Citation Nr: 21069445 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 17-20 352 DATE: November 18, 2021 REMANDED Entitlement to service connection for chronic strain, left ankle is remanded. REASONS FOR REMAND The Veteran served on active duty from April 2, 1982 to October 1, 1987 and from August 9, 1989 to March 31, 2005. This matter is before the Board of Veterans' Appeals (Board) on appeal of a February 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The matter was previously remanded by the Board in a February 2019 decision. 1. Entitlement to service connection for chronic strain, left ankle The Veteran seeks service connection for a left ankle condition, including as secondary to her service-connected lumbar back disability. The Veteran's service treatment records (STRs) show that during a 5-year annual examination conducted in April 2000, she was noted to have a left ankle condition. As a result of this finding, in February 2015, the Veteran was provided a VA examination to determine whether she had a current left ankle condition and, if so, whether it was related to the left ankle condition noted in service or secondary to her service-connected lumbar back disability. During the February 2015 VA examination, the Veteran did not recall any significant injury to either ankle. After an examination, the examiner diagnosed a bilateral chronic ankle strain. The examiner opined this condition was less likely than not related to service, stating that current imaging showed no abnormality of the left ankle joint. Therefore, the current left ankle complaints were not related to the left ankle condition documented in 2000. The examiner also opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition, noting for rationale that a lumbar strain was not known to cause or lead to discrete ankle joint conditions. In February 2019, the Board found the February 2015 VA examiner's opinion inadequate as to direct service connection because it was conclusory without supporting rationale. Specifically, it was noted that the examiner's rationale was based on the premise that there was no current disability; however, the examiner had also noted (in contradiction to that rationale) that the Veteran had a diagnosis of ankle strain of both ankles in 2007. The Board also found the February 2015 VA examiner's secondary service connection opinion inadequate because it did not address the question of whether the claimed condition was aggravated by the service-connected lumbar back disability. Finally, the Board noted there were indications in the record to suggest that the Veteran may be considered a Persian Gulf veteran and requested a medical opinion that addressed questions relevant to that issue if the Veteran was confirmed to have service in Southwest Asia. As a result of the Board's remand, a new VA examination was conducted in March 2021. During that examination, the Veteran reported that beginning in the early 2000s she started having lower back pain that radiated down the posterior left thigh into the anterior knee and anterior ankle as well as the plantar arch of the foot. The pain was accompanied by intermittent swelling in the ankle and intermittent bilateral foot and ankle pain and tingling, which was worse when laying down at night. After interviewing and examining the Veteran, the examiner indicated she did not have a current diagnosis associated with the claimed left ankle condition. The examiner stated instead that the Veteran's abnormal findings of left ankle pain and intermittent swelling were due to her lumbosacral radiculopathy rather than an ankle condition; therefore, no diagnosis for the ankle could be rendered. The examiner also stated the Veteran's claimed "left ankle condition to include chronic strain" was due to her service-connected lumbosacral radiculopathy rather than an ankle condition. Therefore, neither a diagnosis nor an opinion regarding direct service connection, secondary service connection, or Persian Gulf War service could be rendered for the ankle condition. The examiner further stated that as the Veteran was already service-connected for lumbosacral radiculopathy, a new opinion pertaining to the condition could not be rendered either. While the Board regrets any further delay, a remand is necessary to clarify whether the Veteran has a current left ankle condition and, if so, whether such is related to her military service or to her service-connected lumbar back disability. As outlined above, the Veteran was noted to have a left ankle condition in a 2000 STR. The February 2015 VA examination also resulted in a diagnosis of left chronic ankle strain, with a date of diagnosis in 2007. However, the February 2015 VA examiner then noted that current imaging reports showed no abnormality of the left ankle joint when providing a negative direct service connection etiology opinion. The more recent March 2021 VA examination similarly found that the Veteran did not have a left ankle condition, but rather had symptoms in the left ankle related to her already service-connected lumbosacral radiculopathy. In light of the conflicting information, clarification and reconciliation of the record is necessary to determine whether the Veteran has a current left ankle condition, whether the Veteran had a left ankle condition that resolved during the appeal period, or whether any prior notations of a left ankle condition in the record were misdiagnoses. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claimed left ankle condition. The Veteran's claims file should be reviewed. The examiner should note any and all diagnoses found related to the Veteran's left ankle. In determining whether the Veteran has a left ankle condition, the examiner should consider and discuss the Veteran's STRs, and in particular the April 2000 STR noting a left ankle condition; the February 2015 VA examination report where it is noted that the Veteran has a current diagnosis of chronic left ankle strain, but that current imaging reports show no abnormality of the left ankle joint; the March 2021 VA examination report where it is indicated the Veteran does not have a current left ankle condition apart from those symptoms that are attributable to her service-connected lumbosacral radiculopathy; as well as any relevant postservice treatment records. If it is determined that the Veteran does not have a current left ankle condition, the examiner must address whether the Veteran had a left ankle condition at any point during the appeal period (even if that condition has since resolved) or whether the prior diagnoses noted in the record for the left ankle were misdiagnoses. If it is determined that the Veteran does have a current left ankle condition, or that the Veteran had a left ankle condition during the appeal period that resolved, the examiner must opine as to whether that condition is at least as likely as not caused by or related to any in-service event, injury or disease. The examiner must also opine as to whether that left ankle condition is at least as likely as not caused OR aggravated by her service-connected lumbar back condition. Aggravation in this context is defined as any increase in disability. Finally, the examiner must also opine as to whether that left ankle condition is at least as likely as not related to the Veteran's presumed environmental exposures experienced during service in Southwest Asia. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. If it is determined that any of the requested opinions may not be provided without an examination of the Veteran, such should be arranged. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Stuedemann, Angela L. 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.