Citation Nr: 1324061 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 06-32 279 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected postoperative hammertoe disorders. 2. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected postoperative hammertoe disorders. 3. Entitlement to service connection for a right ankle disorder, to include as secondary to service-connected postoperative hammertoe disorders. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD B. R. Mullins, Counsel INTRODUCTION The Veteran had active service from June 1978 to July 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran was scheduled to present testimony at a video conference hearing before a Veterans Law Judge in January 2009, but he failed to report to the hearing. As the Veteran has not requested that the hearing be rescheduled, the Board deems the Veteran's request for such a hearing to be withdrawn. See 38 C.F.R. § 20.702 (2012). In October 2009, the Board issued a decision which found that new and material evidence had been submitted to reopen the Veteran's claim of entitlement to service connection for a right knee disorder, and remanded the reopened claim and the remaining claims on appeal for additional evidentiary development. The claims were subsequently remanded by the Board again in February 2010 and June 2012 for additional development. FINDINGS OF FACT 1. The Veteran's left knee disorder did not manifest during, or as a result of, active military service, nor is it secondary to his service-connected postoperative hammertoe disorders. 2. The Veteran's right knee disorder did not manifest during, or as a result of, active military service, nor is it secondary to his service-connected postoperative hammertoe disorders. 3. The Veteran's right ankle disorder did not manifest during, or as a result of, active military service, nor is it secondary to his service-connected postoperative hammertoe disorders. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a left knee disorder, to include as secondary to service-connected postoperative hammertoe disorders, have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2012). 2. The criteria for establishing entitlement to service connection for a right knee disorder, to include as secondary to service-connected postoperative hammertoe disorders, have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2012). 3. The criteria for establishing entitlement to service connection for a right ankle disorder, to include as secondary to service-connected postoperative hammertoe disorders, have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify VA has a duty to notify and assist veterans in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Proper notice from VA must inform the Veteran of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the Veteran is expected to provide in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements apply to all five elements of a service-connection claim, including: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. Letters sent to the Veteran in March 2005, May 2005, June 2005 and June 2006 addressed all notice elements listed under 3.159(b)(1). The letters informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. While all necessary notice was not provided to the Veteran until after the initial adjudication of his claims, the claims were subsequently readjudicated, no prejudice has been alleged, and none is apparent from the record. See Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant notification followed by readjudication of the claim, such as a statement of the case or supplemental statement of the case, is sufficient to cure a timing defect). Under these circumstances, the Board finds that the notification requirements have been satisfied as to both timing and content. Adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board that complied with the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). Duty to Assist Next, VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting him in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). VA obtained the Veteran's service treatment records. Also, the Veteran received VA medical examinations in November 2009 and April 2010, and VA has obtained these records as well as the records of the Veteran's outpatient treatment with VA. The Veteran was scheduled for an additional VA examination in July 2012. However, the Veteran failed to report to this examination. A review of the record indicates that the Veteran was notified of this examination via letter sent to his address of record. This letter was not returned as undeliverable. The Veteran's failure to attend the examination was noted in the RO's January 2013 supplemental statement of the case, which was also mailed to the Veteran's address of record. Since then, VA has not received any statement of good cause from the Veteran for his failure to attend this examination. Private treatment records have also been obtaining and incorporated into the evidence of record. Significantly, neither the Veteran nor his representative has identified any additional existing evidence that is necessary for a fair adjudication of the claim that has not yet been obtained. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Additionally, the Board finds there has been substantial compliance with its most recent remand directives of June 2012. The Board notes that the Court has held that "only substantial compliance with the terms of the Board's engagement letter would be required, not strict compliance." See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268) violation when the examiner made the ultimate determination required by the Board's remand). The record indicates that the Appeals Management Center (AMC) scheduled the Veteran for an additional examination, although he failed to report. The AMC later issued a Supplemental Statement of the Case (SSOC). Based on the foregoing, the Board finds that the AMC substantially complied with the mandates of its remand. See Stegall, supra, (finding that a remand by the Board confers on the appellant the right to compliance with its remand orders). Relevant Laws and Regulations Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); see also Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). To establish service connection, there must be: (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999) (citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996)). Where a veteran has served for 90 days or more during a period of war, or during peacetime service after January 1, 1947, and a chronic disorder, such as arthritis becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309 (2012). In order to show a chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim. There must be competent medical evidence unless the evidence relates to a condition as to which lay observation is competent to identify its existence. See 38 C.F.R. § 3.303(b) (2012). A recent decision of the United States Court of Appeals for the Federal Circuit (Federal Circuit Court), however, clarified that this notion of continuity of symptomatology since service under 38 C.F.R. § 3.303(b), which as mentioned is an alternative means of establishing the required nexus or linkage between current disability and service, only applies to conditions identified as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Also, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. See 38 C.F.R. § 3.310(b); Libertine v. Brown, 9 Vet. App. 521, 522 (1996); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). An appellant's own conclusion, stated in support of his claim, that his present disability is secondary to his service-connected disability is not competent evidence as to the issue of medical causation. See 38 C.F.R. § 3.159 (2011); see also Grivois v. Brown, 6 Vet. App. 136 (1994). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that " [w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). Left Knee Disorder The Veteran contends that he is entitled to service connection for a left knee disorder. Specifically, the Veteran has alleged that this condition arose as secondary to his postoperative hammertoe disorders. He has also alleged that his injuries arose due to the hardships of military service, including parachute jumping. However, as outlined below, the preponderance of the evidence of record demonstrates that this disability is not secondary to his service-connected hammertoes and it did not manifest during, or as a result of, active military service. As such, service connection is not warranted. The Veteran's service treatment records fail to reflect treatment for a left knee injury or any associated symptomatology. The first evidence of record pertaining to the left knee is a November 2002 private treatment record noting left knee pain for the past month. This is approximately 18 years after the Veteran's separation from active duty. It was noted that there was no known trauma. A magnetic resonance image (MRI) performed at this time revealed a ruptured Baker's cyst with a very small remnant, edema, small loose bodies within the popliteus tendon sheath, a medial meniscus tear and a complex tear at the bottom and posterior horn of the lateral meniscus. Subsequent records continue to reflect complaints involving the left knee. A November 2004 record notes that the Veteran complained of arthritis in the knees, bilaterally. It was noted that he had a left knee torn meniscus repair in 2002. The Veteran was afforded a VA joint examination in November 2009. It was noted that the Veteran had bilateral knee pain with a history of prior surgery. The examiner diagnosed the Veteran with internal derangement of the left knee, postoperative. No opinion was offered regarding rationale. An additional examination was performed in April 2010. It was noted that there was no documentation of any knee injury in service. The examiner diagnosed the Veteran with post-operative degenerative arthritis of the knees. The examiner opined that it was not likely that this condition was related to service and it was not likely that it was related to the Veteran's hammertoes. The cited rationale was that there was no documentation of any injury or problems with either knee in service. The Board recognizes that the rationale offered in April 2010 is insufficient. As such, the Veteran's claim was remanded in June 2012 so that the Veteran could be scheduled for a new examination. This examination was scheduled in July 2012, but the Veteran failed to report to the scheduled examination. To date, VA has not received a statement of good cause for the Veteran's failure to report. Generally, when a veteran, without good cause, fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be decided based on the evidence of record. 38 C.F.R. § 3.655(b). While VA has a statutory duty to assist in developing evidence pertinent to a claim, the Veteran also has a duty to assist and cooperate with VA in developing evidence; the duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190 (1991). The preponderance of the evidence of record demonstrates that the Veteran is not entitled to service connection for a left knee disability, to include as secondary to service-connected hammertoe disabilities. There is no evidence of injury to the left knee during military service or any symptomatology associated with the left knee. The first evidence of record is from approximately 18 years after separation from active duty. When considering whether or not to grant a claim for service connection, the Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact, i.e., the lack of evidence is itself evidence). In the present case, the absence of any complaints involving the left knee for approximately 18 years tends to suggest that this condition has not existed since military service. Finally, the record contains no competent evidence linking this disability to military service. The only evidence regarding etiology is the negative nexus opinion offered in April 2010. The Board recognizes that the Veteran believes his disability is secondary to his service-connected hammertoe disabilities. However, the record does not reflect that the Veteran has the requisite training or expertise to offer a medical opinion as complex as linking one joint disability to another disability incurred many years earlier. The record contains no other evidence suggesting an etiological relationship, and the only evidence regarding etiology is the negative nexus opinion of April 2010. The Board recognizes that an opinion is less than adequate when based on the lack of in-service injury. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). However, the Board attempted to remedy this deficiency by scheduling the Veteran for a new examination. Nonetheless, in light of the Veteran's failure to report without good cause, the Board has proceeded to decide the Veteran's claim based on the evidence of record. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for a left knee disability, to include as secondary to service-connected hammertoe disabilities, must be denied. Right Knee Disorder The Veteran also contends that he is entitled to service connection for a right knee disorder. Specifically, the Veteran has alleged that this condition arose as secondary to his postoperative hammertoe disorders. He has also alleged that his injuries arose due to the hardships of military service, including parachute jumping. However, as outlined below, the preponderance of the evidence of record demonstrates that this disability is not secondary to his service-connected hammertoes and it did not manifest during, or as a result of, active military service. As such, service connection is not warranted. Service treatment records fail to reflect any injury to the right knee or any treatment for any associated symptomatology. The first evidence of record pertaining to the right knee is an April 1999 private treatment record. This is approximately 15 years after the Veteran's separation from active duty. It was noted that the Veteran was complaining of right knee pain for the past 10 days. There was no history of trauma and the pain worsened with walking. A MRI revealed no evidence of an anterior cruciate ligament tear or other ligamentous injury. However, there was joint effusion, a Baker's cyst and signal abnormality in the posterior horn and body of the medial meniscus on the inner aspect that appeared to contact the superior articular surface consistent with a meniscal tear. Subsequent records continue to reflect complaints involving the right knee. A November 2004 record notes that the Veteran complained of arthritis in the knees, bilaterally. It was noted that he had a right knee torn meniscus repair in 2000. The Veteran was afforded a VA joint examination in November 2009. It was noted that the Veteran had bilateral knee pain with a history of prior surgery. The examiner diagnosed the Veteran with internal derangement of the right knee, postoperative. No opinion was offered regarding rationale. An additional examination was performed in April 2010. It was noted that there was no documentation of any knee injury in service. The examiner diagnosed the Veteran with post-operative degenerative arthritis of the knees. The examiner opined that it was not likely that this condition was related to service and it was not likely that it was related to the Veteran's hammertoes. The cited rationale was that there was no documentation of any injury or problems with either knee in service. The Board again recognizes that the rationale offered in April 2010 is insufficient. As such, the Veteran's claim was remanded in June 2012 so that he could be scheduled for a new examination. This examination was scheduled in July 2012, but the Veteran failed to report to the scheduled examination. To date, VA has not received a statement of good cause for the Veteran's failure to report. As such, the Veteran's claim shall be decided based on the evidence currently of record. See 38 C.F.R. § 3.655(b). While VA has a statutory duty to assist in developing evidence pertinent to a claim, the Veteran also has a duty to assist and cooperate with VA in developing evidence; the duty to assist is not a one-way street. See Wood, 1 Vet. App. at 190. The preponderance of the evidence of record demonstrates that the Veteran is not entitled to service connection for a right knee disability, to include as secondary to service-connected hammertoe disabilities. There is no evidence of injury to the right knee during military service or any symptomatology associated with the right knee. The first evidence of record is from approximately 15 years after separation from active duty. In the present case, the absence of any complaints involving the right knee for approximately 15 years tends to suggest that this condition has not existed since military service. See Maxson, 12 Vet. App. at 459. Finally, the record contains no competent evidence linking the right knee disability to military service. The only evidence regarding etiology is the negative nexus opinion offered in April 2010. The Board again recognizes that the Veteran believes his disability is secondary to his service-connected hammertoe disabilities. However, as previously noted, the record does not reflect that the Veteran has the requisite training or expertise to offer a medical opinion as complex as linking one joint disability to another disability incurred many years earlier. The record contains no other evidence suggesting a positive etiological relationship, and the only evidence regarding etiology is the negative nexus opinion of April 2010. The Board is unable to consider any potentially positive evidence that may have resulted from the July 2012 examination due to the Veteran's failure to report without good cause, and as such, the evidence of record as it currently exists fails to relate a right knee disability to military service or service-connected hammertoe disabilities. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for a right knee disability, to include as secondary to service-connected hammertoe disabilities, must be denied. Right Ankle Disorder Finally, the Veteran contends that he is entitled to service connection for a right ankle disorder. Specifically, the Veteran has alleged that this condition arose as secondary to his postoperative hammertoe disorders. He has also alleged that his injuries arose due to the hardships of military service, including parachute jumping. However, as outlined below, the preponderance of the evidence of record demonstrates that this disability is not secondary to his service-connected hammertoes and it did not manifest during, or as a result of, active military service. As such, service connection is not warranted. The Veteran's service treatment records do not reflect any injury to the right ankle or complaint involving right ankle symptomatology. The first evidence of record involving the right ankle is a June 1998 X-ray report. This is approximately 14 years after separation from active duty. The right ankle was noted to have slight soft tissue swelling adjacent to the lateral malleolus. The bone was within the normal range, but there was a small calcification seen adjacent to the lateral aspect of the calcaneus. There was also calcification of the Achilles tendon attachment to the calcaneus. According to a November 2004 VA outpatient treatment record, the Veteran was complaining of chronic right ankle pain for the past 8 months. The Veteran also reported arthritis of both knees at this time. An X-ray revealed osteophyte formations at several bones with no acute bony abnormalities. A May 2006 record also notes right ankle pain for the past 18 months. Subsequent records continue to reflect complaints of right ankle pain. A May 2006 X-ray revealed no acute bony abnormality, but there was a large well-corticated ossification inferior to the medial malleolus. There was also spurring at the anterior talus. An August 2006 MRI revealed tenosynovitis of the flexor hallucis longus tendon, a fluid signal area above the calcaneus possibly due to posttraumatic and inflammatory changes, and a probable tear of the calcaneofibular ligament with soft tissue swelling. The Veteran was afforded a VA joint examination in November 2009. It was noted that the Veteran had ankle pain, aching, soreness and tenderness. The examiner diagnosed the Veteran with tendinitis, strain, of the right ankle. No opinion was offered regarding rationale. An additional examination was performed in April 2010. It was noted that there was no documentation of any ankle injury in service. The examiner diagnosed the Veteran with tendinitis to the right ankle. The examiner opined that it was not likely that this condition was related to service and it was not likely that it was related to the Veteran's hammertoes. The cited rationale was that there was no documentation of any injury or problems with the ankle in service. The Board again recognizes that the rationale offered in April 2010 is insufficient. As such, the Veteran's claim was remanded in June 2012 so that the Veteran could be scheduled for a new examination. This examination was scheduled in July 2012, but the Veteran failed to report to the scheduled examination. To date, VA has not received a statement of good cause for the Veteran's failure to report. As such, the Veteran's claim shall be decided based on the evidence currently of record. See 38 C.F.R. § 3.655(b). While VA has a statutory duty to assist in developing evidence pertinent to a claim, the Veteran also has a duty to assist and cooperate with VA in developing evidence; the duty to assist is not a one-way street. See Wood, 1 Vet. App. at 190. The preponderance of the evidence of record demonstrates that the Veteran is not entitled to service connection for a right ankle disability, to include as secondary to service-connected hammertoe disabilities. There is no evidence of injury to the right ankle during military service or any symptomatology associated with the right ankle. The first evidence of record is from approximately 14 years after separation from active duty. In the present case, the absence of any complaints involving the right ankle for approximately 14 years tends to suggest that this condition has not existed since military service. See Maxson, 12 Vet. App. at 459. Finally, the record contains no competent evidence linking the right ankle disability to military service. The only evidence regarding etiology is the negative nexus opinion offered in April 2010. The Board again recognizes that the Veteran believes his disability is secondary to his service-connected hammertoe disabilities. However, as previously noted, the record does not reflect that the Veteran has the requisite training or expertise to offer a medical opinion as complex as linking one joint disability to another disability incurred many years earlier. The record contains no other evidence suggesting a positive etiological relationship, and the only evidence regarding etiology is the negative nexus opinion of April 2010. The Board is unable to consider any potentially positive evidence that may have resulted from the July 2012 examination due to the Veteran's failure to report without good cause, and as such, the evidence of record as it currently exists fails to relate a right ankle disability to military service or service-connected hammertoe disabilities. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for a right ankle disability, to include as secondary to service-connected hammertoe disabilities, must be denied. ORDER The claim of entitlement to service connection for a left knee disorder, to include as secondary to service-connected postoperative hammertoe disorders, is denied. The claim of entitlement to service connection for a right knee disorder, to include as secondary to service-connected postoperative hammertoe disorders, is denied. The claim of entitlement to service connection for a right ankle disorder, to include as secondary to service-connected postoperative hammertoe disorders, is denied. ____________________________________________ WILLIAM YATES Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs