Citation Nr: 21071654 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 14-24 430A DATE: December 1, 2021 ORDER Service connection for a right ankle condition (claimed as swelling of the ankle) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a right ankle condition (claimed as swelling of the ankle) began during active service, or is otherwise related to an in-service injury or disease. 2. The Veteran's right ankle condition (claimed as swelling of the ankle) are not secondary to (caused or aggravated by) service-connected left ankle and/or right great toe disabilities. CONCLUSION OF LAW The criteria for service connection for a right ankle condition (claimed as swelling of the ankle) are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service in the United States Army from April 1971 to August 1980. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board videoconference hearing in June 2019; a transcript is of that hearing is of record. In January 2020, the Board remanded this matter for an addendum medical opinion. The Board remanded again in December 2020 to gain substantial compliance with its January 2020 remand directives to obtain an adequate VA examination and medical opinion, Since there has been substantial compliance with the remand directives, the matter is ready for adjudication. Service connection for a right ankle condition (claimed as swelling of the ankle) is denied. The Veteran contends that he injured his right ankle during service when he ran and stepped into a pothole. See Hearing Transcript received 6/08/2019 at page 13. He adds that he twisted his right ankle several times during service. Id. The Veteran claims that his current right ankle condition which is characterized by swelling is related to his in-service injuries. Id. at page 14. Alternatively, the Veteran has also claimed that his right ankle condition is related to his service-connected right great toe arthritis. Id. at page 4. 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). Regulations provide that service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disorder may be service connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439, 449 (1995); 38 C.F.R. § 3.310(b). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease or secondary to a service-connected disability. The Board finds that the competent evidence shows (1) that the Veteran has a current diagnosis of resolved right ankle sprain and degenerative joint disease (DJD) and (2) that he had a right ankle injury in-service, specifically a right ankle bruise in August 1979 and a right ankle sprain in June 1980. However, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of resolved right ankle sprain and DJD began during service or is otherwise related to the aforementioned in-service injury/event. Regarding a current disability during the appeal period, a VA examination report from October 2010 shows that the Veteran was diagnosed with right ankle healed sprain. See VA examination received 10/21/2010 at page 6. Additionally, the April 2021 VA examiner found DJD in an August 2018 x-ray. See C&P exam received 4/10/2021 at page 2. Based on the foregoing competent evidence, the Board finds that he has a current disability since he has made competent reports of right ankle pain, swelling, tenderness, and stating that his ankles give out. See Capri received 7/14/2020 at page 40. Over the period on appeal, several VA examinations/medical opinions have been provided with regard to the ankle. All the VA examiners found no nexus between the Veteran's current right ankle disability and his in-service right ankle bruise and sprain and/or post-service onset. Specifically, the March 2020 VA examiner found that the Veteran's current right ankle disability began in 1990. See C&P Exam received 3/13/2020 at page 3. As for the in-service bruise and sprain, the April 2021 VA examiner opined that any in-service right ankle condition was acute and resolved, since the Veteran's examination in 1984 was negative for a right ankle condition as was his C&P Examination in 1980. See C&P exam received 4/10/2021 at page 2. Consistent with the March 2020 VA examiner, the April 2021 VA examiner also found that around 1990 the Veteran had an acute ankle sprain that resolved. See C&P Exam received 3/13/2020 at page 3. Relatedly, the March 2020 VA examiner noted objective evidence, such as a 1993 x-ray, showed a normal right ankle with no abnormalities. Id. at page 17. The April 2021 VA examiner opined that his 1990 ankle sprain likely led to him developing DJD that was later found in an August 2018 x-ray. The April 2021 VA examiner, a medical doctor, opined that the DJD was the result of wear and tear over time and consistent with natural pathology. Additionally, the VA examiner related that DJD is not caused by sprains absent evidence of injury in the joint itself; and, as stated above, the 1993 x-ray showed no evidence of fracture in his right ankle. See C&P exam received 4/10/2021 at page 2. While the Veteran is competent to report having experienced symptoms of pain, swelling, and tenderness in his right ankle since service, he is not competent to determine that these symptoms were manifestations of a right ankle condition due to his inservice treatment of a bruise and sprain of his right ankle. The issue is medically complex, as it requires knowledge of the interpretation of complicated diagnostic medical testing, e.g., an x-ray to diagnose DJD, and knowledge of the body's musculoskeletal system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Without such knowledge, skill, training in these or like areas, the Veteran's statement regarding etiology of his ankle disability are not competent and lack weight. Rather, the Board finds that the competent medical opinions of record to be probative of the nexus matter and worthy of weight for several reasons. For example, the April 2021 VA examiner opinion on direct and secondary service connection is probative and competent because it is based on an accurate medical history and provides an explanation that contains clear conclusions, supporting data, and a rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). It also showed awareness of relevant facts, such as the Veteran's in-service treatment, his separation examination, and post-service treatment, to include in the 1990s. Furthermore, this examiner's opinion was supported by reference to diagnostic tests, such as the 1993 x-ray, and medical text. Regarding secondary service connection, the April 2021 VA examiner opined that the Veteran's service-connected left ankle disability less likely than not is the cause of his sprain in his right ankle since "one joint does not cause a condition in the collateral joint" referencing Wheeless' Textbook of Orthopaedics in support. See C&P exam received 4/10/2021 at page 2. With regard to the Veteran's right great toe disability, the April 2021 VA examiner found that a simple gait accomodation does not cause DJD, nor does it cause a sprain in the opposing joint. Id. Although, the April 2021 VA examiner noted a rare exception to that rule, a less than 5 percent chance where there is a leg length difference or a chronic, exaggerated Trendelenburg gait; the April 2021 VA examiner explained that both of those conditions were not evident in the Veteran's case. Id. As to aggravation, the April 2021 VA examiner found that there was no evidence of aggravation of the Veteran's DJD beyond its natural course. Id. Similar to the reasons for finding the direct opinion probative and worthy of weight, the Board finds the secondary service connection opinion to consider relevant facts, explain the reasoning, and support such with medical literature. The Board also finds that the record does not tend to support continued symptomology of a chronic disease (arthritis). 38 C.F.R. § 3.303(b), 3.309(a). In backing, the Board notes that post-service objective examinations that found a normal right ankle. For example, the Veteran's examination in 1984 was negative for a right ankle condition as was his C&P Examination in 1980. See C&P exam received 4/10/2021. Additionally, the 1993 x-ray showed no evidence of fracture in his right ankle. See C&P exam received 4/10/2021 at page 2. (Continued on the next page) In sum, the Board finds that the preponderance of the evidence goes against the Veteran's claim for service connection. Specifically, no positive nexus opinion on record linking his current right ankle disability to his active duty service. Indeed, the probative opinion of the April 2021 VA examiner weighs against a nexus. Therefore, service connection for a right ankle disability is denied. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Dixon, Associate 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.