Citation Nr: 18139985 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 16-25 345 DATE: October 2, 2018 ORDER Service connection for a right knee strain is denied. A compensable rating for residuals of fractured right second metatarsal is denied. FINDINGS OF FACT 1. The Veteran’s right knee strain is not shown to have been caused by his service connected right foot disability. 2. The Veteran’s stress fracture residual of the second metatarsal of the right foot has been manifested by symptoms equivalent to a mild degree of severity. CONCLUSIONS OF LAW 1. The criteria for service connection for right knee strain have not been met. 38 U.S.C.§§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 2. The criteria for a compensable rating for residual, fractured right second metatarsal have not been met. 38 U.S.C § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.71a, Diagnostic Codes 5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1993 to March 1994. This matter is on appeal from a June 2015 rating decision. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). In general, service connection requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service connected disability. The Veteran contends developed a right knee disability as a result of his service connected right foot fracture. Service treatment records are silent for complaints, treatment, or diagnosis of a right knee condition. His separation examination reported normal clinical findings in relation to his knees. Post service, a May 2015 VA treatment record noted that the Veteran complained of a right knee injury after twisting it when he rose from a sitting to standing position. As a result, his knee was in pain all weekend. Imagining result of the right knee showed no acute osseous or adjacent soft tissue abnormality. At a VA examination dating June 2015, the Veteran was found to have a right knee strain. The Veteran told the examiner that his strain was a result of his service connected right foot condition and a recent injury after twisting it. He reported flare-ups of the knee approximately once every two weeks. He demonstrated an abnormal range of motion, with slight limitation of flexion. However, the examiner concluded that it was less likely than not that the Veteran’s right knee disability related to his service connected foot condition. The examiner found no abnormalities in the Veteran’s gait or standing due to his foot. There was also no ankle problem that would have affected the Veteran’s knee. Rather than finding documentation of a right knee condition in service, the examiner noted that the Veteran had recently complained of injury to a right knee. In his Notice of Disagreement, the Veteran asserted that the June 2015 VA examination was inadequate because the VA examiner was preoccupied with his own personal issues rather than conducting a sufficient examination of his knee. In reviewing the VA examination report, the Boards finds that the examination was adequate as it was performed by a medical professional and was based on a thorough physical examination of the Veteran. The examination includes an extensive review of the record with a timeline of the Veteran’s post-service medical history, citing to examples in support of the rationale. Consideration has been given to the Veteran’s allegation that he had problems with his knee because of his service connected right foot. He is clearly competent to report symptoms of knee pain as well as injury. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, while the Veteran may describe knee pain, he lacks the medical training or qualification to diagnose a knee disability or to determine its etiology. Id. His opinion therefore cannot provide the requisite nexus and does not refute the medical opinion of record. The record does not contain evidence of a diagnosis of an ongoing knee condition related to his right foot condition, as the first evidence of knee problems does not appear until at least 2015, more than a decade after separation. The passage of time between the Veteran’s discharge and an initial diagnosis of the claimed disorder, while not dispositive, is one factor that weighs against the Veteran’s claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Here, a medical professional reviewed the Veteran’s contentions but ultimately, for reasons laid out above, concluded that it was less likely than not that the Veteran’s right knee problems were the result of his service connected right foot disability. Thus, based on the foregoing, service connection for a right knee disability is denied. Increased Rating The Veteran is currently assigned a noncompensable rating under 38 C.F.R. § 4.71a, DC 5284, which provides that a 10 percent disability rating is warranted if the disability is moderate, a 20 percent disability rating is warranted if the disability is moderately severe and a 30 percent disability rating is warranted if the disability is severe in nature. 38 C.F.R. § 4.17a, DC 5284. The words “moderate and “severe” are not defined in the rating schedule. Use of terminology by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Moderate is generally defined as “tending toward the mean or average amount.” Merriam-Webster’s Collegiate Dictionary, 798 (11th ed. 2003). Severe is generally defined as “of a great degree” or “serious.” Id. at 1140. Turning to the specifics of this case, the Veteran was granted service connection for a stress fracture in the second metatarsal of the right foot by a November 1995 rating decision, and assigned a noncompensable rating. He later filed a claim for an increased rating in February 2015. The Veteran was afforded a VA examination in May 2015. There, he was evaluated for residuals of his in-service right foot fracture. He reported chronic dull pain on site and asserted that his foot occasionally gives way. He denied any flare ups, and there was no evidence of swelling, characteristics callouses, extreme tenderness, decreased longitudinal arch height, marked deformity, or pronation on physical examination. There were also no signs of Morton’s neuroma, metatarsalgia, hammer toe, or symptoms due to hallux valgus. In summation, the examiner found the Veteran’s stress fracture residuals of the right foot collectively presented symptoms of a mild degree. An October 2015 imaging result showed a probable small subcortical cyst in the proximal first cuneiform bone and also near the head of the first metatarsal bone. However, there was no acute osseous process identified. There was also no appreciable tendinous or ligamentous injury. Finally, there is no mass or abnormal fluid collection. Given the Veteran’s treatment records, the Board finds that a compensable rating for a residual stress fracture of the right second metatarsal is not warranted. To warrant a higher rating, the Veteran’s symptoms must have demonstrated at least a moderate degree of severity, which he currently does not. Other Diagnostic Codes have been considered, such as Diagnostic Code 5276 for pes planus, Diagnostic Code 5277 for weak foot, Diagnostic Code 5278 for pes cavus, Diagnostic Code 5279 for metatarsalgia (Morton’s disease), Diagnostic Code 5280 for hallux valgus, Diagnostic Code 5281 for hallux rigidus, Diagnostic Code 5282 for hammer toe, Diagnostic Code 5283 for malunion or nonunion of the tarsal or metatarsal bones, and Diagnostic Code 8521for paralysis of the external popliteal nerve. However, none of these Diagnostic Codes would allow for higher ratings for the Veteran’s stress fracture residuals of the second metatarsal of the right foot. The Board is sympathetic to the concerns that have been voiced, and notes that the Veteran’s disability causes him some difficulty. However, the record contains no evidence showing that his stress fracture of the second metatarsal of the right foot rises to the level of assignment of a compensable rating. Furthermore, the Veteran has not specifically identified any symptoms that would merit a higher schedular rating. Thus, his claim for an increased rating is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N.Yeh, Associate Counsel