Citation Nr: 21006740 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 14-25 405 DATE: February 5, 2021 ORDER The previously denied claim of entitlement to service connection for a lower back disorder is reopened. The previously denied claim of entitlement to service connection for a left ankle disorder is reopened. The previously denied claim of entitlement to service connection for a right ankle disorder is reopened. REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. Entitlement to service connection for a left wrist disorder is remanded. Entitlement to service connection for a lower back disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. FINDINGS OF FACT 1. A May 2008 rating decision denied entitlement to service connection for lower back pain and bilateral ankle pain and popping. The Veteran did not appeal that decision or submit new and material evidence within one year. 2. Since the May 2008 rating decision, new and material evidence has been received regarding the claim of entitlement to service-connection for a lower back disorder. 3. Since the May 2008 rating decision, new and material evidence has been received regarding the claim of entitlement to service-connection for a left ankle disorder. 4. Since the May 2008 rating decision, new and material evidence has been received regarding the claim of entitlement to service-connection for a right ankle disorder. CONCLUSIONS OF LAW 1. The criteria to reopen the previously denied claim of entitlement to service connection for a lower back disorder have been met. 38 U.S.C. §§ 5107, 5108 (2012); 38 C.F.R. § 3.156. 1. The criteria to reopen the previously denied claim of entitlement to service connection for a left ankle disorder have been met. 38 U.S.C. §§ 5107, 5108 (2012); 38 C.F.R. § 3.156. 2. The criteria to reopen the previously denied claim of entitlement to service connection for a right ankle disorder have been met. 38 U.S.C. §§ 5107, 5108 (2012); 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the U.S. Marine Corps from June 2001 to June 2006. Prior to active duty, the Veteran had 11 months and 27 days of inactive service. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an October 2012 rating decision with November 2012 notification letter of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran elected to have a Board hearing on his May 2014 substantive appeal. The hearing was scheduled for March 2020, but the Veteran failed to attend. See January 2020 correspondence; see March 2020 report of general information. As a result, the hearing request is deemed withdrawn. New and Material Evidence In general, decisions of the RO and the Board that are not appealed in the prescribed time period are final. 38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. §§ 3.104, 20.1100, 20.1103 (2019). A finally disallowed claim, however, may be reopened when new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108 (2012). Regardless of the action taken by the RO, the Board must determine whether new and material evidence has been received subsequent to an unappealed RO denial. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). As part of this review, the Board considers evidence of record at the time of the previous final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim, and evidence submitted since a prior final disallowance. Evans v. Brown, 9 Vet. App. 273, 285-86 (1996). New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (2019). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, to include by triggering the Secretary’s duty to assist or consideration of a new theory of entitlement. Shade, 24 Vet. App. at 117-18. Additionally, new and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). Furthermore, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed but were not associated with the claims file when VA first decided the claim, VA will reconsider the claim, rather than requiring new and material evidence. 38 C.F.R. § 3.156(c)(1). To establish service connection, 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 - the so-called nexus requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 1. The previously denied claim of entitlement to service connection for a lower back disorder is reopened. In the May 2008 rating decision, the RO denied service connection because the available evidence did not show a permanent residual or chronic disability of the back after separation from service. The Veteran did not appeal that decision nor submit new and material evidence within one year. The 2008 rating decision is final based on the evidence then of record. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Evidence of record at the time of the May 2008 decision includes the Veteran’s claim for benefits and service personnel and service treatment records from June 2001 through June 2006. Those records did not show a current low back condition. The evidence submitted after the May 2008 rating decision VA treatment records and lay testimony. The VA records include January 2014 x-rays documenting slight posterolisthesis at L5-S1, and a January 2014 VA examination report notes lay testimony of intermittent, chronic back pain since an in-service onset. The Board finds that new and material evidence has been presented. The January 2014 VA x-rays and examination report are new because that evidence was not previously submitted to VA. The evidence is material because it relates to unestablished facts necessary to establish the claim - evidence of current back symptoms, a current back disability, and lay testimony of chronic back symptoms since service. See 38 C.F.R. § 3.303(a); Shedden, 381 F.3d at 1167. Additionally, the evidence is neither cumulative nor redundant as that evidence was not of record at the time of the prior denial. See 38 C.F.R. § 3.156(a). Further, new evidence is to be presumed credible for purposes of deciding whether a previously denied claim may be reopened. Justus, 3 Vet. App. at 513. Moreover, when considering the new evidence in conjunction with the evidence already of record, combined with VA assistance including an examination, it raises a reasonable possibility of substantiating the claim. Shade, 24 Vet. App. at 117. Accordingly, the Veteran’s claim is reopened. 2. The previously denied claim of entitlement to service connection for a left ankle disorder is reopened. 3. The previously denied claim of entitlement to service connection for a right ankle disorder is reopened. The May 2008 rating decision denied service connection for bilateral ankle pain and popping because the available evidence did not show a permanent residual or chronic disability of the ankles after separation from service. The Veteran did not appeal that decision nor submit new and material evidence within one year. The rating decision is thus final based on the evidence then of record. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Evidence of record at the time of the May 2008 decision includes the Veteran’s claim for benefits and service personnel and service treatment records from June 2001 through June 2006. Those records did not show current ankle disabilities or complaints. Evidence submitted after the May 2008 decision private records, VA records, and lay testimony. March 2013 private records document a history of bilateral ankle pain, popping, and weakness. December 2013 VA treatment notes document chronic ankle pain in the setting of polyarthralgia. The January 2014 VA examiner diagnosed bilateral ankle tendonitis and January 2014 VA x-rays revealed a left heel spur. At the 2014 examination, the Veteran reported chronic and worsening bilateral ankle symptoms since an in-service onset. The Board finds that new and material evidence has been presented. The evidence is new because it was not previously submitted to VA. The evidence is material because it relates to unestablished facts necessary to establish the claim - evidence of current ankle diagnoses and symptoms, and lay testimony of chronic symptoms since an in-service onset. See 38 C.F.R. § 3.303(a); Shedden, 381 F.3d at 1167. Additionally, the evidence is neither cumulative nor redundant as that evidence was not of record at the time of the prior denial. See 38 C.F.R. § 3.156(a). Further, new evidence is to be presumed credible for purposes of deciding whether a previously denied claim may be reopened. Justus, 3 Vet. App. at 513. Moreover, when considering the new evidence in conjunction with the evidence already of record, combined with VA assistance including an examination, it raises a reasonable possibility of substantiating the claim. Shade, 24 Vet. App. at 117. Accordingly, for all of the above reasons, the Veteran’s claims are reopened. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disorder is remanded. 2. Entitlement to service connection for a right knee disorder is remanded. The claims of entitlement to service connection for left and right knee disorders are remanded to obtain an adequate medical opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). When a Veteran has provided competent lay statements of an in-service injury, the examiner must consider and address them when developing his rationale. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that when the Veteran has provided lay testimony of an in-service injury, an examiner cannot ignore that lay evidence and base his or her opinion that there is no relationship to service on the absence of in-service corroborating medical records). A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Veteran first underwent a VA examination in January 2014. That examiner noted bilateral knee tendonitis with a 2002 diagnosis date. At that time the Veteran reported his knee pain began in service and had continued. The examiner opined that the diagnosed bilateral knee tendonitis was not related to the Veteran’s period of service. The examiner noted that during military service there were only 2 clinical notes reporting knee complaints in 2001 and 2004, and no evidence of chronicity in service or after separation. The Veteran underwent another VA examination in November 2018. That examiner diagnosed right knee strain and left knee left medial collateral derangement. The examiner concluded that "given the paucity of the written evidence of a significant right knee condition, it is my opinion that the claimed left [sic] knee condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness." The examiner also opined that the left knee condition was not due to service because there was not enough evidence of a significant left knee condition. In support of that opinion, the examiner noted that the April 2006 separation examination did not report any knee condition. Here, neither opinion is based on a full and accurate reporting of the facts, and the examiners did not address the lay testimony of chronic symptoms since an in-service onset. In particular, although no specific knee diagnosis was listed on the April 2006 separation examination report, the examiner did document ongoing bilateral knee pain and popping. Also, the Veteran’s medication list at separation included an active prescription for medication for pain and swelling. January and February 2013 private records document a 5-year history of bilateral knee pain, swelling, and giving way. An MRI report showed right knee partially healed lateral meniscus tear, and left knee meniscal degeneration. The Veteran has consistently testified to chronic knee symptoms since an in-service onset that he attributes to injury and overuse during service. See January 2014 VA examination report; see April 2016 Decision Review Officer hearing testimony; see October 2016 correspondence. He explained he did not have health insurance for several years after separation from service and was unable to receive proper care for his chronic symptoms, which explained the gap in medical care after separation. The 2014 and 2018 VA examiners failed to fully address the April 2006 separation exam, the January and February 2013 private records, and the lay and medical evidence indicating chronic symptoms since an in-service onset. Thus, remand is necessary for an adequate addendum opinion. 3. Entitlement to service connection for a gastrointestinal disorder is remanded. This issue is also remanded for an adequate medical opinion that fully addresses the relevant lay and medical evidence. VA obtained medical examinations and opinions in January 2014 and November 2018. The January 2014 VA examiner noted the Veteran’s report of in-service gastritis and current diagnosis of irritable bowel syndrome. The examiner also noted a double contrast upper gastrointestinal series that showed moderate hiatal hernia and severe gastroesophageal reflux. The examiner opined the current conditions were not due to the Veteran’s period of service. The examiner stated that there was no evidence of chronicity such as multiple clinic visits during or after discharge. VA obtained an addendum opinion in November 2018. That examiner found there was no gastrointestinal diagnosis because there is not pathology to render a diagnosis. The examiner opined that the current gastrointestinal condition was not related to the in-service viral gastroenteritis. The examiner reasoned there was no evidence of chronic gastrointestinal symptoms in service after 2004. The 2014 and 2018 opinions are inadequate, and remand is necessary for an addendum. The examiners did not address a March 2004 radiology report showing localized small bowel ileus in the right lower quadrant. The examiners also failed to address December 2013 VA treatment notes documenting a history of irritable bowel syndrome with chronic loose stools. The 2018 examiner’s conclusion that there was no gastrointestinal diagnosis is contrary to the other medical evidence. The 2018 examiner also failed to consider the lay evidence of chronic symptoms. The Veteran has testified that since service, he experienced recurrent episodes of gastritis and more chronic symptoms of abdominal pain, cramping, and bloating. He also asserts he was exposed to a contaminant in the water during service and told he would have recurrent stomach problems as a result. See August 2016 DRO hearing testimony; see October 2016 correspondence. The Veteran has also explained that the gap in treatment is due to a lapse in medical insurance rather than a lapse in symptoms. On remand, the examiner’s rational should address the competent lay testimony. 4. Entitlement to service connection for a left wrist disorder is remanded. This issue is remanded to obtain a medical examination and opinion regarding the claimed left wrist disorder. A January 2014 VA wrist examination report did not document any diagnosis of the left wrist and the examiner did not provide an opinion for the left wrist. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2019). VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with an examination. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). Here, private medical records dated September 2009 report a history of chronic symptoms of the left hand and wrist since boot camp, described as aching primarily in the thumb/left dorsal wrist. May 2010 private treatment records document the Veteran’s complaint of chronic pain and fatigue in the forearms. A November 2010 private nerve conduction study showed absence of left medial antebrachial cutaneous sensory response, that may be seen in a brachial plexopathy involving the lower trunk. September 2013 private x-rays of the left wrist showed an old left ulnar styloid injury versus non-fused apophysis. The STRs show that in September 2001 the Veteran had left thumb pain after martial arts training, assessed as sprain to the left thumb and he was given a splint. The Board observes the thumb is adjacent to the left dorsal wrist. Because there is evidence of currently diagnosed disabilities, an in-service event, and an indication that the current disabilities may be associated with the in-service event, remand for a VA examination and opinion is required. 5. Entitlement to service connection for a lower back disorder is remanded. This issue is similarly remanded to obtain an adequate medical opinion on the etiology of the claimed lower back disorder. VA obtained an examination and opinion in January 2014. The examiner noted a diagnosis of lumbar posterolisthesis with a 2014 onset date. The Veteran reported the symptoms began in 2004, were intermittent, but became more severe over time. The examiner opined that the claimed back condition was not due to service because there were no in-service clinical notes reporting a lumbar spine complaint or abnormal physical findings. VA obtained an addendum in November 2018. The examiner opined the claimed back condition was not related to the Veteran’s period of service. The examiner cited to a motor vehicle accident with back strain in 2004 and pain noted at separation in April 2006, but noted there was no back condition diagnosed at separation. The examiner noted VA and private records did not show treatment for a back condition. The 2014 examiner failed to address the in-service back injury following a motor vehicle accident, and the 2018 examiner failed to address the lay testimony of chronic, intermittent symptoms since an in-service onset. Further, the evidence shows ongoing back pain at separation and the lack of a diagnosis alone does not equate to lack of a back disability. For these reasons, remand is necessary to obtain an addendum opinion. 6. Entitlement to service connection for a left ankle disorder is remanded. 7. Entitlement to service connection for a right ankle disorder is remanded. The claims of entitlement to service connection for left and right ankle disorders are also remanded to obtain adequate addendum opinions. The Veteran first underwent a VA examination in January 2014. The examiner diagnosed bilateral ankle tendonitis with an onset date of 2003, and right ankle spur. The Board observes that imaging studies documented a heel spur of the left ankle rather than the right. At that exam, the Veteran reported onset of symptoms in service and multiple sprains from running, with chronic, worsening symptoms since separation. The examiner opined that the bilateral ankle tendinitis was not due to the Veteran’s period of service because there were only 2 clinical notes reporting ankle pain in 2003 and no evidence of chronicity such as multiple visits in service and following separation. VA obtained another examination and opinion in November 2018. That examiner did not report any diagnosis of the ankles, stating there was no pathology to render a diagnosis. Then, the examiner opined that the claimed ankle conditions were not due to the Veteran’s period of service. The examiner stated that the STRs only showed two reports of ankle complaints, and there was no evidence of chronicity of ankle complaints after July 2003. Neither examiner adequate addressed evidence of ongoing ankle symptoms after July 2003. The April 2006 separation examination that documents the Veteran had ongoing bilateral ankle pains and popping. At separation his active medications included medication to be taken as needed for pain and swelling. The Veteran reported ongoing bilateral ankle pain on his February 2008 claim for benefits. March 2013 private records document the Veteran had a history of bilateral ankle pain, popping, and weakness, and December 2013 VA treatment notes report chronic ankle pain in the setting of polyarthralgia. On remand, the examiner should provide an adequate opinion that addresses the medical and lay evidence of chronic ankle symptoms since an in-service onset. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, obtain an addendum opinion regarding the etiology of the claimed left and right knee disorder from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) Clarify all diagnosed conditions of the bilateral knees. (b.) For each diagnosis, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the condition had onset in, or is otherwise related to, active service. (c.) The examiner is requested to opine on whether it is at least as likely as not (50 percent or greater probability) that degenerative arthritis of either knee manifested within one year of separation from service. (d.) The examiner must address the following: 1) the STRs documenting a left MCL injury in June 2001 and left knee pain in June 2004, and the April 2006 separation examination report documenting ongoing bilateral knee pain and popping and an active prescription for medication for pain and swelling; 2) January and February 2013 private records documenting a 5-year history of bilateral knee pain, swelling, and giving way; 3) a February 2013 MRI report showing right knee partially healed lateral meniscus tear, and left knee meniscal degeneration; and the Veteran’s testimony of chronic knee symptoms since an in-service onset that he attributes to injury and overuse during service; and 4) the articles cited in the November 2020 submission from the Veteran’s representative. 4. After any additional records are associated with the claims file, obtain an addendum opinion regarding the etiology of the claimed left and right knee disorder from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) Clarify all diagnosed conditions of the gastrointestinal system. (b.) For each diagnosis, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the condition had onset in, or is otherwise related to, active service. (c.) The examiner must address the following: 1) the STRs documenting the Veteran had vomiting and upset stomach in April 2002, February 2004, and May 2004 and the assessment was viral gastroenteritis, a March 2004 assessment of gastritis, flatulence, and constipation, and a March 2004 radiology report showing localized small bowel ileus in the right lower quadrant and a calcified phlebolith in the left pelvis; 2) December 2013 VA treatment notes documenting a history of irritable bowel syndrome with chronic loose stools; and 3) the Veteran’s testimony that since service, he experienced recurrent episodes of gastritis and more chronic symptoms of abdominal pain, cramping, and bloating. He also asserts he was exposed to a contaminant in the water during service and told he would have recurrent stomach problems as a result. 5. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of his claimed left wrist disorder. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that a left wrist disorder had onset in, or is otherwise related to, active military service. (b.) The examiner must address the following: 1) the STRs showing that in September 2001 the Veteran had left thumb pain after martial arts training, assessed as a sprain to and he was given a splint; 2) September 2009 private records noting a history of chronic symptoms of the left hand and wrist since boot camp described as aching primarily in the thumb/left dorsal wrist, May 2010 private records documenting the Veteran’s complaint of chronic pain and fatigue in the forearms, a November 2010 private nerve conduction study showing absence of left medial antebrachial cutaneous sensory response, and September 2013 private x-rays of the left wrist showing an old left ulnar styloid injury versus non-fused apophysis; 3) the Veteran’s lay testimony of chronic left wrist symptoms since around 2001 that he attributed to overuse; and 4) the articles cited in the November 2020 submission from the Veteran’s representative. 6. After any additional records are associated with the claims file, obtain an addendum opinion regarding the etiology of the claimed lower back disorder from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the condition had onset in, or is otherwise related to, active service. (b.) The examiner is requested to opine on whether it is at least as likely as not (50 percent or greater probability) that degenerative arthritis of the spine manifested within one year of separation from service. (c.) The examiner must address the following: 1) the STRs documenting the Veteran was involved in a motor vehicle accident in November 2004 and he had back strain and pain, and the April 2006 report of medical examination at separation documenting ongoing back pain; 2) the Veteran’s lay testimony of chronic, intermittent back symptoms since the in-service onset; and 3) the articles cited in the November 2020 submission from the Veteran’s representative. 7. After any additional records are associated with the claims file, obtain an addendum opinion regarding the etiology of the claimed left and right ankle disorders from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) Clarify all diagnosed conditions of the ankles. (b.) For each diagnosed condition, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the condition had onset in, or is otherwise related to, active service. (c.) The examiner is requested to opine whether it is at least as likely as not (50 percent or greater probability) that degenerative arthritis of the ankles manifested within one year of separation from service. (d.) The examiner must address the following: 1) the STRs documenting right ankle tendonitis in September 2001, bilateral ankle pain in January 2003, right ankle sprain and shin splints in July 2003, and ongoing bilateral ankle pain and popping noted on the April 2006 separation examination; 2) March 2013 private records documenting the Veteran had a history of bilateral ankle pain, popping, and weakness; 3) December 2013 VA records reporting chronic ankle pain in the setting of polyarthralgia; 4) the Veteran’s testimony of chronic ankle pain since service that he attributes to multiple sprains from running and to overuse; and 5) the articles cited in the November 2020 submission from the Veteran’s representative. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Smith, 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.