Citation Nr: 20046789 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 15-39 145 DATE: July 13, 2020 ORDER Service connection for chipped teeth is denied. Service connection for a left ankle disability is denied. Service connection for a right ankle disability is denied. FINDINGS OF FACT 1. The Veteran does not have a dental disability for VA compensation purposes. 2. The Veteran does not have a left ankle disability due to her service. 3. The Veteran does not have a right ankle disability due to her service. CONCLUSIONS OF LAW 1. The criteria for service connection for chipped teeth have not been met, and the payment of disability compensation is precluded by law. 38 U.S.C. §§ 1131, 1712, 5107, 7104(c); 38 C.F.R. §§ 3.102, 3.159, 4.150. 2. The criteria for service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from October 1985 to February 1990. In September 2018, the Board remanded the claims for additional development. Service Connection 1. Chipped teeth The Veteran asserts that she is entitled to service connection for chipped teeth. She asserts that in June 1989, during service in Germany, her husband at the time (who was also on active duty in the Army) punched her in the mouth outside of a club and chipped two of her teeth. See Veteran’s statement in support of claim (VA Form 21-4138), received in April 2010. In her original claim, the Veteran indicated that she sustained chipped teeth in 1988. See Veteran’s claim (VA Form 21-526), received in March 2010. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may also be granted on the basis of a post-service initial diagnosis of a disease, when “all of the evidence, including that pertinent to service, establishes that the disease was incurred during service.” See 38 C.F.R. § 3.303 (d). Dental disabilities which may be awarded compensable disability ratings are now set forth under 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Rating activity should consider each defective or missing tooth and each disease of the teeth and periodontal tissues separately to determine whether the condition was incurred or aggravated in line of duty during active service and, when applicable, to determine whether the condition is due to combat or other in-service trauma, or whether the veteran was interned as a prisoner of war. 38 C.F.R. § 3.381 (b). For loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by suitable prosthesis. Id. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease (pyorrhea) are not disabling conditions. See 38 C.F.R. § 3.381. Overall, the Board first notes that the Veteran’s service treatment records contain multiple entries regarding dental care that are somewhat difficult to read; the Board has discussed the ascertainable and relevant findings below. A dental chart, dated in May 1986, indicates that all four of the Veteran’s molars were missing (teeth #1, #16, #17 and #32) (paradoxically, an April 1987 notation indicates that tooth #32 was extracted). A dental chart, dated in April 1988, only indicates that tooth #1 was missing. A July 1989 notation indicates complaints of teeth hurting from cold air, and that teeth #10 and #11 were chipped. A later July 1989 report notes that the Veteran’s soft tissues were inflamed. A September 1989 notation indicates that tooth #11 was malposed. A report, dated in January 1987, shows that the Veteran was treated after getting hit in the face during a fight, with a notation of a swollen forehead; there were no findings involving the teeth. It appears that the Veteran waived her separation examination report. There are examination reports of record that are undated, and which note “separation” and “Chapter 6” which do not include any findings for the teeth, nor do they note any relevant complaints or diagnoses. The Board finds that the claim must be denied. The Veteran is not shown to have been a prisoner of war. There is no evidence to show that the Veteran has one of the dental disorders listed under 38 C.F.R. § 4.150, and there is therefore no basis for an award of compensation based on the Veteran’s claim. See 38 C.F.R. § 4.150, Diagnostic Code 9905. Given the foregoing, the evidence does not show that the Veteran sustained compensable “dental trauma” in service. As the Veteran does not have a compensable dental disorder, there is no basis for an award of compensation based on the Veteran’s claim. 2. Bilateral ankles. In September 2010, the RO denied claims for service connection for left ankle tendinitis and strain, and right ankle tendinitis and strain. The Board has characterized the claims broadly, as stated on the cover page of this decision. Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). Service treatment records include a May 1986 report which shows that the Veteran sought treatment for a three-day history of right calf pain while running. On examination, the right calf was tender, and there was pain on right ankle dorsiflexion. The assessment was right gastrocnemius strain. Treatment reports, and a hospitalization report, dated in April 1989, show that the Veteran was hospitalized for about 11 days following complaints of a one-month history of a breast mass, and painful raised lesions of the lower extremities, with about a three-week history of painful low back and joints in the lower extremities, to include at the right ankle. Upon initial evaluation, she was noted to ambulate on crutches. She had a 9-centimeter (cm.) x 9 cm. tender mass at the right breast, and the ankles were swollen and erythematous bilaterally. She was neurovascularly intact. The assessments included rule out compartment syndrome vs. rule out DVT (deep vein thrombosis). She underwent surgical drainage of a right breast abscess. Upon discharge, the final diagnoses were right breast abscess, with secondary erythema nodosum. It was noted that, “Further evaluation of the lower extremities was felt to be consistent with erythema nosum, secondary to the breast abscess.” An associated inpatient treatment record cover sheet (DA Form 3647) contains diagnoses of chronic right breast abscess, and incision and drainage of abscess. A January 1990 form shows that the Veteran waived a separation examination. There are undated examination reports of record that include the notations “Chapter 6” and “separation,” respectively, which do not include any relevant complaints, findings, or diagnoses. As for the post-service medical evidence, a private treatment report, from the University of Pittsburg Medical Center (UPMC), dated in September 2000, shows that the Veteran reported that she had twisted her left foot twice in the last ten days. It was noted that X-rays did not show evidence of a fracture; the left foot had a small calcaneal spur. The impression was left foot sprain. VA progress notes, dated in 2009, include problem lists noting “pain in joint involving ankle and foot.” Beginning in 2010, VA progress notes include problem lists noting conditions that include “pain in joint involving ankle and foot,” with a date of July 2010. In August 2010, the Veteran sought treatment for right ankle pain which started the night before, after she twisted her ankle. In December 2011, the Veteran sought treatment for ankle pain. She indicated that she had an ankle injury while in service, and that she “has had this pain since then.” A VA examination report, dated in August 2010, shows that the Veteran reported a history of right ankle sprain in the service. After getting out of the service, she had to jump out of a burning building in 1998, and she injured both ankles. The examiner noted, “Consequently, she has bilateral ankle pain.” She gets aching soreness and tenderness. Her most recent X-rays show a bit of a spur on the talus. There is no residual injury to the ankle noted or identified by X-ray. She gets bilateral ankle pain aching, soreness, tenderness and “give way.” There is no history of surgery. The Veteran was noted to wear braces on both ankles. The diagnosis was tendinitis and strain to both ankles. The examiner concluded that it is less likely than not that the Veteran’s ankle conditions are related to her service. A VA ankle disability benefits questionnaire (DBQ), dated in March 2017, shows that the Veteran reported that her ankles pop, get stiff, and swell. The left ankle was worse than the right. Her symptoms worsened after walking, standing for 45 minutes, walking for 20 minutes, and cold and damp weather. The Veteran reported that she had some sore ankles during her military service and that after service she jumped from a second-floor window of a home that was on fire, but that she had no fracture or problems from the jump regarding the ankles. The DBQ notes that there was no relevant history of surgery. The impression in an X-ray report was bilateral calcaneal spurs, with no acute bony abnormality. The examiner concluded that there is no objective evidence of a right ankle condition, or a left ankle condition, on examination, and therefore it is less likely than not that the Veteran's subjective complaints and exam findings are from a condition incurred in or caused by service. A VA ankle DBQ, dated in September 2019, shows that the Veteran reported having a history of bilateral ankle pain since her service. She stated that she rolled and sprained her ankles during basic training and that her ankles have continued to roll, sprain, and swell since that time. The examiner noted that the Board’s remand indicated inservice ankle treatment in May 1986 and April 1989, but that no such record was found for 1986 (presumably the Veteran’s May 1986 treatment for right calf symptoms was dismissed as irrelevant) and that the 1989 treatment related to symptoms other than an ankle. The examiner concluded, “If documentation in the service treatment records is required to show a nexus, then it is less likely than not that the Veteran's ankle tendonitis[,] strain [and] sprain is related to service.” As an initial matter, the Veteran has reported that she “rolled and sprained her ankles during basic training,” and that she has had ongoing ankle pain since her service. See e.g., December 2011 VA progress note, September 2019 VA DBQ. However, service treatment reports do not show any complaints or finding of an injured ankle during basic training, whether it is characterized as twisted, rolled, sprained, or as some other type of ankle injury. Nor is there any evidence of treatment for ankle symptoms during service, following basic training. In this regard, when read in context, her treatment in May 1986 (for right calf pain) and April 1989 (for a right breast mass with secondary erythema nodosum, with complaints that included right ankle pain) do not shown any report of injury or trauma to either ankle, and they cannot reasonably be interpreted to show treatment for an ankle injury. Following separation from service, there is no evidence of treatment for ankle symptoms for over ten years after separation from service. See September 2000 UPMC report. At that time, the Veteran did not give a history of previous ankle injury. Rather, she reported a 10-day history of two left ankle sprains. Thereafter, there is about a nine-year gap for which no ankle treatment is shown. Specifically, VA progress notes, dated through 2008. show treatment for a wide variety of symptoms that included back pain, but do not show complaints of ankle symptoms. AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013). The next medical evidence of ankle symptoms is found in VA progress notes dated in 2009. Accordingly, the Board finds that the Veteran’s reports of ankle problems since basic training are not found to be credible as they are inconsistent with the evidence of record. The Board finds that the claims must be denied. During service, in May 1986, the Veteran is shown to have received one treatment for right calf symptoms, with associated right ankle pain on motion, but there was no evidence of ankle pathology and no diagnosis of a right ankle condition. In April 1989, the Veteran was hospitalized for treatment of a right breast mass, with associated complaints of lower extremity joint pain, to include right ankle pain. The final diagnoses were right breast abscess, with secondary erythema nodosum. This evidence shows that treating physicians stated that her lower extremity symptoms were “consistent with erythema nosum, secondary to the breast abscess,” and there is nothing in the April 1989 reports to show that the Veteran was found to have an ankle condition. Accordingly, a chronic ankle condition of either the left ankle, or the right ankle, is not shown during service. The earliest medical evidence of an ankle disability is dated no earlier than September 2000. This was more than 10 years after separation from service, and at that time the Veteran reported a history of two recent left ankle injuries. Thereafter, she has reported sustaining bilateral ankle injuries in 1998. See March 2017 VA DBQ. She also reported twisting her right ankle in August 2010. See August 2010 VA progress note. There is no competent opinion of record in favor of either of the claims. The VA opinions all weigh against the claims. To the extent that the September 2019 VA examiner indicated that a favorable opinion could be rendered if documentation in the service treatment records was not required, as previously noted, the Veteran’s service treatment records do not support either of the claims, and she has been found not to be a credible historian in that her assertions are undermined by the evidence of record. (Continued on the next page)   Accordingly, the Board finds that the weight of the evidence is against the claims, and they are denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.S.E., Counsel 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.