Citation Nr: 21074837 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 16-41 704 DATE: December 16, 2021 ORDER Service connection for a left knee disability is denied. Service connection for a left ankle disability is denied. Service connection for a right ankle disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a left knee disability at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had a left ankle disability at any time during or approximate to the pendency of the claim. 3. The preponderance of the evidence is against finding that a right ankle disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left ankle disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the United States Air Force from August 1991 to September 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran attended a videoconference hearing before the undersigned in June 2019. In July 2019 and January 2021, the Board remanded this matter for further development. The Veteran has not raised any issues with the duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board ... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); see also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection for a disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Left Knee The Veteran contends that she has a left knee disability related to her active-duty service. For the following reasons the Board disagrees and finds that service connection is not warranted. 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. The Board concludes that the Veteran does not have a current diagnosis of a left knee disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran underwent a VA examination in August 2015. The examiner was unable to diagnose the Veteran with a left knee condition. The Veteran reported her symptoms as mild aches and swelling depending on weather changes. She demonstrated normal range of motion and the examiner found no functional impact on the Veteran's ability to perform an occupational task due to her knee. The Board finds the examiner to be competent and their findings to be credible. Accordingly, the Board affords this examination great probative weight. After a remand, the Veteran underwent another VA examination in September 2019. This examiner was able to diagnose the Veteran with a left knee strain and patellofemoral pain syndrome in her left knee. The examiner noted these disabilities onset in 1992. The Veteran described her symptoms as pain and swelling that limits her ability to stand and walk. The Board notes that the examiner cited to no evidence from 1992 or provided an explanation for their diagnoses. The evidence cited by the examiner is a service treatment record from June 1995 that documents complaints of right knee pain. Furthermore, when providing an opinion, the examiner found that it was less likely than not that the Veteran's left knee disability was related to service finding no evidence of a left knee condition while in service. Due to the inconsistencies in the dates of onset and the examiner finding of no evidence of an in-service disability renders this examination inadequate and the Board affords it little probative weight. After another remand, the Veteran underwent a VA examination in April 2021. This examiner was unable to diagnose the Veteran with a left knee disability. The Veteran reported that she twisted her right knee during service but did not report a left knee injury. She described her symptoms as pain. On examination the Veteran demonstrated normal range of motion and the examiner found the Veteran's left knee to not impact her ability to perform any type of occupational task. The Board finds the examiner to be competent and their findings to be credible. Accordingly, the Board affords this examination great probative weight. The Veteran submitted a July 2019 letter from her treating chiropractor. Though the chiropractor was able to diagnose a right knee disability, they did not diagnose a left knee disability. The Veteran also submitted private treatment records ranging from September 2010 to February 2018. None of these records document any complaints of knee pain. The Veteran also submitted an April 2016 statement from her husband. He stated that the Veteran has experienced pain since April 1999 that she treated with Tylenol, Advil, warm baths, and massages. He also stated that the Veteran's pain can interfere with doing scheduled things that have been planned or simply need doing. The Veteran testified at a June 2019 hearing. She testified that she treats her pain with asprin, ibuprofen, ice packs, and heating packs. No testimony was provided on the functional impact of the Veteran's left knee pain. The Board finds that the preponderance of the evidence is against finding that the Veteran has had a left knee disability at any time during or approximate to the pendency of her claim. Only one examiner was able to diagnose the Veteran with a left knee disability, but the Board affords the findings of this examiner little probative weight due to inconsistencies with their finding of an onset date during service and that there is no evidence to support an in-service diagnosis. All other examiners, including the Veteran's chiropractor, have been unable to diagnose the Veteran with a left knee disability. The Board has considered whether the Veteran's pain creates a functional impairment to be sufficient to meet the definition of a disability. See Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Only the September 2019 examiner found a functional impairment, but as explained above the Board affords the findings of this examiner little probative weight. No other examiner was able to find a functional impairment caused by the Veteran's left knee pain. Private treatment records are also silent for any complaints of knee pain. Though the Veteran's husband stated that pain interferes with the Veteran doing planned things, the statement is unclear which of the Veteran's claimed orthopedic conditions caused this impairment. Furthermore, the Veteran did not testify at her hearing of any functional impairment that her left knee pain caused. Without competent and credible evidence of a functional impairment caused by the Veteran's left knee pain, the Board cannot find the Veteran to have a left knee disability. Accordingly, the preponderance of the evidence is against a finding that the Veteran has a left knee disability. Because the preponderance of the evidence weighs against this claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As such, service connection for a left knee disability is denied. Left Ankle The Veteran contends that she has a left ankle disability related to her active-duty service. For the following reasons the Board disagrees and finds that service connection is not warranted. 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. The Board concludes that the Veteran does not have a current diagnosis of a left ankle disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In August 2015, the Veteran underwent a VA examination for her claim. The examiner was unable to diagnose the Veteran with a left ankle disability. The Veteran reported her symptoms began during service and they consist of swelling and pain during weather changes. She demonstrated normal range of motion and the examiner found the Veteran's ankles to impact her ability to work due to pain if she was required to stand or walk for more than four hours. After remand, in September 2019, the Veteran underwent another VA examination for her claim. This examiner was also unable to diagnose the Veteran with a left ankle disability. The Veteran reported that she twisted her ankle during service and that her current symptoms are her left ankle turns a couple times a month. She had normal range of motion and the examiner found the Veteran's left ankle to not impact her ability to work. In April 2021, after another remand, the Veteran underwent a VA examination. The examiner was unable to diagnose the Veteran with a left ankle disability. The Veteran reported she twisted her ankles during service and her symptoms consisted of pain that waxes and wanes. She denied decreased range of motion, which was confirmed on examination. The examiner found the Veteran's left ankle to have no impact on her ability to perform any type of occupational task. The Veteran submitted a July 2019 letter from their chiropractor. The chiropractor diagnosed the Veteran with left ankle pain with myalgia and subluxation. The chiropractor provided findings on the Veteran's physical limitations, but it is unclear which of the Veteran's orthopedic disabilities the chiropractor diagnosed her with cause these limitations. The Board notes that the chiropractor's biggest concern was the Veteran's back in causing a physical limitation. The Veteran also submitted private treatment records ranging from September 2010 to February 2018. None of these records document any complaints of left ankle pain. As described above, the Veteran submitted an April 2016 statement from her husband. He described her history of pain, how she treated it, and what limitations it caused. The Veteran also testified about her pain at her June 2019 hearing. She testified on how she treated her pain, but no testimony was provided on the functional impact of the Veteran's left ankle pain. The Board finds that the preponderance of the evidence is against finding that the Veteran has had a left ankle disability at any time during or approximate to the pendency of her claim. None of the VA examiners were able to diagnose the Veteran with a left ankle disability. Though the Veteran's chiropractor was able to diagnose the Veteran with left ankle pain, myalgia, and subluxation, no explanation was provided how they reached these diagnoses. The Board has considered whether the Veteran's pain creates a functional impairment to be sufficient to meet the definition of a disability. See Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Only the August 2015 examiner found a functional impairment, but it is unclear if this relates to the diagnosed disability of the Veteran's right ankle or both ankles. The Veteran's chiropractor described physical limitations, but the Board is unable to determine if these limitations are in reference to the combined effect of the Veteran's orthopedic disabilities or any specific disability. No other examiner was able to find a functional impairment caused by the Veteran's left ankle pain. Private treatment records are also silent for any complaints of ankle pain. Though the Veteran's husband stated that pain interferes with the Veteran doing planned things, the statement is unclear which of the Veteran's claimed orthopedic conditions caused this impairment. Furthermore, the Veteran did not testify at her hearing of any functional impairment that her left ankle pain caused. Considering all the evidence available, the Board finds that a preponderance of the evidence is against finding a left ankle disability. Without evidence of a functional impairment caused by the Veteran's left ankle pain, the Board cannot find that the Veteran has a left ankle disability. Accordingly, the preponderance of the evidence is against a finding that the Veteran has a current left ankle disability. Because the preponderance of the evidence weighs against this claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As such, service connection for a left ankle disability is denied. Right Ankle The Veteran contends that she has a right ankle disability related to her active-duty service. For the following reasons, the Board disagrees and finds that service-connection is not warranted. The Veteran has a current diagnosis of status post tibial fracture of the right ankle. She reported that she twisted her ankle during service. The Veteran is competent to report injuries during service, and the Board does not doubt her credibility. As such, she meets the first two elements for service-connection. Turning to the third element, medical nexus, the evidence consists of VA examinations. The Veteran's first examination was in August 2015. The examiner found it was less likely than not incurred in or caused by a claimed in-service injury. Their rationale was that the Veteran's right ankle disability was caused by a 2011 motor vehicle accident. In September 2019, another VA examiner again found it was less likely than not that the Veteran's right ankle disability was incurred in or caused by service. Their rationale was that there is a lack of documentation of treatment for the Veteran's right ankle during service and that the Veteran's current right ankle disability was caused by a 2011 motor vehicle accident. This opinion is repeated after an April 2021 examination. The claims file includes private treatment records from when the Veteran was in a motor vehicle accident. In September 2011, she was admitted to a hospital with an admitting diagnosis of closed right tibia and fibula fracture. Her discharge diagnoses included closed right tibia and fibula fracture. The Board acknowledges the Veteran's contention that her current right ankle disability is related to service. Though the Veteran is competent to describe an in-service injury the Veteran has not shown that he has the requisite medical knowledge to provide a medical nexus opinion for her current disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board affords the Veteran's lay statement less probative weight and affords more probative weight to the opinions of the VA examiners. Accordingly, the preponderance of the evidence is against a finding that the Veteran's right ankle disability began during service or is otherwise related to service. Because the preponderance of the evidence weighs against this claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As such, service connection for a right ankle disability is denied. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Chandeck, 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.