Citation Nr: 21007485 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 13-28 955 DATE: February 9, 2021 ORDER Entitlement to service connection for a left leg disability, to include left fibular head fracture and/or knee disability, is denied. FINDINGS OF FACT 1. The Veteran’s left leg disabilities, to include left fibular head fracture and/or knee disability, were not caused, or aggravated, by any incident of his active service. 2. The Veteran’s left leg disabilities, to include left fibular head fracture and/or knee disability, were not caused, or aggravated, by any service-connected disability, including his bilateral pes planus. CONCLUSION OF LAW The criteria for service connection for a left leg disability, to include left fibular head fracture and/or knee disability, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from January 1998 to October 1999. The Board remanded the Veteran’s claim in August 2017 and January 2019. Review of the completed development reveals that, at the very least, substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). 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, 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). Service connection may also be granted for disability, which is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (a). “When aggravation of a veteran’s non-service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation.” Allen v. Brown, 7 Vet. App. 439 (1995). With disability compensation claims, VA adjudicators are directed to assess both medical and lay evidence. In addressing lay evidence and determining its probative value, if any, attention is directed to both competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent with regard to diseases with “unique and readily identifiable features” that are “capable of lay observation.” See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See generally Caluza v. Brown, 7 Vet. App. 498 (1995). Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for a left leg disability The Veteran contends that his knee injury is due to stepping off a grassy area onto a sidewalk in April 2012, injuring his left knee by hyperextending it because his foot and ankle were unable to support his weight at the time. The Veteran contended that chronic pain and weakness from his service-connected bilateral pes planus caused, or aggravated, the resulted in left leg disability. See May 2012 Statement in Support of Claim. The evidence of record indicates that the Veteran suffered anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears in addition to a documented fibular fracture. See May 2012 Radiology Report. As such, a current disability of the left leg, to include, left fibular head fracture and knee disability, is present during the appeal period. As such, the question before the Board is whether there is a nexus between the resulting left leg fracture, anterior cruciate ligament, and medial collateral ligament tears in the left knee and the Veteran’s service-connected bilateral pes planus disability (or an incident or injury of his period of active service). Unfortunately, the Board finds that the probative evidence of record weighs against a finding that any left leg disability present during the appeal period was caused, or aggravated, by the Veteran’s service-connected bilateral pes planus disability. The Board finds probative the opinion of the June 2012 VA examiner and January 2019 VA examiner that opined that the Veteran’s left leg disabilities were less likely than not caused by his service-connected bilateral pes planus. The January 2019 VA examiner supported the provided opinion by stating that a fibular fracture, ACL, and MCL tears of the left knee and pes planus not medically related conditions and would not cause any of the listed conditions. The examiner also stated that based on review of the Veteran’s medical records, including a physical therapy progress notes, the Veteran sustained a hyperextension injury in April 2012 when stepping off a curb, resulting in internal knee derangement and fibular head facture. Based on these facts, and a review of the record, the examiner found no evidence suggesting that pes planus caused the left leg disability. The Board finds that the examiner’s opinion considered all of the pertinent evidence of record, to include the lay statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The opinion of the 2019 examiner is supported by the opinion of the June 2012 examiner that the left leg disabilities were less likely than not caused by his service-connected bilateral pes planus. The 2012 examiner noted that an orthopedic note recited that Veteran had complained of ankle and foot troubles in the past but did not mention he was having problems on the day of the knee injury. The Board also finds probative the opinions of the January 2019 examiner that opined that the Veteran’s left leg disabilities were less likely than not aggravated by the Veteran’s service-connected bilateral pes planus. The January 2019 VA examiner noted a history of morbid obesity which places excess weight distribution and stress on the joints for ambulation. The VA examiner explained that there is no evidence to suggest aggravation by the bilateral pes planus or flattening of the longitudinal arch of the feet. Based on these facts, the VA examiner provided a negative nexus opinion as to permanent aggravation of the left knee disabilities beyond their natural progression by the Veteran’s service-connected pes planus. The Board finds this opinion highly probative because it discusses the medical principles applied in relation to evidence of record. Id. The Board notes that the Veteran has reported in November 2012 that his surgeon informed him that his left knee injury was service-connected injury secondary to his bilateral pes planus and that an injury like his knee does not come from a misstep. While the Veteran is competent to report what he was told by a physician, the Board finds that this opinion of a limited probative value as a complete rationale was not provided to explain the opinion provided. See Jandreau; see also Nieves-Rodriguez, 22 Vet App. at 303 (2009) (noting that the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion). As such, the Board finds that the opinion reported by the Veteran is outweighed by the January 2019 and June 2012 VA medical opinions of record. The Board has considered the Veteran’s May 2012 statement that his foot and ankle gave out and could not support his weight. While the Veteran competent to relate first-hand experiences, such as his knee hyperextending and pain beginning from there, the Veteran is not a trained medical expert. The Board does not find that the Veteran is competent to provide an opinion that his left leg disabilities have been caused, or aggravated, by his service-connected bilateral pes planus. See Jandreau, 492 F.3d at 1372. The Board finds that the issue is medically complex and falls outside of the realm of lay diagnosis. Id. As such, the opinions provided by the Veteran have no probative value. The Veteran, through his representative, has also submitted links to several research articles that flat feet can cause problems in the ankles and knees because of the alter position of the feet and pressure changes of walking and moving. See November 2020 Informal Hearing Presentation. The Veteran’s representative also stated that “[i]t is doubtful that the Veteran has walked right since release from service in 1999.” Id. The Board, however, finds these articles to be of limited probative value compared to the opinions provided by the January 2019 and June 2012 VA medical opinions of record as they do not discuss the Veteran’s specific history or provide an opinion regarding the etiology of the Veteran’s left leg disabilities. Further, the evidence does not support that the Veteran had an altered gait prior to his left knee injury. The only time an abnormal gait is identified in the medical evidence of record is for a period of time after the Veteran’s left knee injury. See e.g., June 2012 Private Treatment Record; July 2012 Physical Therapy Consult. Prior to his left knee injury, there are no notations of an abnormal gait. Additionally, the most recent records indicate the Veteran’s gait has returned to normal. See e.g., June 2019 Physical Therapy Note (Noting normal reciprocating gait for 1,000 feet over a 6 minute period without assistive devices). The Veteran’s VA and private treatment records associated with the claims file do not otherwise report that any left leg disability present during the appeal period was caused, or aggravated, by any service-connected disability. In sum, the Board finds that the weight of the competent evidence of record does not support that any service-connected disability caused, or aggravated, any disability of the left leg present during the appeal period; accordingly service connection on a secondary basis must be denied. See 38 C.F.R. § 3.310. The Board also finds that the evidence of record also does not support direct service-connection for any left leg disability present during the appeal period. The Veteran’s service treatment records from his active duty service are silent for any complaints of injury to the left knee. The Veteran’s examination prior to separation from active service in May 1999 did not report any impairment of the left knee or fibula. The competent evidence of record does not support a nexus between any current left leg disability and any activity of the Veteran’s active service. The Board notes that the Veteran has not contended his left leg disabilities are directly due to his period of service and has not reported that any medical professional has informed him of such a connection. Without any evidence indicating a relationship between the Veteran’s left leg disabilities and his period of service, the Board finds that service connection on a direct basis must also be denied. See 38 C.F.R. § 3.303. (Continued on the next page)   In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 58 (1990). Patrick M. Johnson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Boushehri, Darjush M. 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.