Citation Nr: 18140156 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 14-03 395 DATE: October 2, 2018 ORDER Service connection for a right knee disability is denied. Service connection for a right ankle disability is denied. Service connection for a left knee disability as secondary to a right knee disability is denied. Service connection for a low back disability as secondary to a right knee disability is denied. Service connection for a hallux valgus deformity, right first metatarsophalangeal joint, as secondary to a right knee disability is denied. Service connection for meralgia paresthetica as secondary to a low back disability is denied. FINDINGS OF FACT 1. The Veteran currently has a right knee disability. However, the preponderance of the evidence does not demonstrate that the Veteran’s current right knee disability arose in or was caused by service. 2. The Veteran currently has a right ankle disability. However, the preponderance of the evidence does not demonstrate that the Veteran’s current right ankle disability arose in or was caused by service. 3. The Veteran currently has a left knee disability. However, the preponderance of the evidence does not demonstrate that the Veteran’s current left knee disability was caused or aggravated by a service-connected right knee disability. 4. The Veteran currently has a low back disability. However, the preponderance of the evidence does not demonstrate that the Veteran’s current low back disability was caused or aggravated by a service-connected right knee disability. 5. The Veteran currently has a hallux valgus deformity. However, the preponderance of the evidence does not demonstrate that the Veteran’s current hallux valgus deformity was caused or aggravated by a service-connected right knee disability. 6. The Veteran currently has meralgia paresthetica. However, the preponderance of the evidence does not demonstrate that the Veteran’s current meralgia paresthetica was caused or aggravated by a service-connected low back disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a left knee disability as secondary to a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for a low back disability as secondary to a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for a hallux valgus deformity, right first metatarsophalangeal joint, as secondary to a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for service connection for meralgia paresthetica as secondary to a low back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1979 to April 1982 with additional service in the United States Army Reserve and the Alabama Army National Guard. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a June 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In February 2015, the Veteran testified at a Board hearing before the undersigned. A transcript of the hearing is of record. In May 2016, the Board granted service connection for hemorrhoids and gastroesophageal reflux disease and dismissed service connection for obstructive sleep apnea as it had been withdrawn. The Board then remanded the issues mentioned above for further development. The Board finds there has been substantial compliance with its prior remand directives. 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 (1998)) violation when the examiner made the ultimate determination required by the Board’s remand). In a May 2012 VA treatment record associated with the Veteran’s claims file in June 2016, the Veteran reported that he received disability benefits from the Social Security Administration (SSA). In a separate December 2011 VA treatment record associated with the Veteran’s claims file in June 2016, the Veteran reported to a mental health professional that he was medically disabled due to a disc in his back. The Board acknowledges that normally VA has a duty to attempt to obtain SSA records when it has actual notice that the Veteran is in receipt of SSA disability benefits. See Murincsak v. Derwinski, 2 Vet. App. 363 (1992). However, the Board finds that obtaining the Veteran’s SSA records is not required in the instant case as the Veteran has limited his theory of entitlement regarding a low back disability as a disability caused or aggravated by his right knee. As the Board is denying service connection for a right knee disability, the Veteran’s SSA records are not relevant in the instant case. See Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2009). Service Connection Generally, establishing service connection requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Additionally, service connection may also be established for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). To substantiate secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). 1. Service Connection for Right Knee and Right Ankle Disabilities As an initial matter, the Board finds that the Veteran has current disabilities of the right knee and right ankle. Specifically, during a June 2016 VA examination, the examiner diagnosed the Veteran with a right patellar spur after diagnostic testing. Additionally, a May 2011 VA treatment record documented reports of right knee pain and the Veteran reported right knee pain during his February 2015 Board hearing. See Hearing Tr. at 4-5. Recently, in Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit held that pain alone, when causing functional impairment, may constitute a “disability” for VA compensation purposes, even if the pain is not with an accompanying diagnosis. 886 F.3d 1356, 1368 (Fed. Cir. 2018). Regarding the right ankle, the June 2016 examiner diagnosed the Veteran with a right ankle strain. At the February 2015 Board hearing, the Veteran testified that, since service, he easily sprains his ankle. See Hearing Tr. at 13. Next, the Board notes that a January 1981 service treatment record (STR) documents that the Veteran complained of general ankle and knee pain of several months duration. An examination of the knees revealed no instability, discoloration, swelling or limitation of motion. Comparatively, an examination of the right ankle revealed slight edema, limited range of motion, and tenderness to touch. The clinician assessed the Veteran with a sprained right ankle. The clinician did not provide any right knee diagnosis. Thereafter, the Veteran’s April 1982 separation examination did not document any right knee or ankle problems and a later April 1986 periodic examination from the Veteran’s Reserve service also did not document any right knee or ankle issues. Although the first 2 requirements for service connection on a direct basis have been met, the Board finds that, after reviewing the evidence of record, the requirement of nexus is lacking for both claimed disabilities. Accordingly, the Board must deny the issues of service connection for right knee and right ankle disabilities. In support of this determination, the Board considers significant the findings of the June 2016 VA examiner. Specifically, regarding the right knee, after examining the Veteran and reviewing the claims file, the examiner opined that it was less likely than not that the Veteran’s right knee disability was incurred in or caused by service. In support of this conclusion, the examiner noted that he considered the Veteran’s lay reports that (1) he was treated with pain medication in service, and (2) he had x-rays on his right knee in service. The examiner stated that this was not documented anywhere in the Veteran’s STRs. Lastly, the examiner stated that the Veteran did not have a knee condition diagnosed in service and there was no evidence of a chronic condition or ongoing treatment since separation. Turning to the right ankle, the examiner also opined that it was less likely than not incurred in or caused by service. In support of this determination, the examiner again noted that he took into account the Veteran’s lay reports of right ankle pain in service. The examiner explained that the Veteran was diagnosed with a right ankle strain in service and that strains are usually “self limiting without any sequela.” (citation internal quotation marks omitted). Similar to the right knee, the examiner stated that the Veteran had no evidence of a chronic or ongoing right ankle condition during active duty service. The Board agrees with the June 2016 VA examiner’s characterization of the Veteran’s right knee and ankle disabilities and finds the opinions to be adequate for adjudicative purposes. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Mainly, the only documented report of a knee or ankle-related issue in service was in the January 1981 STR noted above. Additionally, although the Veteran is competent to report about his experience of right knee and ankle pain, see Layno v. Brown, 6 Vet. App. 465 (1994), on the whole, the Board finds that the evidence is not at least evenly balanced to permit the benefit-of-the-doubt standard to result in grants of service connection. Accordingly, service connection for a right knee and right ankle disability is denied. 2. Service Connection for a Left Knee Disability, a Low Back Disability, and a Hallux Valgus Deformity As stated by the Veteran and his representative during the February 2015 Board hearing, the issues of service connection for a left knee disability, a low back disability, and a hallux valgus deformity were only claimed as secondary to a right knee disability. See Hearing Tr. at 8-12. As the Board is denying entitlement to service connection for a right knee disability, it must therefore also deny service connection for the left knee, low back, and hallux valgus as the second requirement for secondary service connection—i.e., evidence of a service-connected disability—has not been satisfied in the instant case. See 38 C.F.R. § 3.310(a). 3. Service Connection for Meralgia Paresthetica Relatedly, during the February 2015 Board hearing, the Veteran and his representative also indicated that the Veteran’s theory of entitlement for service connection for numbness in his left thigh was limited to only as secondary to the low back. See Hearing Tr. at 14. Accordingly, the Board must also deny the issue of service connection for meralgia paresthetica as the requirement of an already service-connected disability has not yet been satisfied. See 38 C.F.R. § 3.310(a). S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N.S. Pettine, Associate Counsel