Citation Nr: 18150871 Decision Date: 11/16/18 Archive Date: 11/15/18 DOCKET NO. 16-23 313 DATE: November 16, 2018 ORDER Entitlement to service connection for a cervical spine disability is granted. Entitlement to service connection for a left hip disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a right ankle disability is denied. FINDINGS OF FACT 1. Resolving all doubt in the Veteran’s favor, the evidence shows that his cervical spine disability is causally related to active service. 2. The preponderance of the evidence is against finding that the Veteran’s left hip disability was incurred during or is otherwise causally related to active service. 3. The preponderance of the evidence is against finding that the Veteran’s left ankle disability was incurred during or is otherwise causally related to active service. 4. The preponderance of the evidence is against finding that the Veteran’s right ankle disability was incurred during or is otherwise causally related to active service. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a cervical spine disability have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 2. The criteria for establishing entitlement to service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 3. The criteria for establishing entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 4. The criteria for establishing entitlement to service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from April 1987 to May 2007. His decorations include a Combat Infantry Badge. These matters are before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. § 1110, 1131 (2012); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical ‘nexus’ requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303(a) (2018). Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). 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. 1. Entitlement to service connection for a cervical spine disability The Veteran contends that he suffers from a cervical sprain that is related to active service. Specifically, he asserts that he suffered a neck injury during service and his symptoms have persisted since that time. The Board concludes that the Veteran’s current diagnosis of cervical sprain is causally related to active service, to include as due to frequent complaints of neck pain therein. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a) (2018). Service treatment records show that the Veteran was treated for neck pain. A medical record, dated March 1994, indicated that the Veteran was involved in a motor vehicle accident (MVA) in February 1994. During the clinical evaluation, he reported sharp and throbbing pain in the neck and upper mid back. X-ray films yielded normal findings. Cervical range of motion was described at 75 percent at ranges, with slow guarded motion. The Veteran was diagnosed with a cervical sprain and a neck collar was provided. In an emergency care and treatment note, dated May 2000, notes the Veteran’s report of neck pain following another MVA. The Veteran described being rear-ended by another vehicle while travelling at 35 miles per hour (MPH). X-ray films of the cervical spine revealed normal findings. Tylenol and Motrin were prescribed to treat pain. Physical therapy treatments for neck pain were noted in May and June 2000. An October 2001 record indicated that the Veteran was treated for persistent neck and back pain due to a prior MVA. The pain was described as “chronic” and occurred with physical activity or prolonged sitting. Daily stretching improved the severity of his symptoms. Three separate MVAs were reported during the Veteran’s active service, to include in October 1998. Chronic neck pain was also noted in November 2001, with worsening symptoms over the prior 3-year period. A November 2006 report of medical examination at separation yielded normal findings. No complaints of neck pain or a cervical spine condition were indicated. On VA examination in July 2007, the Veteran reported chronic neck pain since 1994. He endorsed general stiffness and radiating pain, with aching and burning. Pain was described as an 8 on a 10-point scale. Range of motion testing yielded normal findings, with pain at the endpoints in all directions. X-ray findings were normal. The Veteran was diagnosed with a cervical strain. An orthopedic clinic record from October 2010 listed neck pain. The Veteran described chronic pain over the prior 10-year period. X-ray films of the cervical spine yielded normal findings. The Veteran was referred to a rheumatologist for consideration of a possible systemic inflammatory condition. In December 2010, a diagnosis of cervicalgia was noted. In November 2011, the Veteran was involved in a motor vehicle accident. He reported neck pain with radiation to the upper extremities. In February 2016, the Veteran was afforded an additional VA examination. Upon review of the record, the examiner opined that it was less likely than not that the Veteran cervical strain was causally related to active service. In support of the stated conclusion, the examiner acknowledged that the Veteran was treated for episodes of cervical pain and neck sprains on several occasions during service, but no symptoms or abnormalities were reported ay separation. Thus, the examiner concluded that there was no evidence of a chronic neck condition during service, and the Veteran’s current cervical condition is less likely related to active service. On review of the record and resolving all doubt in the Veteran’s favor, the Board finds that the evidence supports a finding that the Veteran’s cervical strain in causally related to active service. Specifically, service treatment records indicate that the Veteran was treated for numerous instances of neck pain and multiple cervical strains. At times, his symptoms were described as “chronic.” Shortly after his discharge from service, a July 2007 VA examiner diagnosed the Veteran with a cervical sprain. Post service treatment records reveal ongoing treatment for cervical pain and impaired range of motion, which predated the MVA in December 2011. Further, in multiple lay statements, the Veteran endorsed chronic neck pain. Lay statements from the Veteran’s wife and others, also assert corroborate the Veteran’s reports of ongoing neck symptoms since service. Thus, Board finds the lay statements both competent and credible. While the Board recognizes the VA examiner’s negative opinion, the examiner’s findings appeared to ignore favorable evidence suggesting chronic cervical spine symptoms that pre-dated the Veteran’s MVA in December 2011. Accordingly, more probative weight is assigned to the favorable medical evidence and credible lay statements of record. Resolving all doubt in the Veteran’s favor, the evidence supports a finding of service connection for a cervical spine disability. Therefore, the claim is granted. 2. Entitlement to service connection for a left hip disability. The Veteran contends that his left hip disability is casually related to active service, to include as due to complaints of hip pain therein. The preponderance of the evidence is against his claim. Service treatment records show that the Veteran complained of hip pain following a motor vehicle accident in December 2006. Specifically, the Veteran reported that he was struck by a car following a verbal altercation in a parking facility. During the clinical evaluation, paraspinal spasms were noted on the right side. Radiologic images of the pelvis and hips were normal and there was no evidence of traumatic, arthritic, inflammatory, or neoplastic changes. The sacroiliac and hip joints also appeared normal. No additional complaints of hip pain or any related injuries were reported. On his November 30, 3006 report of medical history at separation, the Veteran expressly denied having arthritis, rheumatism, or bursitis; impaired use of his legs; swollen or painful joints; or bone, joint, or other deformity. The corresponding report of medical examination at separation was silent for any abnormality pertaining to his left hip. In September 2007, the Veteran was afforded a VA examination. During the clinical evaluation, he reported persistent hip pain since 1995. He stated that his pain was associated with physical training, falling, and general wear and tear. No specific injury was endorsed. X-rays conducted in conjunction with the examination were within normal limits. Based on his reports of left hip pain, stiffness, and tenderness, the Veteran was diagnosed with a hip sprain. Private treatment records show that the Veteran’s hip abduction and flexion were within normal ranges in December 2010. An orthopedic evaluation in December 2011, mild tenderness of the Veteran’s hamstrings with hip flexion and knee extension. X-ray findings were negative. In February 2016, the Veteran was afforded a subsequent VA examination. He was diagnosed with trochanteric pain syndrome. Upon review of the record, the examiner opined that it is less likely than not that the Veteran’s hip condition was casually related to active service. In support of the stated conclusion, the examiner noted that there was no evidence of a chronic left hip condition in service. Moreover, the Veteran denied any hip pain at separation from service. The examiner also found that the medical records were against finding the existence of a longitudinal hip condition from service to present time. On that basis, the examiner opined that it was less likely as not that the Veteran’s current hip findings were secondary to his military service. After reviewing the evidence of record, the Board finds that the February 2016 VA opinion is the most probative evidence. The examiner reviewed the entire claims file, examined the Veteran, and noted his reports of in-service and post-service symptoms. The opinion was accompanied by a rationale for the conclusion reached. Accordingly, it is accorded great probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. While the Veteran is competent to report having experienced symptoms of hip pain since service, he is not competent to provide a diagnosis or determine that his symptoms were manifestations of similar symptoms in service. This issue is medically complex, as it requires specialized knowledge, training, and the ability to interpret complicated diagnostic testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Accordingly, the Board ultimately assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. Accordingly, as 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 hip disability must be denied. 3. Entitlement to service connection for a left ankle disability The Veteran asserts that his left ankle sprain is causally related to active service, to include as due to a left ankle sprain in service. The preponderance of the evidence is against his claim. Service treatment records show that the Veteran was treated for a left ankle sprain in March 1992. No obvious deformities were shown on X-ray films. A temporary profile was issued with restrictions on jumping and running. In June 1992, the Veteran’s left ankle condition was re-evaluated. Radiological films were silent for evidence of fracture, dislocation, or any underlying bone abnormality. His gait, range of motion, and muscle strength were all normal. No swelling was noted on physical examination. In January 1988, that Veteran underwent a bone scan of the left and right leg. Both ankles were included in the scan. Diagnostic findings yielded normal results. No acute abnormalities were shown. On his November 30, 3006 report of medical history at separation, the Veteran expressly denied having arthritis, rheumatism, or bursitis; swollen or painful joints; or bone, joint, or other deformity. The corresponding report of medical examination at separation was silent for any abnormality pertaining to his ankle. The Veteran was afforded VA examinations in July 2007 and January 2010. The examination reports are silent for any left ankle disability. Range of motion of the left ankle was normal. There was no evidence of edema, instability, effusion, weakness, tenderness, deformity, malalignment, guarded movement, or subluxation. No pain was reported with repetitive use testing and pain did not cause any functional loss. There was X-rays taken in conjunction with the July 2007 examination revealed no evidence of abnormality, malunion of the os calcis or astragalus of the left ankle. Post service treatment records show sporadic complaints of ankle pain, beginning in October 2010. Swelling was reported in March 2011. In January 2012, the Veteran underwent an orthopedic evaluation. He reported persistent ankle pain over several years. No specific injury was identified. The Veteran described pain over the medial and lateral aspects of the ankle, with worsening symptoms occurring at the end of the day. He denied any episodes of swelling, catching, locking, or instability. No numbness, weakness, or tingling in the lower extremities was reported. A physical examination revealed full range of motion of both ankles with no evidence of erythema, ecchymosis or erythema. However, diffused tenderness with palpation throughout the medial and lateral aspects of the left ankle was acknowledged. The Veteran underwent a subsequent VA examination in February 2016. On review of the record, the examiner opined that it is less likely than not that the Veteran’s left ankle condition was caused by or otherwise related to active service, to include as due to a left ankle sprain in service. In support of the stated conclusion, the examiner noted that there was no evidence of persistent treatment for left ankle pain either during active service or at separation from service. The examiner further noted that post-service treatment records did not document treatment for left ankle pain until years later. Thus, based on the lack of evidence of a chronic left ankle condition during service, the examiner opined that it was less likely than not that the Veteran’s current left ankle condition was related to active service. After reviewing the evidence of record, the Board finds that the February 2016 VA opinion is the most probative evidence. The examiner reviewed the entire claims file, examined the Veteran, and noted his reports of in-service and post-service symptoms. The opinion was accompanied by a rationale for the conclusion reached. Accordingly, it is accorded great probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. While the Veteran is competent to report left ankle pain since service, he is not competent to render a diagnosis or opine that his current symptoms are manifestations of similar symptoms in service. Further, the record does not suggest that the Veteran possesses the relevant medical training or expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Accordingly, the Board assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. In this case, the record fails to show complaints of chronic left ankle symptoms either in service or since separation, and the VA examiner found no nexus between the Veteran’s current symptoms and in-service symptoms. Specifically, service treatment records show only a single complaint of a left ankle sprain. No symptoms were reported at separation. Years later, the Veteran reported left ankle pain sporadically, to include following a motor vehicle accident. The Board acknowledges receipt of multiple lay statements suggesting persistent symptomology since separation, the medical evidence does not support these contentions. Specifically, a January 2010 VA examination report was silent for any left ankle abnormalities. Additionally, the February 2016 VA examiner acknowledged that Veteran’s complaints of current symptoms, but concluded that the evidence failed to show a “nexus” between a remote injury in service and current symptoms and treatment which began years later. While the lay statements are acknowledged, the medical evidence does not support any assertion of persistent symptoms. Accordingly, as 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 ankle disability must be denied. 4. Entitlement to service connection for a right ankle disability. The Veteran asserts that his right ankle sprain is causally related to active service, to include multiple right ankle sprains during service. The preponderance of the evidence is against his claim. Service treatment records show that the Veteran was treated for multiple right ankle sprains. In March 1988, the Veteran reported stepping in a whole during a physical training. He described symptoms including pain with weight-bearing and tenderness. A physical examination was negative for edema, any deformity or acute abnormality. A ligament strain was indicated. Thereafter, subsequent right ankle sprains reportedly occurred in August 1989 and November 1993. Complaints of pain, tenderness, and limitation of motion were endorsed. Diagnostic findings yielded normal results. At no time was the Veteran’s right ankle condition described as chronic. No symptoms or injuries to the right ankle were reported at separation. To the contrary, on his November 30, 3006 report of medical history at separation, the Veteran expressly denied having arthritis, rheumatism, or bursitis; swollen or painful joints; or bone, joint, or other deformity. The corresponding report of medical examination at separation indicates was silent for any abnormality pertaining to his ankle. In July 2007, the Veteran was afforded a VA examination. During the clinical evaluation, he reported persistent right ankle pain since 1992. Specifically, the Veteran indicated that he suffered a right ankle injury during a road march in 1991. Current symptoms included weakness, frequent swelling, and lack of endurance. He denied stiffness, giving way, locking, or fatigability. Localized pain reportedly occurred 3 times per week and lasted up to 2 hours. Pain was described as a 4 on a 10-point scale. The Veteran acknowledged pain with physical activity and stated that his symptoms were relieved with rest. He denied incapacitation due to his symptoms. The Veteran acknowledged use of Motrin and an ankle brace for pain management. Pain reportedly causes some difficulty with prolonged walking. On examination, tenderness was noted to the right ankle. There was no evidence of edema, effusion, weakness, guarded movement or subluxation. Range of motion was normal at all ranges, with evidence of pain at the end points. Pain did not result in any additional functional loss with repetitive use testing. There was no evidence of abnormality, malunion of the os calcis or malunion of the astragalus. Post service treatment records show sporadic complaints of ankle pain. In December 2011, the Veteran complained of right ankle pain following a motor vehicle accident. No specific injuries or abnormalities were documented. In January 2012, the Veteran underwent an orthopedic evaluation. He reported persistent ankle pain over several years. The Veteran described pain over in the medial and lateral aspects of both ankles, with worsening symptoms occurring at the end of the day. He denied any episodes of swelling, catching, locking, or instability of the ankles. No numbness, weakness, or tingling in the lower extremities was reported. On examination, full range of motion was indicated with no evidence of erythema, ecchymosis or erythema. In February 2016, the Veteran was afforded a subsequent VA examination. On review of the record, the examiner opined that it is less likely than not that the Veteran’s right ankle condition was caused by or otherwise related to active service, to include his multiple right ankle sprains during service. In support of the stated conclusion, the examiner noted that there was no evidence of persistent treatment for right ankle pain either during active service or chronic symptoms noted at separation. The examiner also noted that post-service treatment for right ankle pain began years after service, and occurred only sporadically. As the evidence failed to show chronic symptoms, the examiner opined that the Veteran’s current right ankle condition was less likely than not related to active service. After reviewing the evidence of record, the Board finds that the February 2016 VA opinion is the most probative evidence. The examiner reviewed the entire claims file, examined the Veteran, and noted his reports of in-service and post-service symptoms. The opinion was accompanied by a rationale for the conclusion reached. Accordingly, it is accorded great probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. While the Veteran is competent to report right ankle pain since service, he is not competent to render a diagnosis in this case or opine that his current symptoms are manifestations of similar symptoms in service. Further, the record does not suggest that the Veteran possesses the relevant medical training or expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, the Board assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. Although service treatment records show multiple instances of right ankle sprains, his symptoms were not described as chronic during service and there is no evidence of ongoing ankle symptoms at separation. Further, post-service treatment records show only sporadic complaints of symptoms, to include following a motor vehicle accident in December 2011. While the Board acknowledges receipt of multiple lay statements attesting to persistent symptoms, the medical evidence does not support these contentions. Specifically, a January 2010 VA examination report was silent for any right ankle abnormalities. Additionally, the February 2016 VA examiner acknowledged that Veteran’s complaints of current symptoms, but concluded that the evidence failed to show a “nexus” between a remote injury in service and current symptoms and treatment which began years later. While the lay statements are acknowledged, the medical evidence does not support any assertion of persistent symptoms. Accordingly, as 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 must be denied. J. A. Anderson Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Whitaker, Associate Counsel