Citation Nr: 0007978 Decision Date: 03/24/00 Archive Date: 03/28/00 DOCKET NO. 95-18 102 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for bilateral metatarsalgia with heel spur syndrome. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD S.M. Cieplak, Associate Counsel INTRODUCTION The veteran served on active duty from October 1949 to June 1977. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from a March 1995 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma, which denied the benefits sought on appeal. FINDING OF FACT The claim of entitlement to service connection for bilateral metatarsalgia with heel spur syndrome is supported by cognizable evidence demonstrating that the claim is plausible or capable of substantiation. CONCLUSION OF LAW The claim of entitlement to service connection for bilateral metatarsalgia with heel spur syndrome is well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Initially, it must be determined if the appellant has presented a well grounded claim for service connection. In this regard, the claimant bears the burden of submitting sufficient evidence "to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). Simply stated, a well grounded claim must be plausible and capable of substantiation. Id. In determining whether a claim is well grounded, the Board is required to presume the truthfulness of evidence. Robinette v. Brown, 8 Vet. App. 69, 77-8 (1995); King v. Brown, 5 Vet. App. 19, 21 (1993). In August 1994, the veteran was afforded a VA foot examination. He provided a detailed history of foot pain starting in the 1970's. Clinical findings included pes planus of grade 1 over 4 of the right foot and minimal pes planus of less than grade 1 of the left foot. The examiner assessed the veteran's chronic foot pain, physical examination and history as consistent with plantar fasciitis (heel spur syndrome). Calcaneal heel spurs were identified in a September 1994 X-ray. The Board considers this report to suggest a plausible association between the veteran's current foot pathology and service. In accordance with the pertinent qualifying factors, the Board finds the claim is well grounded in this case. As the duty to assist is triggered here by a well-grounded claim, the Board finds that VA has an obligation to further develop the veteran's claim. See Grivois v. Brown, 5 Vet. App. 136, 140 (1994). ORDER The claim for entitlement to service connection for bilateral metatarsalgia with heel spur syndrome is well grounded and to this extent the appeal is granted. REMAND The Board notes that the veteran's foot pathology has been divergently assessed over the years. Apart from the August 1994 clinical findings mentioned above, in 1975 and 1976, the veteran was seen only for complaints of left foot pain in service. The veteran reported a history of hip arthritis. Pain was not persistent, and it was reported he had full range of motion. X-rays in May 1975 showed no abnormalities. In December 1975, a podiatry consult showed an old incidious injury of the left third metatarsal. The records also demonstrate the veteran was provided arch supports. X-rays in April 1976 showed a small exostosis, and a metatarsal pad was provided. In July 1976, the veteran was again seen by podiatry, having presented with 2nd metatarsal head pain. It appears the metatarsal pad required adjustment because the examiner prescribed that the pad be removed, reduced or replaced. Service medical records are otherwise silent as to complaints, treatment or diagnoses relating to any foot pain. The veteran was afforded a VA rating examination in November 1977, and there were no complaints, treatment or diagnoses relating to pain in either foot at that time. Nearly 12 years thereafter, in June 1989, the veteran had complaints relating to his right foot and was afforded a foot X-ray, which revealed mild degenerative joint disease at the right metatarsophalangeal and interphalangeal joints and no other significant abnormalities. The veteran was afforded a foot examination in September 1989. The veteran reported he had no left foot complaints at that time or previously; X-rays showed no evidence of fracture. Diagnosis before X-rays was mild pes cavus. The Board is of the opinion that another podiatry examination should be afforded to reconcile current findings with divergent findings in the historical record and to ascertain the nature and etiology of any current foot pathology. The appellant is hereby notified that it is his responsibility to report for any examination and to cooperate in the development of the case, and that the consequences of failure to report for a VA examination without good cause may include denial of his claim. 38 C.F.R. §§ 3.158, 3.655 (1999). To ensure that VA has met its duty to assist the appellant in developing the facts pertinent to the claim, the case is REMANDED to the RO for the following development: 1. The RO should request that the veteran provide information as to the medical facilities at which he received inpatient and outpatient treatment pertaining to his foot conditions from 1995 to the present. Upon receipt of the requested information, the RO should contact the identified facilities and request that all available pertinent clinical documentation be forwarded for incorporation into the record. 2. The veteran should then be afforded a special podiatry examination in order to identify any current foot pathology that may now be present and to ascertain the etiology of any pathology identified. The examiner is requested to review the claims file and is asked to indicate in the examination report that he or she has examined the claims folder. All tests deemed necessary by the examiner should be conducted to determine the nature and etiology of any current foot pathology. The examiner is asked to express an opinion as to whether it is at least as likely as not that any current foot pathology is related to the veteran's military service. The complete medical rationale for any opinion is to be provided. 3. After undertaking any development deemed appropriate in addition to that specified above, the RO should review evidence of record. Thereafter, the RO should readjudicate the issue of entitlement to service connection for a foot disorder. If the determination remains adverse to the veteran, he and his representative, if any, should be furnished a supplemental statement of the case and an opportunity to respond thereto. Thereafter, the case should be returned to the Board for further appellate consideration, if in order. The Board intimates no opinion, either favorable or unfavorable, as to the ultimate disposition of this case. No action is required of the veteran until he is notified by the RO. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). BRUCE KANNEE Member, Board of Veterans' Appeals