Citation Nr: A21017790 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 201002-102082 DATE: November 3, 2021 ORDER Entitlement to service connection for a right ankle disability is granted. Entitlement to service connection for a left ankle disability is granted. FINDINGS OF FACT 1. The Veteran's right ankle disability is related to an in-service injury or disease. 2. The Veteran's left ankle disability is related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a right ankle disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left ankle disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1996 to January 2001. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2020 Higher-Level Review (HLR) decision. In October 2020, the Veteran submitted a VA Form 10182, requesting review of a right ankle and left ankle condition, and electing the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran, or his representative, at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The rating decision on appeal is the February 2020 HLR decision, which was issued in response to a request to review a September 2019 rating decision. The HLR decision only considered the evidence of record at the time of the September 2019 decision, as the evidentiary record on HLR is limited to the evidence of record as of the date the AOJ issued notice of the prior decision under review. 38 C.F.R. § 3.2601(f). Therefore, the Board can consider evidence of record prior to the September 2019 rating decision, and evidence submitted at the July 2021 hearing or within 90 days following the July 2021 hearing. The Veteran or his representative submitted a July 2021 private provider opinion in September 2021, which is within the 90 days following the hearing. As such, the Board can consider this evidence. Service connection for right and left ankle disabilities The Veteran contends he is entitled to service connection for bilateral ankle disabilities. He states that his current ankle condition is related to service, namely, his occupation as a paratrooper and the numerous jumps he made during service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Veteran testified that he was a paratrooper and completed approximately 50 jumps while in service. The Veteran testified that he injured his ankle on a jump and reported to sick bay several days later when swelling did not go down. He was evaluated and given ibuprofen and told to rest. The Veteran testified that he generally did not report his injuries from jumps because he did not want to lose the higher level of pay he received while on jump status, and because the general culture did not promote reporting injuriesreporting injuries could jeopardize promotions or lead to being ostracized. He testified that he commonly took ibuprofen before and after a jump, but did not report the pain or go to sick bay. The Veteran's service treatment records (STRs) contain two reports of treatment for left ankle pain in January 1997 and April 2000. The Veteran was treated with medication and diagnosed with an ankle sprain in 1997. The Board finds the Veteran's statements regarding his in-service injury credible and probative. Additionally, they are supported by STRs indicating treatment for ankle pain. The Veteran also provided a credible explanation for why he did not report ankle pain more frequently in service. As such, the second element of service connection is met. A July 2021 letter from an internal medicine practice submitted by E.C., APRN, states that the Veteran has been treated for a bilateral ankle condition and that it was more likely than not related to service. The Board finds this evidence probative as to whether there is a relationship, or nexus, between the Veteran's service and his current disability. Although it is not clear the exact diagnosis of the Veteran's bilateral ankle disability, the Veteran's medical provider did link his condition to service. Moreover, Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), pain alone without an accompanying diagnosis or identifiable condition can be a disability because pain in the absence of a presently diagnosed condition can cause functional impairment. Therefore, a grant of service connection for the Veteran's right and left ankle disabilities is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. S. Sorathia Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Patrick, 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.