Citation Nr: 18148703
Decision Date: 11/08/18	Archive Date: 11/07/18

DOCKET NO. 16-44 404
DATE:	November 8, 2018
REMANDED
Entitlement to service connection for a left ankle disability is remanded.
REASONS FOR REMAND
The Veteran served on active duty from December 1975 to May 1980 and from July 1981 to February 1988.  This matter is before the Board of Veterans' Appeals (the Board) on appeal from a December 2014 rating decision. 
Service connection for a left ankle disability is remanded.
The Veteran's service treatment records show that he was seen in April 1981 when he injured his left ankle sliding into second base.  X-rays of the left ankle were consistent with a rupture of the Achilles tendon, but clinical correlation was recommended.  He was referred to a private orthopedist who noted in May 1981 that he had been evaluated the day after the injury and it was stated that he had torn ligaments in the left ankle.  The orthopedist noted that the Veteran had been seen with torn deltoid and lateral ligaments in the left ankle.  Examination found reduced swelling.  A short leg walking cast was applied.  In June 1985, he complained of left ankle pain after aerobics that morning.  There was tenderness to palpation to the distal Achilles.  He had full range of motion and no swelling was noted.  The assessment was left Achilles strain.  On January 1988 report of medical history, the Veteran denied foot trouble or bone or joint deformity. On the January 1988 service separation examination, the feet and lower extremities were normal.
On December 2014 VA examination, the diagnosis was arthritis of the left ankle.  The examiner opined that it was less likely as not that the Veteran's left ankle disability was incurred in or caused by service.  He noted that there were no findings on the examination that would correlate with an ankle injury in the early 1980’s.  He noted that there were no medical record showing recurring or chronic issue with the left ankle for more than 30 years.  Finally, the examiner stated that an ankle sprain is typically self-limiting and resolves within a few weeks, and that the Veteran's service treatment records did not reflect a significant ankle injury. 
In October 2016, D. Roussel, a podiatrist, stated that he had treated the Veteran for a few years.  He reviewed service treatment records provided to him.  He opined that with a reasonable degree of medical certainty that the Veteran's physical impairments with the left ankle are more likely than not to be related to service.  This was based on clinical examination and imaging studies that showed arthritis and pain associated with the left ankle.  It was consistent with the previous significant left ankle injury, and the only injury the Veteran had to the left ankle was in service.  
In view of the conflicting opinions, additional development is warranted. 
The matter is REMANDED for the following action:
Forward the Veteran’s record to the examiner who conducted the December 2014 VA examination for review and an addendum medical advisory opinion regarding the nature and likely etiology of his left ankle disability (if that provider is unavailable, or unable to provide the addendum opinion sought, forward the record to another appropriate VA provider for review and the opinions sought).  [If further examination of the Veteran is deemed necessary for the opinions sought, such should be arranged.]  The examiner should review the record and provide an opinion as to whether it is at least as likely as not (a 50 percent or higher probability) that the Veteran’s left ankle disability is related to service.  The examiner must consider the November 2016 opinion of the Veteran's podiatrist. 
The examiner must include rationale with all opinions.
 
M. H. HAWLEY
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	James R. Siegel, Counsel