Citation Nr: 20060784 Decision Date: 09/15/20 Archive Date: 09/15/20 DOCKET NO. 16-62 075 DATE: September 15, 2020 ORDER Entitlement to service connection for bilateral wrist condition is granted. Entitlement to service connection for right ankle condition is granted. Entitlement to service connection for right foot condition is granted. FINDING OF FACT The probative evidence of record is at least in relative equipoise that the Veteran’s bilateral wrist, right ankle, and right foot conditions are related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral wrist condition have been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for right ankle condition have been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. The criteria for service connection for right foot condition have been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1974 to March 1977, and from March 1977 to July 1978. The claims were brought before the Board in April 2019. In the April 2019 Board decision, the Board found that the Veteran’s service from July 19, 1974 to July 18, 1977 was considered honorable. However, his service from July 19, 1977 to July 1978 received an other than honorable discharge. The Board then remanded the claims for consideration under his period of honorable service. The claims were brought before the Board again in September 2019 and were remanded for further development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability.  Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009).  When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)).  The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient.  Waters v. Shinseki, 601 F.3d 1274, 1278 (2010).  Entitlement to Service Connection: Bilateral Wrist Condition, Right Foot Condition, and Right Ankle Condition The Veteran contends that his bilateral wrist, right foot, and right ankle conditions are related to his active duty service. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with right foot plantar fascitis, plantar and posterior calcaneal spurs, chronic right ankle collateral ligament sprain, and degenerative arthritis of the wrists.  Further, the Veteran’s service treatment records show he had a right ankle sprain in August 1976, right ankle and foot pain in September 1976 with right foot injury, had left hand injury in March 1976, and complained of right hand pain in March 1975.  Thus, the issue turns upon whether there is evidence of a nexus between the claimed in-service event or injury and the present disability, to include whether his condition is caused by or aggravated by his service-connected disabilities.  See Sheldon v. Principi 381 F.3d 1163, 1167 (Fed. Cir. 2004). In June 2020, the Veteran provided a private opinion. The physician noted he reviewed the Veteran’s medical and service records and that he had seen the Veteran for his pain in his right ankle and joints of the right foot, pain in right wrist, and pain in left wrist. The physician noted that the Veteran has no other known risk factors that precipitated his current conditions and complaints. The physician provided that after review of pertinent records, it is his professional opinion that it is likely that the Veteran’s conditions are a direct result of his paratrooper performance/training during his military service, which consisted of jumping off an 8 foot platform multiple times. The physician rationalized that those events in and of themselves can and should be considered significant multiple traumas to the joints of the body. The physician further explained that in his personal experience and in medical literature, it is well known and understood that trauma, especially repetitive trauma, to joints causes significant long-term damage. It is also well documented that prior injuries to joints can cause post-traumatic osteoarthritis and future problems and pain. The physician additionally explained that forces sustained at the time of injury cause a disruption of muscles, ligaments, and cartilage, which support the joint in the area of concern. The acute injury accounts for initial pain; however, as healing progresses, the patient typically continues to experience pain due to scarring and local inflammatory reaction of the site injury, which shorten the tissue and cause weakness of the supportive tissue. The physician lastly noted that healing in these areas is often incomplete and results in a weakening of the supporting soft tissues of the joint, which render them susceptible to future minor stresses ordinarily not capable of causing symptoms for the average individual. The Board acknowledges that a November 2019 VA examiner found that the Veteran’s conditions were not related to his service. However, in applying the benefit of the doubt in favor of the Veteran, the Board finds that the evidence is in relative equipoise that the Veteran’s bilateral wrist, right foot, and right ankle disabilities are related to his active duty service. Further, the Board notes that the examiner noted the Veteran had no history of injury to his wrists in service; however, his records show he complained of left- and right-hand pain in service. Moreover, the examiner found the Veteran’s in-service right ankle injury resolved; however, the examiner also noted that the sprain was chronic and recurrent. The Board finds that this is contradictory. Lastly, the examiner did not address any of the multiple in-service right foot complaints for the opinion on the right foot condition. Therefore, the Board finds the June 2020 private opinion to be of significant probative value in determining the Veteran’s disabilities are related to his active service. The Board notes that the probative value of medical opinion evidence is based on the medical experts’ personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Here, the private physician showed knowledge of the Veteran’s background and based the opinion on the Veteran’s lay contentions, the physician’s medical knowledge, review of his records, as well as medical literature. Additionally, the opinion rendered is consistent with the medical evidence of record. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Therefore, the Board concludes that the probative evidence of record is for the claims and the benefit of the doubt doctrine has been applied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Negron, Associate 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.