Citation Nr: 21067188 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-05 166 DATE: November 3, 2021 ORDER Entitlement to service connection for a right ankle condition is denied. Entitlement to service connection for a right knee condition is denied. Entitlement to service connection for a right thumb condition is denied. FINDINGS OF FACT 1. The competent medical evidence does not demonstrate that the Veteran's right ankle condition was incurred in service or is otherwise attributable to his service. 2. The competent medical evidence does not demonstrate that the Veteran's right knee condition was incurred in service or is otherwise attributable to his service. 3. The competent medical evidence does not demonstrate that the Veteran's right thumb condition was incurred in service or is otherwise attributable to his service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right ankle condition have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for entitlement to service connection for a right knee condition have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for entitlement to service connection for a right thumb condition have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty, including from July 1989 to June 2001. These matters were last before the Board in February 2020, whereupon they were remanded to the Agency of Original Jurisdiction (AOJ) for further development of the record. Following the issuance of an October 2020 supplemental statement of the case continuing the denial of all three claims, the case was returned to the Board for its adjudication. As a reminder, the Veteran testified at an October 2019 videoconference hearing before the undersigned Veterans Law Judge. Service Connection Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 1. Right Ankle Condition The Veteran seeks service connection for a right ankle condition, which he contends was incurred in service and has continued to the present. In the alternative, he asserts that even if his currently diagnosed right ankle condition manifested after his discharge from service, it nevertheless is attributable to his service. Accordingly, the question for the Board is whether the Veteran has a diagnosis of a right ankle condition that was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed with a lateral collateral right ligament strain, and he has attested to experiencing chronic right ankle pain, the preponderance of the evidence is against a determination that a diagnosable right ankle condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). Available service treatment records show that the Veteran sought treatment for right ankle pain on two occasions, once in January 1983 and again in May 1985. Records pertaining to the January 1983 course of treatment reflect that the Veteran had a tissue injury to the right ankle that had resolved by the time of a follow up a week after the initial injury. As for the right ankle pain in May 1985, the Veteran reported that he twisted his ankle, and received treatment for a sprained right ankle. There are no subsequent records showing continued treatment for right ankle symptomatology. Right ankle pain was not noted on any of the medical examinations afforded to the Veteran following these two instance of treatment for right ankle symptomatology, to include the October 2000 separation examination, and the Veteran did not report any history of right ankle symptomatology on the Reports of Medical History corresponding to each periodic examination. Post-service, an February 2017 evaluation reflects that the Veteran reported that he had been experiencing right ankle pain for several years and developed tenderness in the area of the achilles in the past year; after an evaluation, the impression was achilles tendinitis. A March 2017 right ankle X-ray examination revealed a well-corticated ossific density adjacent to the medial malleolus that was likely a sequalae of prior trauma, but with no acute findings. At no point has any treating medical professional attributed the Veteran's right ankle pain to his service. The Veteran was first afforded a VA ankle examination to evaluate the nature and likely etiology of the claimed right ankle condition in September 2014, during which he reported that he sprained his right ankle on multiple occasions in service and still experienced intermittent popping of his right ankle. After an in-person examination, the examiner declined to endorse a diagnosis of a right ankle condition, and as such did not set forth any opinion as to the likely etiology of the claimed right ankle condition. Pursuant to the Board's February 2020 remand instructions, the Veteran was afforded a VA ankle examination in October 2020, during which he asserted that he injured his right ankle in service and has experienced intermittent right ankle pain and swelling ever since service. According to the Veteran, he treated his right ankle condition by using an ace wrap, ice, crutches, and bulky sores wrap. After an in-person evaluation, the examiner set forth a diagnosis of lateral collateral ligament sprain. The examiner also noted the results of a January 2017 radiographic examination, which revealed well-corticated ossific density adjacent to the medial malleolus, that was likely a sequalae of prior trauma. The examiner then opined that it was less likely than not that the Veteran had a right ankle condition that was incurred in or is otherwise attributable to service. In support thereof, the examiner acknowledged the history of treatment for right ankle pain on two occasions in service but found no evidence to support that the Veteran developed a chronic right ankle condition in service in light of the lack of any further treatment as well as the absence of any documentation of a right ankle condition on the October 2000 separation examination or the corresponding October 2000 Report of Medical History. As the examiner thoroughly reviewed the claims file and supported her opinion by reference to the Veteran's medical history, the Board finds the October 2020 examination and opinion to be highly probative of the ultimate question of whether the right ankle condition was incurred in or is otherwise attributable to service. Sklar v. Brown, 5 Vet. App. 140 (1993). During the October 2019 hearing, the Veteran asserted that he sprained his right ankle while working on the flight line in service and sought treatment for the injury, for which he was given a bandage wrap and pain medication. He also acknowledged seeking treatment for right ankle pain at a later date during service, which his representative identified to have occurred around 1991. According to the Veteran, soon after his discharge from service he also sought treatment for right ankle pain from a private medical professional, who prescribed a brace for him to wear. He further attested to continuing to seek treatment for right ankle pain intermittently since his discharge, both through VA and through private medical professionals. Upon review of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for a right ankle condition. The Board acknowledges that the Veteran has asserted that his right ankle pain manifested in service and has continued since then. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, there is no evidence in the record which indicates that the Veteran is competent through expertise or knowledge to conclude that his currently diagnosed right ankle condition is attributable to his service. Jandreau v. Nicholson, 491 F.3d 1372 (Fed. Cir. 2007). As such, the Veteran's contentions must be considered in light of the objective medical evidence of record to better establish the likelihood of there being a nexus between the Veteran's service and his currently diagnosed right ankle condition. In considering the likelihood that the Veteran either incurred a right ankle condition in service that continued to the present, or that his right ankle condition is otherwise attributable to his service, the Board relies on the highly probative opinion of the October 2020 VA examiner, who found it less likely than not that the Veteran's currently diagnosed right ankle condition was attributable to service. As stated, the examiner noted the lack of a diagnosis of a chronic right ankle condition and the lack of documented treatment following service until 2017, over 15 years after his discharge from service. The Board finds this probative opinion to far outweigh the Veteran's general assertions, unsupported as they are with no objective medical evidence. Ultimately, although the Veteran did seek treatment in service on two isolated instances for right ankle symptomatology, the absence of a diagnosis of a chronic condition coupled with the utter lack of potentially supportive evidence following service far outweighs the Veteran's general assertion that he has a right ankle condition that is attributable to service. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). As such, the preponderance of the evidence is against the claim of service connection for a right ankle condition on either a direct basis under 38 C.F.R. § 3.303(a) or based on continuity of symptomatology under 38 C.F.R. § 3.303(b). Furthermore, the lack of any potentially positive and competent evidence also negates the possibility of granting the claim as otherwise attributable to service under 38 C.F.R. § 3.303(d). Consequently, the benefit of the doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Right Knee Condition The Veteran seeks service connection for a right knee condition, which he contends was incurred in service and has continued to the present. In the alternative, he asserts that even if his currently diagnosed right knee condition manifested after his discharge from service, it nevertheless is attributable to his service. Accordingly, the question for the Board is whether the Veteran has a diagnosis of a right knee condition that was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed variously with a right knee meniscal tear as well as right knee osteoarthritis, the preponderance of the evidence is against a determination that a diagnosable right knee condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). Available service treatment records show that the Veteran sought treatment for right knee pain in July 1981. The impression at that time was Osgood-Schlatter disease. The Veteran reported a history of experiencing right knee pain on subsequent Reports of Medical History dated in October 1999 and in October 2000. On the October 1999 Report, the examiner noted that the pain has been occurring for the past two years but found that the condition was not a chronic disorder. On the October 2000 Report, the examiner noted that the right knee pain was not incapacitating but was recurrent. The Board highlights that no right knee abnormalities were documented on the corresponding October 1999 and October 2000 periodic examinations, and there is no documentation of the Veteran being diagnosed with a right knee condition in service. Post-service, an January 2009 outpatient record from Stephens Family Practice reflects that the Veteran reported experiencing right knee pain for the past few days that was not precipitated by any trauma. A radiographic evaluation did not reveal any abnormalities, and the impression was simply joint pain. Thereafter, there is no record of treatment for right knee symptomatology until January 2017, at which point the Veteran reported experiencing right knee pain for several years that began in service. More recently, the Veteran sought treatment in August 2018 for right knee pain that had been occurring for the past two weeks. A September 2018 radiographic evaluation of the right knee revealed joint effusion and degenerative changes throughout the right knee. At no point has any treating medical professional attributed the Veteran's right knee pain to his service. The Veteran was first afforded a VA knee examination in September 2014, during which he reported that he experienced right knee pain in service and currently experienced anterior right knee pain with weather changes as well as when climbing ladder and stairs. After an in-person examination, the examiner set forth a diagnosis of degenerative joint disease of the right knee. As for the likely etiology of the condition, the examiner remarked that they could not set forth such an opinion without resorting to speculation. In support of this conclusion, the examiner acknowledged the history of in-service treatment for a right knee condition but did not find evidence of a chronic disease. The examiner also noted that the Veteran's symptomatology reported at the time of the examination was most consistent with degenerative joint disease, which is an age-related condition. Pursuant to the Board's February 2020 remand instructions, which directed the AOJ to secure an addendum opinion regarding the likely etiology of the right knee condition that did not utilize speculative language, the Veteran was afforded a VA knee examination in October 2020, during which he asserted that he injured his right knee in service during boot camp and experienced aching pain and swelling of the knee. According to the Veteran, he currently experienced right knee pain, grinding and joint cracking. After an in-person evaluation, the examiner set forth a diagnosis of a meniscal tear and right knee joint osteoarthritis. The examiner also noted the results of a January 2018 radiographic examination, which revealed a meniscal tear as well as joint effusion and degenerative changes throughout the knee. The examiner then opined that it was less likely than not that the Veteran had a right knee condition that was incurred in or is otherwise attributable to service. In support thereof, the examiner acknowledged the history of treatment for right knee pain in service but noted that the right knee pain that the Veteran reported around his time of separation was found to not be chronic in nature. The examiner also highlighted the lack of consistent treatment for right knee symptomatology following service, to include a 2009 radiographic examination that revealed no abnormalities of the right knee. During the October 2019 hearing, the Veteran asserted that his right knee first started to hurt when he was in boot camp, and that he was given pain medication at the time. When queried he estimated that he sought treatment for right knee pain on 10 occasions while in service and was only ever given pain medication to alleviate his symptomatology. He also confirmed that he was diagnosed with Osgood-Schlatter disease in service during boot camp, although he did not assert that he was diagnosed with any other knee condition during service. According to the Veteran, he was diagnosed with right knee arthritis after service and has continued to receive treatment for arthritis. Upon review of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for a right knee condition. The Board acknowledges that the Veteran has continually asserted that his knee pain began in service and has continued since then. The Veteran is competent to testify as to when his symptoms began. Layno, supra. However, the Veteran's contentions must be considered in light of the objective medical evidence of record to better establish the likelihood of there being a nexus between the Veteran's service and his currently diagnosed right knee condition. To that end, the Board notes that it finds the two VA etiology opinions to be sufficiently probative when considered cumulatively. Although the Board remanded the right knee claim in order to secure an opinion more responsive to the issue of whether service connection is warranted, it must also be noted that both examiners thoroughly reviewed the claims file and referenced the lack of any treatment or diagnosis of a chronic right knee condition in service. Furthermore, both VA examiners discussed the lack of any treatment for a right knee condition for several years following service other than the one documented instance in 2009, which resulted in a radiographic examination that showed no right knee abnormalities. Therefore, although the Board rejected the September 2014 examination for utilizing inconclusive language, this deficiency was adequately addressed by the October 2020 examiner, who thoroughly reviewed the claims file and set forth a definitive opinion based on the objective evidence of record. In summation, the Board finds the October 2020 opinion, representing as it does the cumulative weight of the VA examiners who evaluated the likely etiology of the claimed right knee condition, to be highly probative, in light of the examiner's detailed discussion of the record and consideration of medical literature. Sklar, supra. Ultimately, the absence of objective in-service medical evidence documenting a diagnosis of a chronic right knee condition coupled with the probative VA examiner opinions far outweighs the Veteran's assertion that his right knee condition knee began in service and that his symptoms have continued since his discharge from service. See Buchanan, supra. As such, the preponderance of the evidence is against the claim of service connection for a right knee condition on either a direct basis under 38 C.F.R. § 3.303(a) or based on continuity of symptomatology under 38 C.F.R. § 3.303(b). The Veteran may still be entitled to service connection for a right knee condition if all of the evidence establishes that it is otherwise attributable to an in-service occurrence. 38 C.F.R. § 3.303(d). As stated above, however, the weight of the objective medical evidence of record is against such a determination, as the opinion of the most recent VA examiner is supported by the weight of the evidence. This evidence shows that the Veteran was never evaluated as having a chronic right knee condition in service and did not have documented treatment for knee symptomatology until 2009, over 7 years after his discharge from service. To that end, the Board reiterates that a radiographic examination at the time of the 2009 evaluation did not reveal any right knee abnormalities. Indeed, it was not until the September 2014 VA knee examination, another 5 years later, that the Veteran received a diagnosis of a right knee condition, that being degenerative joint disease. Furthermore, the Board notes that there is no evidence in the record showing that the Veteran has the medical training, credentials, or other expertise to competently conclude that his right knee condition is attributable to service. Jandreau, supra. In summation, the Board finds that the most recent VA examiner opinion substantially outweighs the lay evidence of record, in light of the rationale presented and the absence of training or credentials on the part of the Veteran. Therefore, the preponderance of the evidence is against the claim of service connection for a right knee condition, the benefit-of-the-doubt standard of proof does not apply, and the claim is denied. 38 U.S.C. § 5107(b). 3. Right Thumb Condition The Veteran seeks service connection for a right thumb condition, which he contends developed in service as the result of an injury during which he hyperextended his thumb on duty. In the alternative, he asserts that even if his currently diagnosed right thumb condition manifested after his discharge from service, it nevertheless is attributable to his service. Accordingly, the question for the Board is whether the Veteran has a diagnosis of a right thumb condition that was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed with a right thumb strain, the preponderance of the evidence is against a determination that a diagnosable right thumb condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). Available service treatment records show that the Veteran sought treatment in October 1987 for a right thumb injury he incurred while on duty. After an evaluation, he was diagnosed with a thumb sprain, and his right hand was set in a splint. He was assigned to one week of light duty. There are no subsequent records showing continued treatment for right thumb symptomatology. Right thumb pain was not noted on any of the medical examinations afforded to the Veteran following this treatment, to include the October 2000 separation examination, and the Veteran did not report any history of right thumb symptomatology on the Reports of Medical History corresponding to each periodic examination. Post-service, an January 2017 outpatient record reflects that the Veteran reported that he was experiencing right thumb pain that he associated with the in-service right thumb injury. After an in-person examination, the medical professional evaluating the Veteran found no evidence to support a diagnosis of a right thumb condition. There are no further records documenting specific treatment for a right thumb condition, and at no point has any treating medical professional attributed the Veteran's right thumb pain to his service. The Veteran was first afforded a VA thumb examination to evaluate the nature and likely etiology of the claimed right thumb condition in September 2014, during which he reported that he hyperextended his right thumb in service and that he continued to experience some clicking at the base of his right thumb even after his discharge from service. After an in-person examination, the examiner declined to endorse a diagnosis of a right thumb condition, and, as such, did not set forth any opinion as to the likely etiology of the claimed right thumb condition. Pursuant to the Board's February 2020 remand instructions, the Veteran was afforded a VA thumb examination in October 2020, during which he asserted that he hyperextended his right thumb in service in October 1987 and experienced right thumb pain and swelling. According to the Veteran, he currently experienced occasional dull pains and partial locking up of the thumb joint, which he treated with over-the-counter pain medication. He also reported that he was unable to grip with his right hand as well as he could with his left. After an in-person evaluation, the examiner set forth a diagnosis of a right thumb strain. The examiner then opined that it was less likely than not that the Veteran had a right thumb condition that was incurred in or is otherwise attributable to service. In support thereof, the examiner acknowledged that the Veteran underwent treatment for a right thumb injury in service in 1987 but highlighted the lack of subsequent treatment for a right thumb condition for the remainder of his service time. In addition, the examiner noted the lack of treatment for right thumb symptomatology for over 15 years after the Veteran's discharge from service. As the examiner thoroughly reviewed the claims file and supported her opinion by reference to the Veteran's medical history, the Board finds the October 2020 examination and opinion to be highly probative of the ultimate question of whether the right thumb condition was incurred in or is otherwise attributable to service. Sklar, supra. During the October 2019 hearing, the Veteran asserted that he hyperextended his right thumb while on service and sought treatment for the injury. According to the Veteran, his thumb and arm were placed in a splint as well as a cast, and he was placed on light duty for multiple weeks while he recovered. He acknowledged that he did not receive any further treatment for right thumb symptomatology after this incident in service, and further reported that he was not receiving any treatment for a right thumb condition at the time of the hearing. Upon review of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for a right thumb condition. The Board acknowledges that the Veteran has asserted that his right thumb symptomatology manifested in service following the documented injury in October 1987 and that the symptomatology has continued since then. Layno, supra. However, there is no evidence in the record which indicates that the Veteran is competent through expertise or knowledge to conclude that his currently diagnosed right thumb condition is attributable to his service. Jandreau, supra. As such, the Veteran's contentions must be considered in light of the objective medical evidence of record to better establish the likelihood of there being a nexus between the Veteran's service and his currently diagnosed right thumb condition. In considering the likelihood that the Veteran incurred a right thumb condition in service that continued to the present, or that his right thumb condition is otherwise attributable to his service, the Board relies on the highly probative opinion of the October 2020 VA examiner, who found it less likely than not that the Veteran's currently diagnosed right thumb condition is attributable to service. As stated, the examiner noted the lack of diagnosis of a chronic right thumb condition and the lack of documented treatment following service until 2017, over 15 years after his discharge from service. The Board finds this probative opinion to far outweigh the Veteran's general assertions, unsupported as they are with no objective medical evidence. Ultimately, although the Veteran did seek treatment in service for a right thumb injury, the absence of a diagnosis of a chronic condition coupled with the utter lack of potentially supportive evidence following service far outweighs the Veteran's general assertion that he has a right thumb condition that is attributable to service. See Buchanan, supra. As such, the preponderance of the evidence is against the claim of service connection for a right thumb condition on either a direct basis under 38 C.F.R. § 3.303(a) or based on continuity of symptomatology under 38 C.F.R. § 3.303(b). Furthermore, the lack of any potentially positive evidence also negates the possibility of granting the claim as otherwise attributable to service under 38 C.F.R. § 3.303(d). Consequently, the benefit of the doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b). A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Collins, 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.