Citation Nr: 21064959 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 17-60 338 DATE: October 22, 2021 ORDER Service connection for a left ankle disorder is denied. FINDING OF FACT A left ankle disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service. CONCLUSION OF LAW The criteria for service connection for a left ankle disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1973 to February 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in December 2016 by a Department of Veterans Affairs (VA) Regional Office. In January 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In April 2020, the Board remanded the issue on appeal as well as claims for service connection for bilateral knee and bilateral shoulder disorders. While on remand, a February 2021 rating decision granted service connection for bilateral shoulder strain and impingement syndrome, and bilateral knee strain and instability, with associated scars. Thus, as such represents a full grant of the benefits sought with respect to the claims for service connection for bilateral shoulder and bilateral knee disorders, they are no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). The remaining issue now returns for further appellate consideration. Entitlement to service connection for a left ankle disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). The Veteran contends that he has a left ankle disorder that is directly related his military service, to specifically include his in-service parachuting duties, to include the fitting of the harness and jumps. In this regard, the Veteran's service treatment records (STRs) reveal that he injured his left foot in August 1975 and had pain in his lateral dorsum of such foot for 6 days. An impression of rule out stress fracture was noted. However, his STRs are otherwise negative for any relevant complaints, treatment, or diagnoses and his lower extremities were normal upon clinical evaluation at his January 1976 separation examination. Similarly, the Veteran's post-service treatment records are negative for complaints, treatment, or diagnoses referable to a left ankle disorder until January 2013. In this regard, at such time, the Veteran complained of left ankle pain, which his physician diagnosed as osteoarthritis, and he underwent excision of painful osteophyte of the left ankle with debridement the following month. Additionally, at a VA examination in December 2016, the examiner opined that such disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, he reasoned that there was only a single episode of foot pain in service, the Veteran's separation examination was silent for a left ankle disorder, and there was an absence of any documentation of recurring or persistent left ankle pain from 1975 until arthroscopic surgery in 2012. Thus, he concluded that it was less likely than not that the Veteran's diagnosed chronic musculoligamentous strain of the left ankle was related to the in-service incident. However, as the examiner did not consider whether such disorder was related to his in-service parachute jumps or address his lay statements of having continued left ankle pain since his military service, the Board remanded the case in order to obtain an addendum opinion addressing such concerns in April 2020. Thereafter, in October 2020, the December 2016 VA examiner reviewed the record and again opined that the Veteran's left ankle disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, he noted that the Veteran stated his left ankle began hurting around 2003, while working for Dupont, and indicated that it may have been injured during a parachute jump in 1975 at the December 2016 VA examination. The examiner also noted that the Veteran made a total of about 20 jumps in the 1970s, but there was no documentation in the STRs of any visits to sick call for an injury to his left ankle as the result of a parachute jump. The examiner also reasoned that the Veteran's STRs documented a single visit to sick call in August 1975 for left foot pain of 6 days duration, without mention of any ankle pain, and X-rays were negative. He further observed that the Veteran's January 1976 separation examination was silent for any left ankle problems. The examiner also noted that the Veteran underwent arthroscopic debridement without significant benefit in 2013 and X-rays in December 2016 were negative for any degenerative joint disease (DJD) or other abnormality other than bilateral calcaneal spurs. Thus, he indicated that the most likely diagnosis was chronic musculoligamentous strain of the left ankle. The examiner ultimately concluded that, given the single episode of foot pain in-service, the absence of any ankle pain documented in service, the silent separation examination, and the absence of any documented recurring or persistent left ankle pain form the time of entrance into military service to his arthroscopic debridement in 2012, it was less likely than not that his left ankle strain was related in any way to his military service, to include his documented foot pain or as a result of parachute jumps. In this regard, he explained that the Veteran made approximately 20 parachute jumps when he was 19 to 22 years old and, although repeated jumps can lead to strain and/or DJD in the ankles, this was usually seen in those individuals making a far greater number of jumps (typically greater than 75) over a prolonged period of time when they are in their 30's and 40's, which was not the case for the Veteran. The Board affords great probative weight to the October 2020 VA examiner's opinion as such considered all of the pertinent evidence of record, to include the Veteran's statement and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, he offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). In this regard, the Board notes that, in the Veteran's representative's September 2021 Informal Hearing Presentation, he argued that the October 2020 VA examiner did not fully consider the Veteran's statements and lay evidence, including repeated parachute jumps. However, as detailed above, the examiner specifically addressed the Veteran's lay statements and considered his parachute jumps. Furthermore, such opinion is based on the correct facts and sufficiently informs the Board of the medical expert's judgment on the medical question at issue, as well as the "essential rationale" for the opinion. Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012). Thus, the Board finds the Veteran's representative's argument to be without merit. Notably, there is no medical opinion to the contrary. The Board also considered the Veteran's assertions as to the etiology of his left ankle disorder; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Specifically, the etiology of a musculoligamentous strain involves an internal process, and specialized knowledge is necessary to determine whether a specific event led to such disorder. Thus, such matter may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinion as to the etiology of his left ankle disorder is not competent evidence and, consequently, is afforded no probative weight. Therefore, the Board finds that a left ankle disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service. Thus, service connection for such disorder is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim for service connection for a left ankle disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Clark 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.