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Single Judge Application; Rating by Analogous Condition; 38 C.F.R. § 4.20 (2014); Hudgens v. Gibson, 26 Vet.App. 558, 563 (2014) | Veteranclaims's Blog
Single Judge Application; Rating by Analogous Condition; 38 C.F.R. § 4.20 (2014); Hudgens v. Gibson, 26 Vet.App. 558, 563 (2014)
Filed under: Uncategorized — Tags: 26 Vet.App. 558, 563 (2014), Single Judge Application; Rating by Analogous Condition; Hudgens v. Gibson — veteranclaims @ 6:12 pm
“VA regulations acknowledge that not every disability is specifically
listed in the rating schedule. “When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptom[s] are closely analogous.” 38 C.F.R. § 4.20 (2014) (emphasis added). However, by the terms of § 4.20, rating by analogy is limited to situations, i.e., permissible, “[w]hen an unlisted condition is encountered.” Accordingly, this Court has observed that “[a]n analogous rating . . . may be assigned only where the service-connected condition is ‘unlisted.'” Suttman v. Brown, 5 Vet.App.127, 134 (1993) (emphasis added); see Hudgens v. Gibson, 26 Vet.App. 558, 563 (2014) (“When the Secretary’s regulations do not provide DCs for specific disorders, VA may evaluate those conditions under codes for similar or analogous disorders.” (citing Lendenmann v. Principi,
3 Vet.App. 345, 351 (1992))). In Suttman, for example, the Court held that
VA erred in evaluating “peripheral neuropathy . . . etiology [unknown], probably residual from beri-beri” by analogy under the DC for peripheral neuropathy when the rating schedule “provide[d] a specific listed rating for
beriberi” that contemplated peripheral neuropathy residuals. 5 Vet.App. at
134.”
NO. 14-0418
PHYLLIS S. FLIPPEN, APPELLANT,
BARTLEY, Judge: Veteran Phyllis S. Flippen appeals through counsel a
Board of Veterans’ Appeals (Board) decision denying entitlement to an
increased evaluation for
bilateral pes planus in excess of 10% prior to June 29, 2013, and in
excess of 50% thereafter. Record
(R.) at 2-17.1
is appropriate. See Frankel
v. Derwinski, 1 Vet.App. 23, 25-26 (1990). For the reasons that follow,
the Court will affirm the
January 2014 Board decision with respect to pes planus.
The Board granted a 10% evaluation for allergic rhinitis with maxillary
sinusitis prior to June 29, 2013, but
denied an evaluation in excess of 50% from that date. The Court will
dismiss the appeal as to those issues because they
were not argued. See Pederson v. McDonald, __ Vet.App. __, __, No. 13-1853,
2014 WL 4167846 at *7 (Feb. 13, 2015)
(en banc) (declining to review the merits of an issue not argued on appeal
and dismissing the appeal of that issue);
Cacciola v. Gibson, 27 Vet.App. 45, 48 (2014) (holding that, “when an
appellant expressly abandons an issue in his
initial brief or fails to present any challenge and argument regarding an
issue, the abandoned issue generally is not
reviewed by the Court”).
Ms. Flippen served on active duty in the U.S. Army from February 1980 to
June 1998. R.
at 1484. In November 1992 and April 1998 she was diagnosed with flat feet,
also known as pes
planus. See R. at 1481. In April 1998, she sought service connection for
pes planus (R. at 1487-91),
and,shortlythereafter,theVAregionaloffice(RO)grantedserviceconnection for
that condition and
assigned a noncompensable evaluation from July1, 1998, under 38 C.F.R. §
4.71a, Diagnostic Code
(DC) 5276 (“Flatfoot, acquired”) (R. at 1479-83).
In February 2006, Ms. Flippen sought an increased evaluation for flat feet
connection for plantar fasciitis as secondaryto flat feet.2
R. at 857-58. She underwent an April 2006
VA examination, which noted that the veteran “mainly complains of medial-
sided heel pain.” R. at
836. The examiner also noted that Ms. Flippen reported using orthotics for
both feet. Id. Physical
evaluation revealed full and painless ankle range of motion, tenderness to
palpation of the bilateral
plantar fasciae, and no sensory deficits. R. at 837. The examiner
diagnosed asymptomatic, flexible
bilateral flat foot and bilateral plantar fasciitis.
In June 2006, the RO continued the
noncompensable evaluation for bilateral pes planus and denied service
plantar fasciitis. R. at 795-802. Ms. Flippen filed a Notice of
Disagreement as to this decision and
requested decision review officer (DRO) review. R. at 788.
Ms. Flippen underwent an August 2006 VA examination. The examiner noted
veteran denied constant pain, weakness, and fatigability but stated that
she experienced flareup pain
of 10 out of 10 upon arising in the morning or walking a few yards. R. at
729. The examiner also
noted the veteran’s statement that this pain interfered with weight-
bearing activities like walkingand
caused her to change jobs. Id. Medical records showed “a diagnosis of
bilateral pes planus with
hallux valgus.”3
Id. On physical evaluation, the examiner found hallux valgus bilaterally,
a 20 degree deformity in the great toes; tenderness in the plantar fasciae;
abnormal weight-bearing
Plantar fasciitis is inflammation of the plantar fascia, the thick tissue
on the bottom of the foot that connects
the heel bone to the toes; the most common symptom of plantar fasciitis is
See Plantar fasciitis, NAT’L INSTS. OF HEALTH, MEDLINEPLUS MEDICAL
DICTIONARY, www.nlm.nih.gov/medlineplus/
Hallux valgus, commonly referred to as a “bunion,” is an “angulation of
the great toe [(hallux)] away from the
midline of the body, or toward the other toes.” DORLAND’S ILLUSTRATED
MEDICAL DICTIONARY 818 (32d ed. 2012).
with loss of arches consistent with pes planus; bilateral heel pronation;
and antalgic gait. R. at 729-
30. Bilateral pes planus, plantar fasciitis, and great toe hallux valgus
were diagnosed, and the
examiner opined that plantar fasciitis was at least as likely as not a
result of the service-connected
pes planus because literature showed that plantar fasciitis “frequently
occurs” with pes planus. R.
at 730. Later that month, the DRO granted service connection for plantar
fasciitis and an increased
evaluation of 10% under DC 5276 for “pes planus with plantar fasciitis,
bilateral,” from February
27, 2006, stating that, “[b]ased on [the] disability picture produced
being so similar, they are coded
and evaluated together based on the total foot disability presented by the
coexisting conditions.” R.
at 738-39, 767-69; see R. at 740-61 (August 2006 Statement of the Case (
SOC) denying a higher
In September 2006, Ms. Flippen appealed to the Board. R. at 727-28. The
Board remanded
the claim in April 2008 for additional development. R. at 699-714.
Although the veteran testified
at an August 2008 Board hearing as to the nature of her foot
conditions—including that she had foot
calluses, swelling, and pain and wore orthotics—(R. at 673-77), VA
evaluation in excess of 10% when Ms. Flippen failed to report to a
scheduled VA examination (R.
at 468-76 (March 2010 Supplemental SOC (SSOC)). In response to the
veteran’s April 2010 request
for rescheduling of the missed examination (R. at 465), the Board again
remanded the claim for
additional development (R. at 447-53).
Diagnoses of bilateral flat feet and plantar fasciitis with mild to
moderate pain residuals were
confirmed in October 2011 but no Achilles tendon abnormality or pain,
abnormal weight-bearing,
or pronation wereobserved. R.at98-101. Ms. Flippen underwent an
October2012 VA examination
that diagnosed hallux valgus, pes planus, and plantar fasciitis. R. at 123.
Under “medical history,”
the examiner noted “[g]radual onset [of] bilateral foot pain over [the]
course of dutydue to repetitive
overuse injuries diagnosed as plantar fasciitis” and indicated that the
veteran “[c]urrently ha[d]
difficulty standing for long periods.” R. at 124. The examiner also
indicated that left foot hallux
valgus caused mild or moderate symptoms but did not specify those symptoms.
Id. In November
2012, VA issued an SSOC denying an evaluation in excess of 10% for “a
bilateral foot disorder,
variously diagnosed as bilateral pes planus and plantar fasciitis.” R. at
1816; see R. at 1814-20.
When the matter returned in May 2013, the Board again remanded the
veteran’s claim for a VA
examination “toaddress thesymptom[s] associatedwith herbilateral
plantarfasciitis andpesplanus”
and to “distinguish the symptom[s] associated with the service-connected
plantar fasciitis and pes
planus and the nonservice-connected hallux valgus.” R. at 388-89.
Ms. Flippen underwent another VA footexamination inJune2013. The examiner
bilateral pes planus with plantar fasciitis, observed pain and swelling on
use and manipulation,
characteristiccalluses,extremetendernessoftheplantarsurfaces,
decreasedlongitudinalarchheight,
and evidence of marked deformity, i.e., marked pronation. R. at 88-89. The
examiner found no
other lower extremity deformity, no use of assistive devices other than
orthotics, and no effect on
ability to work. R. at 89-90.
In July2013, the RO awarded a 50%evaluation forpesplanuswith
plantarfasciitis, bilateral,
from June 29, 2013. R. at 73-79. The RO noted that this was the highest
schedular evaluation under
DC 5276 (“Flatfoot, acquired”) and that it considered the award to be “a
full and final determination
of this issue on appeal.” R. at 75. Subsequently, the matter returned to
IntheJanuary2014decisiononappeal, theBoarddeniedan increasedevaluation
forbilateral
pes planus in excess of 10% prior to June 29, 2013, and in excess of 50%
thereafter. As relevant to
this appeal, the Board found that DC 5276 “is the most applicable rating
code[ ] and is more
appropriate than a rating under [DC] 5284,” the catchall DC for other foot
injuries, and that a 50%
evaluation under DC 5276 is the highest evaluation available under DCs
applicable to the feet. R.
at 12-13. This appeal followed.
Ms. Flippen’s condition as characterized by VA—pes planus with plantar
fasciitis—is
currentlyevaluated under DC 5276, which provides the following evaluations
for bilateral flat foot:
10% for weight-bearing line over or medial to great toe, inward bowing of
the tendo achillis, pain
on manipulation and use of the feet; 30% for objective evidence of marked
deformity (pronation,
abduction, etc.), pain on manipulation and use accentuated, indication of
swelling on use,
characteristic callosities; and 50% for marked pronation, extreme
tenderness of plantar surfaces of
the feet, marked inward displacement and severe spasm of the tendo
achillis on manipulation, not
improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276 (
2014). DC 5284 applies
to “[f]oot injuries, other,” and provides a 10% evaluation for “[m]
oderate” injuries, 20% for
“[m]oderately severe” injuries, 30% for “[s]evere” injuries, and 40% for
injuries “[w]ith actual loss
of use of the foot.” 38 C.F.R. § 4.71a, DC 5284.
“[T]he Court may set aside the [Board’s] selection of a DC in a particular
case only if such
selection is ‘arbitrary, capricious, an abuse of discretion, or otherwise
not in accordance with law.”
Butts v. Brown, 5 Vet.App. 532, 539 (1993) (en banc) (quoting 38 U.S.C. §
7261(a)(3)(A)). As with
any finding on a material issue of fact and law presented on the record,
the Board must support its
determinations regarding its choice as to the appropriate DC with an
facilitates review in this Court. 38 U.S.C. § 7104(d)(1); Gilbert v.
Derwinski, 1 Vet.App. 49, 52
(1990). To complywith this requirement, the Board must analyze the
credibilityand probative value
of evidence, account for evidence it finds persuasive or unpersuasive, and
provide reasons for its
rejection of material evidence favorable to the claimant. Caluza v. Brown,
Ms. Flippen argues that the Board failed to adequately explain why her ”
disability did not
warrant a rating under DC 5284 for her pes planus with associated plantar
fasciitis.” Appellant’s
Brief (Br.) at 4; see id. at 5-9, 10-13. She also argues that the Board
did not adequately explain why
a separate evaluation under DC 5280 for hallux valgus was not warranted.4
Id. at 9. The Secretary
responds that the Board adequatelyexplained whyan evaluation under DC 5284
was not appropriate
and that the issue of an evaluation for hallux valgus is irrelevant
because that condition is not service
connected. Secretary’s Br. at 5-23. The Court agrees with the Secretary.
To the extent that Ms. Flippen is arguing that the Board failed to explain
whypes planus and
plantar fasciitis should not have been evaluated under DC 5284 instead of
5276, her argument fails.
Disability evaluations are generally determined by applying to the
veteran’s disability the criteria in
VA’s disability rating schedule, which is based on the average impairment
in earning capacity.
38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2014); see also 38 C.F.R. § 3.321(a) (
2014) (“The provisions
Ms. Flippen has not argued that the Board erred in its assignment of
specific evaluations under DC 5276.
Accordingly, the Court does not consider that matter. See Carbino v. West,
168 F.3d 32, 34 (Fed. Cir. 1999) (noting that
arguments not raised in the opening brief are deemed waived).
contained in the rating schedule will represent as far as can practicably
be determined, the average
impairment in earning capacity in civil occupations resulting from
disability.”).
VA regulations acknowledge that not every disability is specifically
listed in the rating
schedule. “When an unlisted condition is encountered it will be
permissible to rate under a closely
related disease or injury in which not onlythe functions affected, but the
anatomical localization and
symptom[s] are closely analogous.” 38 C.F.R. § 4.20 (2014) (emphasis
added). However, by the
terms of § 4.20, rating by analogy is limited to situations, i.e.,
permissible, “[w]hen an unlisted
condition is encountered.” Accordingly, this Court has observed that “[a]n
analogous rating . . . may
be assigned only where the service-connected condition is ‘unlisted.'”
Suttman v. Brown, 5 Vet.App.
127, 134 (1993) (emphasis added); see Hudgens v. Gibson, 26 Vet.App. 558, 563 (2014) (“When the Secretary’s regulations do not provide DCs for specific disorders, VA may evaluate those conditions under codes for similar or analogous disorders.” (citing Lendenmann v. Principi,
The evidence in this case shows that Ms. Flippen has consistently been
diagnosed with pes
planus since before leaving service. See, e.g., R. at 88, 100, 123, 729-30,
1481. Because she has
been diagnosed with a disability for which VA has specifically promulgated
and listed a DC (5276)
in the rating schedule for purposes of evaluating the impairment in
earning capacity due to pes
planus, the Board was not required, indeed, possibly not permitted, to
rate pes planus by analogy
under DC 5284. Cf. Fenderson v. West, 12 Vet.App. 119, 128 (1999) (noting
that a veteran who has
plantar fasciitis may be evaluated under DC 5284 because it is an unlisted
To the extent that Ms. Flippen argues that the Board failed to adequately
why—although bilateral pes planus is evaluated under DC 5276—a
separate evaluation of bilateral
plantar fasciitis under DC 5284 is not warranted, her argument also fails
because any deficiency in
this respect is harmless. See 38 U.S.C. § 7261(b)(2) (requiring the Court
to “take due account of the
rule of prejudicial error”); Shinseki v. Sanders, 556 U.S. 396, 409 (2009) (
noting that the statute
requiring this Court to “take due account of prejudicial error [ ]
requires the Veterans Court to apply
the same kind of ‘harmless error’ rule that courts ordinarily apply in
civil cases”).
The Board stated that “regarding the symptoms attributable to a foot
disabilityother than pes
planus, such as plantar fasciitis . . . , the evidence does not
demonstrate that they have risen to the
level of a moderately-severe foot disability” under DC 5284. R. at 12. As
Ms. Flippen notes, an
evaluation prior to June 29, 2013, of bilateral pes planus under DC 5284
that rose even to a
“[m]oderate” level would entitle her to separate 10% evaluations for each
foot, resulting in a
combined 20% evaluation, higher than the 10% she is currently receiving
under DC 5276 for that
period. Appellant’s Br. at 11; see 38 C.F.R. § 4.25 & Table I (2014) (
explaining that the combined
evaluation for two 10% evaluations is 19, which is converted to the
nearest number divisible by 10,
resulting in a 20% evaluation).
However, the Board found that, prior to June 29, 2013, her “bilateral foot
manifested byno greater than moderate tenderness to palpation of the
arches and fascia”without any
other symptoms such as swelling, callosities, or objective evidence of
marked deformity. R. at 4.
Even putting aside the Board’s characterization of the severity of her
foot symptoms, the record
reflects the Board’s finding—and Ms. Flippen has not asserted the
contrary—that the only symptom
manifested by her plantar fasciitis is pain in or tenderness of the
plantar surfaces of the feet. See,
e.g., R. at 88 (June 2013 VA examination observing “extreme tenderness of
plantar surface[s]”), 99
(October 2011 VA examination noting that the veteran “experiences mild to
moderate pain on both
plantar aspects of her feet and . . . takes pain medications for the
condition”), 684 (April 2008
testimony describing pain “like pins and needles under the bottom of [her]
feet”), 727 (veteran’s
September 2006 statement that she is “consistently in pain” with respect
to the bottom of her feet),
729 (August 2006 VA examination noting on examination “tenderness at the
attachment sites of the
plantar fascia[e]” and recording the veteran’s reports of severe plantar
surface flareup pain when
arisingor walking), 837 (April 2006 VA examination noting that medial
plantar fasciaewere”tender
to palpation”); see also supra note 1 (listing the symptoms of plantar
fasciitis as pain, tenderness,
or stiffness of the plantar fasciae).
VA regulations against “pyramiding”prohibit
compensatingaveteranmorethanoncefor the
“same disability” or the “same manifestation.” 38 C.F.R. § 4.14 (2014). ”
Section 4.14 clearly
contemplates that several separately diagnosed disorders may have a
single manifestation, and it
clearly prohibits the VA from rating that manifestation for each disorder.”
Amberman v. Shinseki,
570 F.3d 1377, 1381 (Fed. Cir. 2009); see also id. (“We agree with the
Veterans Court that two
defined diagnoses constitute the same disabilityforpurposesofsection4.
14iftheyhave overlapping
symptomatology.” (citing Esteban v. Brown, 6 Vet.App. 259 (1994))).
In this case, DC 5276’s 50%, 30%, and 10% evaluations for bilateral pes
planus specifically
contemplate and compensate for “extreme tenderness of the plantar surfaces
of the feet,”
“[accentuated] pain on manipulation and use,” and “pain on manipulation
and use of the feet,”
Therefore, because the only apparent symptom of Ms. Flippen’s plantar
fasciitis—plantar surface pain and tenderness—is adequately
contemplated by and evaluated under
DC 5276, a separate evaluation under DC 5284 for plantarfasciitis in
addition to an evaluation under
DC 5276 for pes planus would violate VA’s rule against compensating the
same manifestation under
two different DCs. See generally R. at 768 (August 2006 DRO decision
for bilateral plantar fasciitis secondary to pes planus and noting that, “[
b]ased on [the] disability
picture produced being so similar, they are coded and evaluated together
based on the total foot
disability presented by the coexisting conditions”). Accordingly, even
though the Board may not
have provided adequate reasons or bases when determining that DC 5284
could not provide a higher
evaluation prior to June 29, 2013, such error was harmless because a
separate evaluation for plantar
fasciitis under DC 5284 was unavailable as a matter of law because it
would have involved
pyramiding. See Sanders, 556 U.S. at 409.
Similarly, although the Board mayhave also erroneouslydetermined that DC
5284 could not
provide an evaluation in excess of 50% from June 29, 2013, R. at 12-13;
see Appellant’s Br. at 12
(explaining how DC 5284 could provide a maximum 60% evaluation); see also
38 C.F.R. §§ 4.25,
4.26 (2014) (explaining how to calculate combined evaluations and apply
the bilateral factor), any
error or reasons-or-bases deficiencyis harmless because Ms. Flippen points
to no evidence that foot
pain or tenderness, whetherattributable to pes planus, plantarfasciitis,
or both, exceeds the “extreme
tenderness of the plantar surfaces of the feet” contemplated by 50%
evaluation under DC 5276.
Next, Ms. Flippen argues that “the Board failed to consider all applicable [
DCs] by omitting
analysis of [her] hallux valgus under DC 5280.” Appellant’s Br. at 9.
Despite acknowledging some
language in the Board decision that seems to reference hallux valgus as
though it were service
connected (see R. at 12), the Secretary asserts that any such reference
was harmless because hallux
valgus is not service connected and the issue of service connection for
that condition was not
reasonably raised below. Secretary’s Br. at 8-12. Although Ms. Flippen
contends that the Board
would have found hallux valgus service connected if it had properly
considered the lay and medical
evidence of record (Reply Br. at 1-5), the Court agrees with the Secretary.
It is true that VA is obligated to recognize, develop, and adjudicate all
claims, see Robinson v. Shinseki, 557 F.3d 1355, 1361-62 (Fed. Cir. 2009),
in the record that the issue of service connection for hallux valgus was
reasonably raised. Ms.
Flippen’s submissions to VA first referred to flat feet alone and then to
flat feet with secondary
plantar fasciitis, but none mentions hallux valgus. See R. at 727-28, 788,
857-58, 1487. Ms.
Flippen’s representative stated in passing during the April 2008 Board
hearing that an August 2006
VA examination showed, inter alia, hallux valgus (R. at 675), but it was
clear that VA did not
consider this as reasonably raising a claim for service connection because,
in its May 2013 remand
order, the Board observed that an October 2012 VA examination “[did] not
symptom[s] associated with the service-connected plantar fasciitis and pes
planus and the
nonservice-connected hallux valgus” (R. at 389).
Nor, contrary to the veteran’s contention, did the medical evidence
suggest a link between
hallux valgus and service or a service-connected disability. Ms. Flippen
cites a few records that
diagnose or note a diagnosis of “bilateral pes planus with hallux valgus” (
Reply Br. at 2 (citing R.
at 123, 729)), but such language does not suggest a link between hallux
valgus and pes planus, or
that Ms. Flippen intended to claim such a link. See Criswell v. Nicholson,
20 Vet.App. 501, 504
(2006) (“The mere existence of medical records generally cannot be
construed as an informal claim;
rather, there must be some intent by the claimant to apply for a benefit.”)
In short, although VA is required to sympathetically and liberally read
the record, it is not
required to address issues that are not reasonably raised. See Parks v.
Shinseki, 716 F.3d 581, 586
(Fed. Cir. 2013); Brannon v. West, 12 Vet.App. 32, 35 (1998). Because
there is no evidence that a
claim for service connection for hallux valgus was reasonably raised by
the record, the Board was
not required to discuss the propriety of a separate hallux valgus
evaluation under DC 5280 and any
language in the Board decision suggesting otherwise is harmless error.5
See Sanders, 556 U.S. at
Finally, Ms. Flippen contends that the June 2013 VA examination is
inadequate because it
did not adequately discuss or distinguish between service-connected and
symptoms. Reply Br. at 3-4. The veteran did not challenge the adequacy of
examination in her opening brief and such argument is not necessary to
respond to an issue raised
in the Secretary’s brief. Thus, the Court deems this argument abandoned
and will not address it. See
Henderson v. West, 12 Vet.App. 11, 18-19 (1998) (holding that an argument
in the appellant’s reply brief is considered abandoned); see also Emenaker
v. Peake, 551 F.3d 1332,
1339 (Fed. Cir. 2008) (“[T]he Veterans Court is not required to consider
an appellant’s argument that
is made for the first time in a reply brief in that court.”).
Upon consideration of the foregoing, the January 13, 2014, Board decision
pes planus is AFFIRMED and the remainder of the appeal is DISMISSED.
The Court notes that, even if hallux valgus were service connected, it
does not appear it would be entitled to
a compensable 10% evaluation, which requires for unilateral hallux valgus
an operation with resection of the metatarsal
head or severity equivalent to amputation of the great toe. 38 C.F.R. § 4.
71a, DC 5280; see R. at 125 (October 2012
VA examination indicating that the veteran has not had surgery for hallux