Citation Nr: 1306446 Decision Date: 02/25/13 Archive Date: 03/01/13 DOCKET NO. 10-10 050 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for a left ankle disorder. ATTORNEY FOR THE BOARD S. Keyvan, Associate Counsel INTRODUCTION The Veteran had active military service from July 1971 to November 1980 and subsequent service in the Reserves during the 1980s. This matter comes to the Board of Veterans' Appeals (Board) from an April 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to service connection for a left ankle disorder. A notice of disagreement was filed in May 2009 and a statement of the case was issued in January 2010. In February 2010, the Veteran filed a substantive appeal with regard to his claim. In June 2011, the Board remanded the Veteran's claim so that additional evidentiary development could be undertaken. Specifically, the claim was remanded so the Agency of Original Jurisdiction (AOJ) could obtain the Veteran's service treatment records for his period of service with the Reserves after 1980. The Board also remanded the Veteran's claim to retrieve outstanding private medical records relating to treatment provided for his left ankle, as well as his updated VA treatment records. In addition, the Board requested another VA medical opinion as to whether the Veteran's claimed disorder had its onset in service, or is otherwise related to service. As will be discussed in greater detail in the decision, the Appeals Management Center (AMC) contacted several sources in an attempt to locate the Veteran's treatment records during his period of service with the Reserves since July 1980. Despite numerous attempts, they were unable to retrieve these records, and a Formal Finding on the Unavailability of treatment records from the Veteran's period of service in the Reserves since July 1980 was issued in October 2012. The Veteran's private treatment records as well as his updated VA treatment records have since been obtained and associated with the claims file. In addition, another VA medical opinion was issued in September 2011, and a copy of this opinion has been associated with his claims file. The AMC subsequently readjudicated the claim in the October 2012 Supplemental Statement of the case (SSOC). Thus, the AOJ has complied with all of the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). FINDING OF FACT Chronic disability of the left ankle did not have its clinical onset in service and is not otherwise related to active duty. CONCLUSION OF LAW The Veteran does not have a left ankle disability that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION I. Duties to Notify and Assist At the outset, the Board will address the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), enacted in November 2000. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, and 5107 (West 2002 & Supp. 2012). To implement the provisions of the law, VA promulgated regulations codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a)(2012). The VCAA and its implementing regulations include, upon the submission of a substantially complete application for benefits, an enhanced duty on the part of VA to notify a claimant of the information and evidence needed to substantiate a claim, as well as the duty to notify the claimant of what evidence will be obtained by whom. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In addition, they define the obligation of VA with respect to its duty to assist a claimant in obtaining evidence. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). In this case, the Board finds that all notification and development action needed to arrive at a decision has been accomplished. In this respect, through a February 2008 notice letter, the Veteran received notice of the information and evidence needed to substantiate his claim. Thereafter, he was afforded the opportunity to respond. Hence, the Board finds that the Veteran has been afforded ample opportunity to submit information and/or evidence needed to substantiate his claim. The Board finds that the February 2008 notice letter satisfies the statutory and regulatory requirement that VA notify a claimant what evidence, if any, will be obtained by the claimant and which evidence, if any, will be retrieved by VA. See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). In the letter, the RO also notified the Veteran that VA was required to make reasonable efforts to obtain medical records, employment records, or records from other Federal agencies. The RO also requested that the Veteran identify any medical providers from whom he wanted the RO to obtain and consider evidence. Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. See Pelegrini v. Principi, 18 Vet. App. 112, 121 (2004). See also Notice and Assistance Requirements and Technical Correction, 73 Fed. Reg. 23,353 (Apr. 30, 2008) (to be codified at 38 C.F.R. § 3.159) (removing the prior requirement that VA specifically ask the claimant to provide any pertinent evidence in his possession). These requirements were met by the aforementioned February 2008 letter. Further, the Veteran was provided notice regarding an award of an effective date and rating criteria in the February 2008 letter. See Dingess/Hartman v. Nicholson, 19 Vet. App. 472 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Nothing about the evidence or any response to the RO's notification suggests that the case must be re-adjudicated ab initio to satisfy the notice requirements of the VCAA. There is no indication that any additional action is needed to comply with the duty to assist in connection with the claim on appeal. The Veteran's service treatment records as well as all identified and available private and VA treatment records pertinent to the years after service are in the claims file and were reviewed by both the RO and the Board in connection with the service connection claims adjudicated herein. Pursuant to the June 2011 Board Remand, the AMC attempted to obtain any treatment records pertaining to the Veteran's period of service in the Reserves since July 1980. Letters dated in July 2011 and September 2011 were sent to the Marine Corps Archives and Special Collections Unit and the National Archives and Records Administration (NARA), requesting any information and/or service records pertaining to treatment provided for the Veteran's claimed left ankle injury during his period of service in the Reserves. Letters dated in July and September 2011 were also sent to the U.S. Naval and Marine Corps Reserve unit, and requested any information as to the Veteran's period of service in the Reserves, to include copies of all physical examination reports, service treatment records, and line of duty determinations. In a letter dated in November 2011, the National Personnel Records Center (NPRC) indicated that they were unable to locate the specified records. It was further noted that the military records had been removed from the file area in an attempt to respond to a previous inquiry, and despite conducting an extensive search, these records had not been located. In a December 2011 letter addressed to the NPRC, the AMC indicated that they had contacted the U.S. Marine Headquarters in Quantico, Virginia, who had instructed them to contact the NPRC again. The AMC once again requested a copy of any service treatment records and line of duty determinations pertaining to the Veteran's period of service in the Reserves since 1980. They also asked that if the NPRC did not have, or could not locate the Veteran's service records, that they provide any information that may help the AMC retrieve these records. A February 2012 request under the Personnel Information Exchange System (PIES) once again requested information and/or treatment records pertaining to the Veteran's period of service in the Reserves since July 1980. A negative response was generated in September 2012 indicating that there were no additional service treatment records on file for the Veteran. An October 2012 Report of General Information form reflects that during a telephone conversation with a representative at the Navy and Marine Corps Reserve, it was discovered that all records were sent to Marine Corps Headquarters in Quantico, VA after three years. The Report of General Information form also reflects that Veteran was subsequently contacted via telephone, and informed that the AMC had contacted a number of repositories in an attempt to locate his treatment records associated with his period of service in the Reserves since July 1980, but had been unsuccessful in retrieving these records. According to the Veteran, he did not have any treatment records from his Reserve service dating from July 1980, nor did he know the location of these records. In October 2012, the AMC issued a Formal Finding on the Unavailability of treatment records from the Veteran's service in the Reserves since July 1980, and listed the various attempts made to locate the Veteran's records. According to the memorandum, all procedures to obtain records pertaining to the Veteran had been correctly followed, all efforts to obtain the needed information had been exhausted, and any further attempts were futile. [Currently, the service treatment records associated with the Veteran's claims file consist of examination and medical history reports, sick call and clinical treatment records and dental records - all of which are associated with the Veteran's period of active service from July 1971 to November 1980; as well as physical examination reports dated in March 1983, July 1984 and May 1985.] Based on the foregoing, the Board concludes that VA has done everything reasonably possible to assist the Veteran in obtaining his complete service treatment records and that the Veteran has not contended otherwise. If there is additional available evidence to help substantiate the Veteran's claim, the RO cannot obtain these records without further assistance from the Veteran. The United States Court of Appeals for Veterans' Claims (Court) has held that the duty to assist is not a one way street and that an appellant must do more that passively wait for assistance when he has information essential to his claim. Wood v. Derwinski, 1 Vet. App. 190 (1990). Furthermore, in accordance with the June 2011 Remand, the AMC obtained the Veteran's more recent VA medical records dated from September 2009 to October 2011, as well as additional private medical records issued by A.G., M.D. (dated in September 2009), and W.K., M.D. (dated in July 2009), and associated these records with the claims file. Significantly, the Veteran has not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. The duty to assist also includes obtaining a medical examination/opinion when such is necessary to make a decision on the claim, as defined by law. A VA examination with respect to the issue on appeal was conducted in April 2009, and a VA medical opinion was obtained in September 2011. 38 C.F.R. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA examinations and medical opinions obtained in this case are adequate, as they were predicated on a review of the Veteran's medical records, an interview of the Veteran and a discussion of his medical history. Both medical opinions consider all of the pertinent evidence of record, to include statements given by the Veteran at the time of the VA examination, and provide a complete rationale for the opinions stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the claims on appeal has been met. 38 C.F.R. § 3.159(c)(4). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome here, the Board finds that any such failure is harmless. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). II. Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish direct service connection for a disorder, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of a disease contracted, an injury suffered, or an event witnessed or experienced in active service; and (3) competent evidence of a nexus or connection between the disease, injury, or event in service and the current disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent". However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Where the Board is presented with conflicting medical evidence, it is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). In this regard, the Board notes that the Federal Circuit and the Court have both specifically rejected the "treating physician rule." See White v. Principi, 243 F.3d 1378 (Fed. Cir. 2001); Guerrieri v. Brown, 4 Vet. App. 467 (1993). Instead, in Guerrieri, the Court offered guidance on the assessment of the probative value of medical opinion evidence. The Court instructed that it should be based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical opinion that the physician reaches. Id. at 470-71; see also Wensch v. Principi, 15 Vet. App. 362, 367 (2001) (it is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons and bases); Owens v. Brown, 7 Vet. App. 429, 433 (1995) (Board favoring one medical opinion over another is not error). The Veteran contends that his current left ankle disorder was incurred in service. Specifically, the Veteran claims that he originally injured his left ankle after a fire extinguisher fell on it in service. He further claims to have injured his left ankle another time while participating in an intra-squadron game. See March 2008 Statement of Veteran. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for a left ankle disorder. Turning to the service treatment records, the Board notes that an April 1971 entry examination was negative for any complaints, treatment or diagnosis of a left ankle disorder. The clinical evaluation of the Veteran's lower extremities was shown to be normal, and the Veteran denied a history of problems in his lower extremities in his medical history report. In addition, the Veteran had a physical profile of 'P1' at the time of this examination. See Odiorne v. Principi, 3 Vet. App. 456, 457 (1992) (observing that the 'PULHES' profile reflects the overall physical and psychiatric condition of the Veteran on a scale of 'P1' (high level of fitness) to 4 (a medical condition or physical defect which is below the level of medical fitness for retention in the military service)). In August 1972, the Veteran presented at the military clinic with complaints of a possible stress fracture to the left tibia area. Upon physical examination of the left ankle, the treatment provider observed no evidence of pain during dorsal flexion, but did note that the left ankle was painful when pressure was applied to it. The Veteran was seen at the military clinic again one week later, at which time, he reported that his foot had been run over by a tractor. The X-ray report was negative for any signs of a fracture. A review of the Veteran's November 1974 re-enlistment examination was clear for any complaints of, or treatment for, left ankle problems. A March 1979 sick call note reflects that the Veteran twisted his left ankle during a game of softball. He was diagnosed with a left ankle sprain and the medical course of treatment included ice and an Ace wrap. Health records dated in September 1979 reflect that the Veteran presented at the military clinic several times with complaints of ongoing pain in his left ankle. Results of the left ankle X-rays were negative, and he was assessed with a left ankle strain, and treated with ice, heat, and an Ace wrap. At the July 1980 separation examination, the clinical evaluation of the Veteran's lower extremities was shown to be normal, and the Veteran did not report a history of foot trouble or any problems with the lower extremities in the medical history report. In September 1980, the Veteran was taken to the hospital emergency room, at which time he presented with complaints of pain in his left foot. It was noted that a cylinder of some sort had exploded and struck his left foot, and the Veteran was diagnosed with a fracture of the medial first metacarpal of the left foot, and placed in a short leg cast. The treatment provider instructed him to wear the short leg cast and to only participate in light duty exercises the following fourteen days. Subsequent examination reports dated in March 1983, July 1984, and May 1985 were also clear for any complaints, signs, notations or treatment for left ankle problems. The evidence clearly shows the Veteran's complaints of left ankle pain during his period of service. However, the weight of the evidence demonstrates that during the Veteran's service there was no combination of manifestations sufficient to identify a left ankle disability so as to establish chronicity of such claimed disorder during service. 38 C.F.R. § 3.303(b). Service treatment records reflect an acute left ankle strain and sprain on various occasions and subsequent healing of that strain; there was no actual clinical finding of chronic left ankle disability. Thus, while the Veteran underwent episodes of left ankle pain while on active duty service, the service treatment records do not reflect a chronic left ankle disability. To the contrary, the evidence indicates that the left ankle symptoms experienced during active duty service were of an acute and transitory nature. As chronicity in service has not been established, a showing of continuity of symptoms after discharge is required to support the Veteran's claim for service connection for a lumbar spine disability. 38 C.F.R. § 3.303(b). With regard to the continuity of post-service symptomatology, a review of the record reflects that many years elapsed following service before the Veteran was treated for his left ankle. Indeed, the post-service record on appeal is negative for any findings of complaints, treatment or diagnosis of a left ankle disorder until many years after his separation from service. The first post-service medical evidence of record reflecting the Veteran's complaints of left ankle pain is an April 2008 VA primary care note, wherein the Veteran reported that he was experiencing pain in the left ankle region - similar to the area he injured in service. VA treatment records dated in April 2008 and January 2009 reflect the Veteran's complaints of ongoing pain in his left foot and ankle region. During the April 2008 VA treatment visit, the Veteran recalled injuring his left ankle in service and reported to experience intermittent swelling and pain in the left foot near the medial ankle. Upon physical examination, the treatment provider observed mild local swelling and tenderness in the left arch of the foot extending just below the left ankle medially. At the January 2009 podiatry consultation, the treatment provider acknowledged the Veteran's complaints of pain in the left foot and ankle, assessed him with pes planovalgus of the left lower extremity with PTTD [posterior tibial tendon dysfunction] and prescribed a "[r]itchie type brace" for the left foot. The Veteran was afforded a VA examination for his left ankle in April 2009. During the examination, the Veteran provided his military history and described the circumstances surrounding his multiple left ankle injuries in service. The Veteran reported to experience pain in the medial aspect of his foot, and described his foot as unstable without his brace. On a scale of one to ten (with one being the lowest level of pain and ten being the highest), the Veteran rated his pain level at a four, but added that it can increase to an eight or nine. Based on his review of the service treatment records, the VA examiner acknowledged the Veteran's treatment for a left ankle sprain in service, and noted that the Veteran was treated through conservative measures and that the Veteran's left ankle injury appeared to have resolved. Upon physical examination, the Veteran was shown to have dorsiflexion to 10 degrees and plantar flexion to 40 degrees. The examiner did not observe any pain during range of motion exercises. He (the VA examiner) also reviewed the April 2008 X-ray films which were clear for any fractures, dislocations or bony destructive lesions, but did reveal the presence of an osteophyte "at the inferior margin of the calcaneus at the origin of the plantar fascia as well as an enthesophyte at the insertion of the Achilles tendon on the posterior aspect of the calcaneus." Based on his review of the claims file, as well as his discussion with, and evaluation of, the Veteran, the VA examiner diagnosed the Veteran with stage 2 posterior tibialis tendon dysfunction; residuals of ankle sprain; and flexible pes planus secondary to posterior tibialis tendon dysfunction. According to the VA examiner, the Veteran's left ankle sprain is less likely than not related to his in-service ankle sprain. The VA examiner acknowledged the Veteran's treatment for an ankle sprain in service but determined that the Veteran now has posterior tibialis tendon dysfunction, a condition which involves a different entity. According to the VA examiner, most ankle sprains occur on the medial side of the ankle, and while the posterior tibialis tendon is located on the medial side of the ankle, it is probably something that developed gradually over time and is not related to a specific acute injury. During a May 2009 treatment visit with his private physician, W.S., M.D., the Veteran relayed his military and medical history and reported to experience problems with his left ankle since injuring it multiple times in service. According to the Veteran, he experiences problems with his mobility and has a hard time getting around as a result of his left ankle condition. Based on his evaluation of the Veteran, Dr. W.S. assessed the Veteran with chronic flat foot on the left with previous injuries that are causing his foot to essentially become less and less useful. According to Dr.W.S., the Veteran would require surgery to recover from this condition. The Veteran was seen by his private physician, Dr. W.K., in July 2009, at which time, he reported pain in the left ankle of two to three years duration. The Veteran related his current left ankle condition to his in-service injury and reported that the ankle hurts slightly when he walks on the medial and lateral sides. Upon physical examination of the Veteran, Dr. W.K. noted that the Veteran's left foot dorsiflexion was ten to fifteen degrees less than the right foot, and his plantar flexion was also a few degrees less than the right ankle. He also observed extreme pronation and loss of arch in the left foot. The Veteran also underwent an X-ray of the left ankle, the results of which were shown to be normal. In an undated opinion, Dr. W.K. concluded that after evaluating the Veteran's left ankle and reviewing his medical history, he was sure "it was cause[d] by a injury why he was in mil[i]tary service. . . ." This opinion was reiterated in the August 2009 office record issued by Dr. W.K. In September 2009, the Veteran was referred to, and evaluated by, another private physician, A.G., M.D. During the interview portion of the evaluation, the Veteran described a worsening pain over the medial aspect of his ankle and arch of his left foot in the past three years. The Veteran attributed his left ankle problems to injuries he sustained in service, and went on to describe his in-service injuries, as well as the type of medical treatment he received afterwards. According to the Veteran, while the left foot had always been flatter since these in-service incidents, he did not begin experiencing pain in this region until three years prior. Upon physical examination, Dr. A.G. noted that the Veteran had dorsiflexion to 0 degrees and plantar flexion to 40 degrees. Dr. A.G. also observed tenderness to palpation over the medial aspect of the ankle and over the course of the posterior tibialis tendon - particularly at the insertion site at the navicular bone. The Veteran also underwent an X-ray of the left ankle, the findings of which revealed "sagging at the talonavicular joint" as well as the presence of very small accessory navicular bones bilaterally. Based on his discussion with, as well as his evaluation of the Veteran, Dr. A.G. diagnosed the Veteran with left stage II posterior tibialis tendon insufficiency. The remainder of the Veteran's post-service VA treatment records revealed diagnoses of chronic left foot/ankle pain (July 2009 practitioner note); and left pes planus and severe valgus deformity at the ankle with pain on weight bearing (October 2009 and December 2009 Physical Medicine Rehab E & M note). The Veteran underwent an evaluation of his feet in February 2011, the findings of which revealed "severe pronation on the left" and a "semi-flexible" left arch. Based on his evaluation of the Veteran, the VA physician assessed the Veteran with posterior tibial tendon dysfunction of the left foot; tibialis posterior tendonitis of the left foot, and left pes planus. VA treatment records dated in July 2011 reflect that the Veteran underwent a number of surgical procedures on the left foot, to include a left medial calcaneal slide osteotomy; a left gastroc recession; left subtalar arthroereisis; and a repair of the left tibialis posterior tendon with advancement. In September 2011, another VA examiner reviewed the Veteran's claims file and issued a medical opinion as to the etiology of the Veteran's current left ankle condition. Based on his review of the medical records, the VA examiner assessed the Veteran with stage 2 posterior tibialis tendon dysfunction of the left foot, and determined that the Veteran did not have any current residuals of a left ankle sprain/strain in service. The VA examiner also concluded that the Veteran's left ankle condition is not caused by or a result of his active duty. In reaching this opinion, the VA examiner acknowledged the Veteran's in-service ankle injuries in 1972 and 1979, but determined that "[t]here is absolutely no evidence of residuals of this condition while in service or evidence of a chronic condition following service." The VA examiner relied on the 1983, 1984 and 1985 physical examination reports, which were silent for a left ankle problem, in arriving at this conclusion. With respect to the April 2009 VA examination findings and diagnosis, the VA examiner determined that such findings revealed a problem of the Achilles tendon which is completely unrelated to his service ankle sprains. Thus, according to the VA examiner, the Veteran does not currently have any residuals of an ankle sprain/strain and "his tibialis tendon dysfunction is most likely a gradual problem that developed over time and is in large part related to his work which requires significant walking and standing." Upon consideration of the above evidence, the Board finds that the preponderance of the evidence is against the Veteran's claim of service connection for a left ankle disability. With regard to this claim, the Board notes that the existence of a current diagnosed disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, the greater weight of the evidence points to the Veteran not having any chronic left ankle pathology. The Board notes that neither the September 2011 VA examiner, nor the Veteran's private treatment physicians have identified a current disease, and a review of the entire medical evidence of record is completely absent for a clear and definitive diagnosis pertaining to the left ankle joint. While the April 2009 VA examiner assessed the Veteran with residuals of the ankle sprain, he did not explain what these residuals were. The April 2009 VA examiner further determined that the Veteran's current "left ankle condition" was less likely than not related to his in-service ankle sprain, and explained that the Veteran currently has posterior tibialis tendon dysfunction - a condition that involves a separate entity from that of the ankle. Furthermore, the Veteran's treatment physicians, Drs. W.S., W.K, and A.G., have not diagnosed the Veteran with a left ankle disability. The Board acknowledges the August 2009 office record as well as the undated medical opinion issued by Dr. W.K. relating the Veteran's left ankle problems to service. However, it should be noted that neither opinion reflected a diagnosed left ankle disability, nor has Dr. W.K. ever diagnosed the Veteran with a left ankle disability. Indeed, the July 2009 X-ray findings indicate that the Veteran's left ankle was normal, and a review of the progress notes are clear for an actual diagnosis of a left ankle disability. Moreover, it is unclear from the opinion provided, whether Dr. W.K. reviewed the Veteran's service treatment records and medical records in their entirety prior to issuing his opinion. Indeed, Dr. W.K. failed to address the July 1980, March 1983, July 1984 and May 1985 examination reports which were clear for any treatment for, or signs or complaints of left ankle problems, nor did he discuss the extended evidentiary gap between the Veteran's active military service, and his first complaints of ankle problems twenty-eight years later. Furthermore, Dr. W.K. did not provide a rationale or explanation as to how he reached his conclusion. As such, the opinions submitted by Dr. W.K. are of little probative value because they (1) failed to provide an actual diagnosis of a left ankle disability, and (2) are not predicated on a thorough review of the claims file. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (which stipulates that it is what an examiner learns from the claims file for use in forming the expert opinion that matters. When the Board uses facts obtained from one opinion over another, it is incumbent upon the Board to point out those facts and explain why they were necessary or important in forming the appropriate medical judgment.) Conversely, the April 2009 VA examination report, in conjunction with the September 2011 VA medical opinion, includes a physical examination of the Veteran, a review of the Veteran's claims file, and a concrete opinion concerning whether the Veteran had a current left ankle disability. The September 2011 VA examiner acknowledged the Veteran's in-service injuries, but based on his review of the service and post-service treatment records, he still found no evidence of any residuals associated with injuries sustained during the Veteran's period of service, or any evidence of a chronic condition following his service. In reaching this conclusion, the VA examiner relied on the examination reports in service which were clear for any complaints of, or treatment for, a left ankle disorder, as well as the April 2009 VA examination findings, which reflected problems with the Achilles tendon, something the examiner described as "completely unrelated to his service ankle sprains." Both VA examiners determined that the Veteran's diagnosed tibialis tendon dysfunction was a gradual problem that developed over time, and was not related to his in-service injury. To the extent that the April 2009 diagnosis of residuals of left ankle sprain was reflective of a definite left ankle disability, the Board still concludes that the Veteran is not entitled to service connection for a left ankle disorder. As previously discussed above, the Board finds the August 2009 office record and undated medical opinion submitted by Dr. W.K. to be of limited probative value and insufficient to grant the Veteran's claim. Furthermore, the April 2009 VA examiner opined that the Veteran's current left ankle residuals were less likely than not related to his in-service ankle sprains, noting that the Veteran received treatment for these injures in service, and his current left foot disability was an entity that was wholly separate from his left ankle and something that had developed gradually over time. This opinion was reiterated in the September 2011 VA medical opinion. The Board has considered the Veteran's assertions that he has a left ankle disorder that is related to his time in service. However, as a layperson, the Veteran is not competent to give a medical opinion on the diagnosis of this claimed disorder. He is competent to report on symptoms he experienced either during or following service, but not to say what any diagnosis is. Thus, while the Veteran is competent to report symptoms observable to a layperson, such as pain in the left ankle area, a diagnosis that is later confirmed by clinical findings, or a contemporary diagnosis, he is not competent to independently provide a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Further, the April 2009 and September 2011 VA examiners considered the Veteran's report of in-service and post-service symptoms in reaching their medical conclusions. Consequently, in this case, lay assertions of medical diagnosis or etiology cannot constitute evidence upon which to grant a claim for service connection. Lathan v. Brown, 7 Vet. App. 359, 365 (1995). Moreover, even if the Veteran's contentions could be read as claiming continuity of symptomatology since service, the medical evidence of record discloses twenty-eight years from the time the Veteran separated from active service and the first evidence of record indicating treatment for the left ankle. As previously discussed above, the Veteran himself admitted that he first began experiencing pain in his left ankle three years prior. See September 2009 treatment report with Dr. A.G. In the absence of any objective evidence to support his complaints of continuity of symptomatology in the years since service, the initial demonstration of left ankle problems twenty-eight years after service is too remote from service to be reasonably related to service and diminishes the reliability of the Veteran's current recollections. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (holding, in an aggravation context, that the Board may consider a prolonged period without medical complaint when deciding a claim). Therefore, the Board concludes that the preponderance of the evidence is against the Veteran's claim for service connection for a left ankle disorder. See 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303. Because the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt provision does not apply. See Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, the Board concludes that service connection for a left ankle disorder is not warranted. ORDER Entitlement to service connection for a left ankle disorder is denied. ____________________________________________ THOMAS J. DANNAHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs