel spurs, plantar fasciitis and Haglund's deformity. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. M. Barnard, Counsel INTRODUCTION The veteran served on active duty from March 1987 to March 1991. This appeal arises from an April 1992 rating decision of the Lincoln, Nebraska, Department of Veterans Affairs (VA), Regional Office (RO), which denied entitlement to the benefits sought, noting that he did not suffer from any of the claimed disabilities. In November 1992, he testified at a personal hearing; the hearing officer confirmed and continued the denials in a decision issued in December 1992. A rating action issued in November 1993 also confirmed and continued the denials. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that he began to suffer from pes cavus, heel spurs, and plantar fasciitis while on active duty. He states that he currently suffers from pain in his feet, which is worse at the end of the day. He also asserts that he experiences swelling and redness around his heel spurs. Therefore, he believes that he is entitled to service connection for these conditions. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports entitlement to service connection for a bilateral foot deformity. FINDING OF FACT The veteran's bilateral foot deformity, manifested by pain, tenderness to pressure, and a painful bony prominence over both posterior heels, developed while on active duty. CONCLUSION OF LAW Bilateral foot deformities were incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented a claim which is plausible. We are also satisfied that all relevant facts have been properly developed. The record is devoid of any indication that there are other records available which should be obtained. Therefore, no further development is required in order to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). In order to establish service connection, the appellant must submit evidence that he suffers from a disability the result of disease or injury incurred during service. 38 U.S.C.A. § 1131 (West 1991). A review of the veteran's service medical records included his entrance examination, conducted in November 1986, which showed that his feet were normal. In May 1990, he complained of a foot problem, which he stated had existed for two years. He had occasional discomfort on the backs of both feet. He reported no history of trauma to the feet. The physical examination at that time found no pain, but some tenderness to direct pressure to both heels existed. No bone deformity was noted to the posterior aspect. There was slight tenderness to the plantar aspect of both feet, and there was full range of motion. The diagnoses were plantar fasciitis; and bilateral heel spurs. A podiatry consult that same month diagnosed Haglund's deformity, heel spur syndrome, and plantar fasciitis. In August 1990, he continued to complain of heel pain. It was noted that he was on light duty. The examination revealed varus heel deformity, bilaterally, and a painful bony prominence on both posterior heels upon palpation. The assessment was Haglund's deformity with secondary varus heel deformity versus retrocalcaneal exostis versus prominent Achilles tendon. In September 1990 a Medical Board examination was performed. This noted that he was apparently well until May 1990 when he began to complain of bilateral foot pain. This pain occurred with walking, standing, running or marching. It was noted that he was not able to perform his duties due to the pain. The physical examination revealed an increase in the longitudinal arch, and an increase at the posterior aspect of both heels. There was excessive heel varus bilaterally. The forefeet were in a valgus position. No excessive plantar callous formation was present. Mild clawing of the second through fifth digits was noted. There was mild discomfort at the medial tubercle of the calcaneus and along the plantar fascial bank to its insertion bilaterally. An x-ray revealed an increase in osseous tissue formation and mild varus position bilaterally. The diagnoses were cavus foot deformity, bilateral; chronic heel spurs; plantar fasciitis secondary to pes cavus; and Haglund's deformity or retrocalcaneal bursitis secondary to pes cavus. After his discharge from the military, the veteran was examined by VA in June 1991. This examination noted a bony enlargement over the posterior calcaneus at the attachment of the Achilles tendon, with mild tenderness. An x-ray was normal, revealing no bony abnormalities. The diagnoses were Haglund's foot disorder by history, and Achilles tendonitis. In November 1992, the veteran testified at a personal hearing. He stated that he has always had, and still has, heel spurs. He stated that he did not know why these were not noted on the June 1991 VA examination. He also stated that he has never had a problem with his Achilles tendon. He then commented that his feet hurt at the end of the day or whenever he is on his feet for long. He noted that his heel spurs stick out 1/2 inch, and that he often has swelling and redness around them. In December 1992, the veteran's feet were again examined by VA. There was excessive pronation present upon weight bearing bilaterally. There was a large, palpable exostosis on the posterior aspect of both heels with mild bursitis over the deformities. There was no evidence of Achilles tendonitis or plantar fasciitis. A large Haglund's deformity was present on the posterior aspect of both heels, and mild bursitis was present over these deformities, which was likely due to shoe irritation. The diagnosis was large Haglund's deformities posterior aspect both heels with overlying bursitis aggravated by most types of shoe gear. After a careful review of the evidence of record, the undersigned concludes that service connection for bilateral foot deformities is warranted. Initially, it is noted that the veteran's bilateral foot deformities have been diagnosed as several different disabilities, to include pes cavus, heel spur syndrome, plantar fasciitis, and Haglund's deformity. Significantly, however, the noted symptomatology and the objective findings have been consistent since his first complaints in service. Every examination sine May 1990, through the VA examination conducted in December 1992, have noted the same findings. He has consistently suffered from pain on walking or standing, tenderness to pressure on the plantar aspect of his feet, and a painful bony prominence over both posterior heels. Whatever the exact diagnosis, it is clear from this record that his current bilateral foot deformities were first manifested while he was on active duty. Therefore, it is the conclusion of the undersigned that the preponderance of the evidence supports the veteran's claim for entitlement to service connection for bilateral foot deformities. ORDER Service connection for bilateral foot deformities is granted. C. P. RUSSELL Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.