Citation Nr: 21063199 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-50 880 DATE: October 13, 2021 ORDER Entitlement to service connection for left knee disability is granted. Entitlement to service connection for left ankle disability is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in favor of the Veteran, his left knee disability is at least as likely as not related to active service. 2. Resolving reasonable doubt in favor of the Veteran, his left ankle disability is at least as likely as not related to active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left knee disability have been met. 38 U.S.C. § 1110, 5.107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2020). 2. The criteria for entitlement to service connection for a left ankle disability have been met. 38 U.S.C. § 1110, 5.107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1978 to May 1988. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. In February 2015, the Veteran filed a notice of disagreement (NOD) and in August 2017, the RO issued a statement of the case (SOC). In September 2017 the Veteran timely submitted a substantive appeal and requested a hearing. In March 2021, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. In a May 2021 decision, the Board remanded these issues for additional development, which has been substantially completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) 1. Entitlement to service connection for left knee disability is granted. 2. Entitlement to service connection for left ankle disability is granted. The Veteran is seeking entitlement to service connection for a left knee disability and a left ankle disability. Specifically, he contends that his disability is related to service. A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection means the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). A Veteran is competent to describe symptoms that she experienced in service or at any time after service when the symptoms he perceived or experienced, were directly through the senses. 38 C.F.R. § 3.159; Layno v. Brown, 6 Vet. App. 465, at 469-71 (1994). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate each claim and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). After a review of the entire evidentiary record and in light of the applicable legal criteria, affording the Veteran the benefit of the doubt, the Board finds that service connection is warranted for a left knee disability and a left ankle disability. Here, the Veteran is currently diagnosed with left knee and left ankle disabilities. See June 2021 VA Examinations. Service treatment records (STRs) from April 1986 indicate inservice injuries to the left knee and left ankle. As such, the first and second elements of service connection have been met. The salient question is thus whether the Veteran's left knee and left ankle disabilities are related to service. Here, the evidence is relatively evenly balanced as to whether the Veteran's disabilities are related to service. Specifically, May 2014 August 2017 VA examiners provided negative nexus opinions. Contrastingly, in a June 2021 VA opinion, an examiner opined that the Veteran's disabilities were at least as likely as not related to service. Specifically, the examiner explained that STRs reference a left knee condition and a left ankle condition multiple times including in April 1986. Provided records note a continued left knee condition and left ankle condition after service and a left knee condition and ankle condition was noted on examination. Therefore, it is at least as likely as not that the claimed left knee conditions of knee strain, knee meniscal tear, PFPS, tendonitis, sprain of lateral collateral ligament of left knee, and bone spur was incurred during service. It was also least as likely as not that the claimed left ankle conditions including lateral collateral ligament sprain, deltoid ligament sprain, and chronic ankle strain were incurred during service. Furthermore, it was at least as likely as not that the claimed left ankle conditions, to include achilles tendon rupture and achilles tendonitis are secondary due to the chronic left ankle strain, lateral collateral ligament sprain, deltoid ligament sprain which were incurred during service. See also April 2021 Private Medical Opinion (left ankle positive nexus opinion); October 2012 Private Treatment Record (positive nexus opinions). The Board notes that, as noted in the May 2021 Board decision, the May 2014 and August 2017 VA opinions are inadequate for adjudicative purposes because they do not adequately address the Veteran's contentions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As such, they are afforded little, if any, probative value. Contrastingly, the June 2021 VA opinion is adequate for adjudicative purposes and of probative value. The examiner based his opinion on treatment of the Veteran, considered lay testimony, and his opinion is consistent with the record and STRs. Based on the foregoing, the Board finds that the evidence as to whether the Veteran's left knee disability and left ankle disability is related to service is, at the very least, in relative equipoise. As such, the Board resolves reasonable doubt in the Veteran's favor and finds that the Veteran's left knee disability and left ankle disability are related to service and the third element of service connection has been met. Gilbert, supra. Accordingly, as the three elements of service connection have been met, and service connection for the Veteran's left knee disability and left ankle disability is warranted. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kaufer, 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.