Citation Nr: A21019297 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 210521-161419 DATE: December 3, 2021 ORDER Entitlement to service connection for a right knee disability is granted. Entitlement to service connection for a left ankle disability is granted. Entitlement to service connection for a right ankle disability is granted. Entitlement to service connection for a left knee disability is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, his right knee disability is at least as likely as not related to his military service. 2. Resolving reasonable doubt in the Veteran's favor, his left ankle disability is at least as likely as not related to his military service. 3. Resolving reasonable doubt in the Veteran's favor, his right ankle disability is at least as likely as not related to his military service. 4. Resolving reasonable doubt in the Veteran's favor, his left knee disability is at least as likely as not related to his military service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a left ankle disability are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a right ankle disability are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a left knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1973 to August 1980 with additional National Guard service. These matters come before the Board of Veterans' Appeals (Board) on appeal from February and May 2021 rating decisions (RDs) of a Department of Veterans Affairs (VA) Regional Office (RO). On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for veterans dissatisfied with VA's decision on their claim to seek review. Following the May 2021 RD, the Veteran opted into the AMA system. In his May 2021 Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182), the Veteran sought Board review of the May 2021 RD and requested a hearing before a Veterans Law Judge (VLJ). In February 2021, he testified at a hearing before the undersigned VLJ. Accordingly, the Board may only consider evidence as of the date of the May 2021 RD, as well as evidence submitted at and within 90 days following the December 2021 Board hearing. As the Board is able to grant the Veteran's claims based on his hearing testimony, the case need not be delayed for the 90-day evidence submission period. 1. Entitlement to service connection for a right knee disability 2. Entitlement to service connection for a left ankle disability 3. Entitlement to service connection for a right ankle disability 4. Entitlement to service connection for a left knee disability Issues 1-4: Under the relevant laws and regulations, 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. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is a chronic disease under 38 C.F.R. § 3.309 (a). As such, 38 C.F.R. § 3.303 (b) is applicable for all issues on appeal. Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303 (d). The Veteran contends that his bilateral knee and ankle disabilities are the result of his military service. Specifically, he claims that he first experienced bilateral knee and ankle pain in service and that his current disabilities are related to those in-service symptoms. Therefore, he believes that service connection is warranted for the bilateral knees and ankles. The RO found that the Veteran has current diagnoses of bilateral knee and ankle arthritis. RD, May 2021. Additionally, the RO found that there were in-service complaints of bilateral knee abrasions following a motorcycle accident, constituting an in-service injury for the bilateral knees. These are favorable findings. The remaining questions before the Board are (1) whether the Veteran has an in-service event or injury for the bilateral ankles, and (2) whether the Veteran's bilateral knee and ankle disabilities are the result of his military service. The Board concludes that the evidence supports such findings. With regard to an in-service event or injury for the bilateral ankles, the Board notes that the July 1979 service treatment record following the motorcycle accident only addresses the knees. However, given the nature of a fall from a motorcycle, the Board finds it reasonable to assume that the ankles may also be affected. As such, the in-service injury criterion is arguably met. The second element of Shedden/Caluza is also met for the bilateral ankles. The remaining question is whether there is a medical nexus between the Veteran's military service and his current bilateral ankle and knee disabilities. The Veteran submitted a private medical opinion from his private physician in April 2021. Dr. P.W.S. letter, April 2021. Dr. P.W.S. indicates that he was familiar with the Veteran's history and treated him for his current bilateral ankle and knee osteoarthritis. Based on this history and his experience as a physician, he concluded that it was likely that the Veteran's arthritis was related to his previous wear and tear and activities during his military service. The Board notes that the RO obtained two VA contract examinations and opinions in February 2021. Although these opinions did not link the Veteran's bilateral knee and ankle disabilities to service, the Board finds them inadequate as the earlier opinion fails to address the in-service injury and both opinions fail to address the Veteran's assertions of continuous symptoms since service. Given the positive private opinion and the lack of adequate negative evidence to contradict that opinion, the Board finds that the evidence is, at minimum, in equipoise regarding the question of whether the Veteran's current bilateral knee and ankle disabilities are related to his military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The benefit-of-the-doubt will be conferred in the Veteran's favor and the claims for service connection for a right knee disability, a left ankle disability, a right ankle disability, and a left knee disability are granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Moore, 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.