Citation Nr: 20040663 Decision Date: 06/15/20 Archive Date: 06/15/20 DOCKET NO. 18-32 740 DATE: June 15, 2020 ORDER Service connection for a left ankle disability is denied. FINDING OF FACT The weight of the evidence is against a finding that a left ankle disability was manifested during the Veteran’s period of active service, or that it is otherwise the result of a disease or injury during active service, or that it is proximately due to or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 2009 to November 2011. The Veteran asserts that he has a disability of the left ankle that is due to service and/or due to a service-connected disability. Service connection is in effect for musculoskeletal strain of the right ankle, rated 10 percent disabling. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, or whether he has a disability of the left ankle that is due to or aggravated by a service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of left ankle strain the preponderance of the evidence weighs against finding that this disability began during service or is otherwise related to an in-service injury, event, or disease, or that the left ankle disability is proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability. 38 U.S.C. § 1110; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). Service treatment records do not reflect any complaints or treatment related to the left ankle. In May 2011, the Veteran underwent a VA examination pertaining to multiple musculoskeletal complaints, to include the knees, right ankle, lumbar spine, feet, left thumb, left wrist, and neck; however, he did not voice any complaints related to the left ankle. Examination of the left ankle was normal, and a left ankle x-ray examination was negative. In July 2017, the Veteran filed a claim of service connection for a left ankle disability due to his right ankle disability. In August 2017, the Veteran underwent a C&P examination wherein the examiner found that an examination of the left ankle was normal and opined that he did not have a left ankle disability due to his right ankle disability. The examiner stated that the two conditions are not medically related. The claimed disorder is a separate entity entirely from the right ankle and unrelated to it. The examiner stated that medical literature does not support a medical relationship and a nexus has not been established. In his October 2017 notice of disagreement, the Veteran asserted that his left ankle was injured multiple times during active duty and that he would constantly roll his ankles causing further damage to the joints. He also indicated in his June 2018 substantive appeal that his complaints related to the left ankle were not in his service treatment records because he saw a corpsman out in the field on active duty. The Veteran’s DD-214 reflects that he participated in Operation Iraqi Freedom and his primary specialties included rifleman, infantry unit leader, and martial arts instructor. The asserted injuries to the ankles are found to be consistent with the types and circumstances of the Veteran’s service. 38 U.S.C.§1154(a). In August 2019, the Veteran underwent a C&P examination wherein the examiner diagnosed an ankle strain and opined that his left ankle disability is not due to active service. The examiner stated that the Veteran’s claims file is silent for having a left ankle condition during service. His claims file is silent for having a left ankle condition that is etiologically related to service. He had a May 2011 examination and his left ankle range of motion was normal, and radiology imaging of the left ankle was negative. He had an August 2017 examination and physical examination of the ankle was normal. The examiner stated that while an ankle strain was diagnosed on present examination, no nexus to service could be established. In January 2020, the examiner proffered an addendum secondary opinion. The examiner stated that the two conditions are not medically related, noting that there was no credible evidence to suggest that an injury or disease of one lower extremity (right ankle) would have any significant impact on the opposite joint (left ankle), unless the injury of the right ankle resulted in major muscle or nerve damage causing partial or complete paralysis of the damaged leg, and/or shortening of the injured lower extremity resulting in a limb length discrepancy of more than four or five centimeters so that the individual’s gait pattern has been altered to the extent that clinically there is an obvious lurching type gait (a significant limp). Per the examiner, the Veteran’s right ankle condition was not of the severity to result in a left ankle condition. A nexus is not established. The examiner also found that there was no evidence of aggravation of the left ankle condition by the right ankle noted in the medical records. The right ankle condition is not of the severity to result in aggravation of the left ankle condition. As detailed above, while a left ankle disability has been diagnosed, such diagnosis was rendered 7 years after separation from service. Service treatment records do not reflect any complaints, treatment, or diagnoses pertaining to the left ankle. Even assuming that the Veteran did sustain injury to the left ankle or rolled his ankle during service, there is a lack of continuity of symptomatology in this case, as examinations in 2011 and 2017 were normal. Furthermore, due to the Veteran’s lay assertions of having left ankle problems during service and his assertion that his left ankle problems are due to his right ankle, opinions were sought. A negative opinion on a direct basis has been provided based on negative service treatment records and a lack of continuity of symptomatology, and negative opinions on a secondary basis have been provided. The collective opinions of the C&P examiners are probative because they are based on review of an accurate medical history, consideration of the Veteran’s lay assertions, and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no contrary opinions of record. The Board has also given consideration to the lay assertions of the Veteran. Due to such lay assertions, opinions were sought. While the Veteran believes that he has a disability of the left ankle due to service and/or due to a service-connected disability, he is not competent to provide a nexus opinion regarding these issues. The issues are medically complex, requiring knowledge of the interaction between multiple organ systems in the body, anatomical relationships, and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). As discussed, a left ankle disability was diagnosed several years after separation from service. The Veteran’s contentions are outweighed by the clinical findings documented several years after separation from service, and the lack of diagnosis or complaints reflected in the medical records, and the opinions of trained medical professionals. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.W. Kreindler The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.