Citation Nr: 21006313 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 14-41 283A DATE: February 3, 2021 ORDER Entitlement to service connection for a left calf cramp and pain disability is granted. Entitlement to service connection for a right calf cramp and pain disability is granted. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for a back disability is denied. FINDINGS OF FACT 1. A left calf cramp and pain disability is related to active service, to include in-service complaints and treatment. 2. A right calf cramp and pain disability is related to active service, to include in-service complaints and treatment. 3. 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. 4. The preponderance of the evidence is against finding that a right ankle disability began during active service or is otherwise related to service or any event, injury, or disease during service; or is caused or aggravated by any service-connected disability. 5. The preponderance of the evidence is against finding that a back disability began during active service or is otherwise related to service or any event, injury, or disease during service; or is caused or aggravated by any service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a left calf cramp and pain 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 right calf crap and pain disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a back disability are not 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 1972 to June 1972, and from September 1972 to July 1992. Service Connection Service connection will be established 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. To establish service connection, the evidence must show: (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 disease or injury in service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 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 event, injury, or disease, or is due to or aggravated by a service-connected disability. 1. Entitlement to service connection for a left calf cramp and pain disability 2. Entitlement to service connection for a right calf cramp and pain disability The Veteran contends that he is entitled to service connection for a bilateral calf muscle disability, because the alleged disability is the result of active service. More specifically, the Veteran asserts that current disability is related to complaints of calf muscle pain during service. After a review of the evidence, the Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). A June 1989 service medical record shows complaints of calf muscle spasms. A July 1989 service medical record shows complaints for a left calf muscle spasm. The record indicates that the Veteran was prescribed medication. In a July 2019 VA examination, the examiner opined that the Veteran’s right and left calf muscle cramping was less likely than not incurred in or caused by the right muscle cramping during service. The examiner noted that calf cramping complaints were not found in service or since service until 2011. When VA obtains an examination or opinion, the examination or opinion must be adequate.  Barr v. Nicholson, 21 Vet. App. 303 (2007). Calf muscle complaints for cramping were noted in service medical records. Therefore, that opinion was based on an inaccurate factual premise and is of little probative value. In a July 2020 VA examination, the examiner noted a diagnosis of bilateral calf cramps and pain. It was opined that the claimed disabilities were at least as likely than not the result of active service and related to the calf pain and spasm during service. The rationale provided was that Veteran had no issues related to the claimed bilateral calf cramps or pain prior to service. The examiner highlighted that there was evidence of chronicity, a nexus has been established, and the claim was made relatively proximate to the end of service, with the historical reference to a ten-year history. The veteran continues to have issues, despite the absence of an actual diagnosis. The examiner stated that no diagnosis could be made, except for bilateral calf cramps and pain. The evidence in favor of the claim includes ongoing documentation for left calf muscle and right calf muscle disability of cramps and pain, which is shown to be a long-standing issue, and thus chronic. The evidence of record also includes a positive July 2020 VA medical opinion. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for a left calf muscle and a right calf muscle disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for a left knee disability The Veteran contends that he is entitled to service connection for a left knee disability, as the claimed disability is the result of active service and related to treatment for left knee pain in service. In support of that contention, the Veteran submitted a September 2020 lay statement by A.M.A. detailing observations of the Veteran experiencing knee pain during active service. The Board find that the preponderance of the evidence is against finding that any current knee disability began during active service, or is otherwise related to any event, injury, or disease during service. While the Veteran believes a left knee disability is related to training during active service, the Board finds that the preponderance of the evidence weighs against findings that an in-service injury occurred, or that any current knee disability is related to any incident during service. 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). At a November 1995 VA examination, the Veteran reported the onset of knee pain in 1980. He could not recall a specific injury to the knee, and he was treated with Motrin. X-rays were negative. At a June 2018 hearing before the Board, the Veteran testified about experiencing knee pain while in active service. The Veteran reported injuring the left knee in 1996 after a run in Korea. A July 2019 VA examiner found that the Veteran had a normal left knee. The VA medical opinion concluded that a left knee disability was less likely than not related to active service. The rationale provided was that there was no data in the record indicating left knee problems during active service or at separation. A July 2019 private X-ray of the left knee found no significant bony, articular, or soft tissue changes. In a July 2020 VA medical opinion, a claimed knee disability was found to be less likely than not the result of active service. The rationale provided was that there was no mention of a left knee condition while in service or proximate to service. The 2019 VA examination was negative for any diagnosed knee disability. The service medical records were negative for any knee conditions. There was no complaint of any knee issue noted until 1995. While the Veteran believes he has a current diagnosis of a left knee disability and has complained of knee pain throughout the duration of the appeal, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372 1377 (Fed. Cir. 2007). Beyond that, the VA examiners of record have not found the knee complaints to be related to active service, and the testimony at the hearing places knee pain after separation from service. Consequently, the Board gives more probative weight to the competent medical evidence. The Board finds that the preponderance of the evidence is against a finding that the Veteran has a current left knee disability during or contemporary to the claim period as the VA examinations have been negative for left knee disability findings. To the extent that the Veteran complains of pain that could constitute a functional limitation and thus a disability, the VA examiners found that it was less likely that any current knee disability was related to service. Accordingly, the Board finds that the preponderance of the evidence is against a finding that any left knee disability was incurred in or aggravated by service. Therefore, service connection must be denied. 38 U.S.C. § 5107. 4. Entitlement to service connection for a right ankle disability The Veteran asserts that he is entitled to service connection for a right ankle disability, because the alleged disability is the result of active service. The Board concludes that, while the Veteran has a current diagnosis of a right ankle disability, and evidence shows in-service complaints and treatment occurred, the preponderance of the evidence weighs against finding that any current right ankle disability began during service or is otherwise related to any event, injury, or disease during service. An undated service medical record shows complaints and treatment for a right ankle strain with persistent tenderness in the anterior talofibular ligament. A May 2015 private treatment record diagnosed peroneus brevis tendinosis and tenosynovitis. At the June 2018 hearing before the Board, the Veteran testified that he experienced a right ankle strain in service. The Veteran stated that following one particular injury, he was in a short leg walking cast and had a follow up in 1983. At a July 2019 VA examination, the examiner noted a diagnosis of peroneus brevis tendon tear. The Veteran reported onset in 1975 while running. Since its onset, the right ankle was reported as getting progressively worse. The examiner opined that the diagnoses were completely separate and unrelated to the right ankle sprain and Achilles tendonitis diagnosed during service. The examiner stated that peroneus brevis tendon tears are acute or chronic and may be asymptomatic or associated with lateral ankle pain and/or instability. They commonly occur at the level of the retromalleolar groove. The diagnosed disability is often are associated with a forced dorsiflexion injury and are most commonly longitudinal rather than transverse. There is a suspected high rate of peroneal tendon injury in those with chronic ankle instability. There is also an association with systemic conditions e.g. rheumatoid arthritis, diabetes, or local steroid injection. The examiner also noted that the right ankle disability was not aggravated by a back disability. The Board finds that the VA examiner’s opinion is the most persuasive evidence in this case as the examiner, who has medical training, examined the Veteran and reviewed the evidence of record, while discussing the particular ankle symptomatology during service and currently. The Veteran believes a right ankle disability is related to an injury, event, or disease during service. The Veteran in this case is not competent to provide an etiology opinion regarding an ankle disability as that requires medical training and diagnostic testing. The issue is medically complex, as it requires knowledge of anatomical relationships and diagnostic testing. Therefore, it is outside the competence of the Veteran, a layperson, in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medica evidence of record. Accordingly, the Board finds that the preponderance of the evidence of record is against a finding that any current right ankle disability was incurred in service; is related to any event, injury, or disease in service; or was caused or aggravated by any service-connected disability. Therefore, the claim for service connection must be denied. 38 U.S.C. § 5107. 5. Entitlement to service connection for a back disability The Veteran contends that he is entitled to service connection for a back disability because the claimed disability began in service. The Board concludes that, while the Veteran has a current diagnosis of degenerative arthritis of the spine and left lower extremity radiculopathy, and evidence shows that in-service complaints occurred, the preponderance of the evidence weighs against finding that the current diagnosis of degenerative arthritis of the spine and left lower extremity radiculopathy began during service or is otherwise related to any event, injury, or disease during service. A January 1975 service medical record shows complaints of low back pain. A November 1978 service medical record shows treatment for an acute back strain. There are other complaints of back pain noted in the service medical records dated through the 1980s. An April 2010 VA treatment record notes complaints of back pain. The Veteran reported injuring his back while in active service in 1986 after fracturing three ribs. In an October 2010 VA examination, the Veteran reported back pain and spasms that had grown increasingly worse over the years. The examiner noted a diagnosis of chronic soft tissue strain of the right mid-thorax of the back. In December 2011 correspondence, the Veteran stated that his military occupational specialty as a pilot placed a lot of stress on his lower back. The Veteran stated that having over 3000 flight hours in three different helicopter aircraft with “a continuous 1-to-1 per revolution vertical bounce” greatly impacted the entire spine. A May 2015 private treatment record noted a diagnosis of mild multilevel spondylosis in the lower lumbar spine. At a June 2018 hearing before the Board, the Veteran testified about back pain and continuity of symptomatology since separation from service. At a July 2019 VA examination, the Veteran reported that he started having back pain with wearing out after running, marching, and walking with a heavy backpack. The examiner noted complaints that the back disabilities had gotten increasingly worse since onset. In an August 2019 VA opinion, the examiner opined that the claimed disability was less likely than not related to active service. The rationale provided was that during service, the condition was acute. The examiner also highlighted that there was no evidence of chronicity of care as degenerative arthritis was diagnosed more than 20 years later. In a September 2020 VA addendum opinion, the examiner opined that the back disability was less likely than not incurred in or caused by service. The rationale provided was that the sprain in service affected only muscles and ligaments and that strain does not progress to arthritis. The Veteran believes the current back disabilities are related to an event, injury, or disease during service. The Veteran in this case is not competent to provide a nexus opinion regarding that issue. The issue is medically complex, as it requires knowledge of the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). Despite the Veteran’s complaints of back pain since service, the medical professionals of record have noted that the back strain in service was acute in nature, involved muscles, and would not lead to the development of arthritis. One examiner highlighted the lack of chronicity of care since separation from service. The Board finds that the most persuasive evidence of record is the August 2019 VA examination with September 2020 addendum. Those opinions were based on examination of the Veteran and review of the evidentiary record, and the examiner stated a plausible rationale. Consequently, the Board gives more probative weight to the medical evidence of record. Accordingly, the Board finds that the preponderance of the evidence of record is against a finding that any current back disability was incurred in service; is related to any event, injury, or disease in service; or was caused or aggravated by any service-connected disability. Therefore, the claim for service connection must be denied. 38 U.S.C. § 5107. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Cross, 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.