Citation Nr: 21071251 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-53 279 DATE: November 30, 2021 ORDER Entitlement to service connection for left anterior tibial stress syndrome, as secondary to now service-connected left ankle lateral collateral ligament sprain with degenerative arthritis, is granted. REMANDED Entitlement to service connection for lower back condition is remanded. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran's left anterior stress syndrome is caused by his now service-connected left ankle lateral collateral ligament sprain with degenerative arthritis. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the elements for service connection for left anterior tibial stress syndrome, as secondary to now service-connected left ankle lateral collateral ligament sprain with degenerative arthritis, on a causation basis, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Army on active duty from March 1960 to March 1963. This matter again comes before the Board of Veterans' Appeals (Board) on appeal from a July 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) and after a 2020 Board decision remanding the matter to the Agency of Original Jurisdiction (AOJ) for further medical examinations and opinions. The Veteran contends that he currently suffers from left shin splints and a lower back condition caused by his military service. Service connection for left anterior tibial stress syndrome, as secondary to now service-connected left ankle lateral collateral ligament sprain with degenerative arthritis, is granted. A Veteran will be compensated for disability resulting from an injury or disease contracted in in the active military, naval, air, or space service. 38 U.S.C. §§ 1110; 1113. Generally, veterans seeking compensation for a service-connected disability must show: (1) a current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38C.F.R. §3.310. To establish service connection on a secondary basis, a veteran must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disease or injury. 38 C.F.R. §3.310. As an initial matter, the Veteran's left shin splint issue is recharacterized with the relevant diagnosis pursuant to Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim). The Veteran maintains he suffers from left "shin splints." In his May 2021 exam, the Veteran was diagnosed with left anterior tibial stress syndrome rather than medial tibial stress syndrome, VA's defined diagnosis for "shin splints." 38 C.F.R. § 4.71a, Diagnostic Code 5262. Thus, the Veteran's left anterior tibial stress syndrome is the relevant diagnosis for this issue. Here, the Veteran has met his burden by showing that his left anterior tibial stress syndrome is proximately due to or the result of his service-connected left ankle lateral collateral ligament sprain with degenerative arthritis (left ankle disabilities). The Veteran currently suffers from left anterior tibial stress syndrome, as diagnosed by a VA examiner in May 2021. Moreover, the same VA examiner found that "it is at least as likely as not that the [Veteran's] left lateral tibial discomfort is caused by the left ankle disabilities." The VA examiner explained "the chronic recurrent lateral collateral ligament sprain of the left ankle will refer pain up along the anterior tibialis region at times reaching up to the left knee area." As the VA examiner explained the reasons for his conclusions based on an accurate characterization of the evidence of record, his opinion is entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Moreover, there is no contrary medical opinion in the evidence of record. For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran's left anterior tibial stress syndrome is caused by the service-connected left ankle disability. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for left anterior tibial stress syndrome, as secondary to now service-connected left ankle disability, on a causation basis, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for lower back disability is remanded. In his August 2017 Notice of Disagreement (NOD), the Veteran claimed he developed back problems after having to constantly march with 50-60-pound rucksacks while in service. Despite this claim, the Veteran did not receive a VA examination of his back. After noting the Veteran's NOD complaints, the Board consequently remanded the issue, directing the Agency of Original Jurisdiction (AOJ), in pertinent part, to "arrange for a VA examination of the Veteran to determine the nature and likely cause of any...lower back disabilities." The Board further instructed the AOJ to obtain a medical opinion and detailed rationale in response to the following question: "Is it at least as likely as not (50% or greater probability) that Veteran's lower back disability was either incurred in or otherwise related to the Veteran's military service?" The Veteran was examined in May 2021 and diagnosed with lumbosacral strain. However, the VA examiner found no direct or secondary service connection between the Veteran's current back condition and the Veteran's military service or service-connected disabilities. In reaching his conclusions, the VA examiner cited a lack of "recurrent care or chronicity of care in records," as well as lack of causation between the Veteran's back condition and a 1962 accident the Veteran experienced in service. The VA examiner did not assess the connection, if any, between the Veteran's current back condition and the Veteran's claim that it was caused by constant marching with heavy rucksacks. Accordingly, the claim for service connection for lower back condition is REMANDED for the following action. Request an opinion from an appropriate physician as to whether it is at least as likely as not (at least a 50 percent probability) that any lower back disability, to include the May 2021 diagnosis of lumbosacral strain, is related to or had its onset during the Veteran's military service, to include consideration of the Veteran's experience of constant marching with heavy (50-60 pounds) rucksacks. The physician should address the Veteran's written statements and the other evidence of record and explain the reasons or rationale for the conclusions reached. If the physician finds an examination is necessary to provide an opinion, one should be conducted. SHAUN S. SPERANZA Veterans Law Judge Board of Veterans' Appeals 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.