Citation Nr: 21012581 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 14-38 885A DATE: March 4, 2021 ORDER Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a right ankle disability is denied. FINDINGS OF FACT 1. The Veteran’s right knee disability did not manifest during, nor is otherwise etiologically related to, his active service; and, it is not caused or chronically worsened by a service-connected disability. 2. The Veteran’s right ankle disability is not casually related to his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.303, 3.310 (2019). 2. The criteria for entitlement to service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. § 3.303 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active air service from March 1983 to May 1985. This case comes before the Board of Veterans’ Appeals (Board) on appeal from October 2011 and May 2013 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in November 2018, December 2019, April 2020 and August 2020, at which times the issues on appeal were remanded for additional development. This case has been returned to the Board for further appellate action. Service Connection – Right Knee and Right Ankle Disabilities The Veteran has asserted that he has right ankle and right knee disabilities that are etiologically related to his active service, or in the alternative, that his right knee disability was caused or aggravated by his service-connected left ankle disability. The Veteran’s STRs are absent of any complaint of, treatment for, or diagnosis of a right knee or right ankle disability. However, the Board notes that there were multiple occasions in 1983 where the Veteran complained of and was treated for left ankle sprains. The Board also notes that the Veteran reported left ankle issues on his September 1984 separation examination, but not right ankle issues. Additionally, the Board notes that the Veteran’s DD Form 214 indicates that his Air Force Specialty Code (AFSC) was a dental laboratory specialist. The Veteran’s post-service treatment records from the time of his separation, in May 1985, to his initial VA examination in March 2013 are also absent of any complaint of, treatment for, or diagnosis of a right knee or right ankle disability. In a March 2014 decision review officer (DRO) conference report, the Veteran was noted as claiming that his right knee disability was secondary to his left ankle degenerative arthritis due to hobbling on his right leg. In a December 2014 treatment note, it was noted that the Veteran had a history of arthritis in his ankles and knees. Additionally, the Veteran reported that he was repeatedly injured in the military, but that he never documented, or sought attention for his injuries. The Board notes that the VA examinations and/or medical opinions were obtained in connection with this appeal in March 2013, October 2014, September 2019, and June 2020. The March 2013 VA examiner diagnosed right ankle sprain, and X-rays of the right ankle were negative. The October 2014 VA examiner diagnosed right knee strain, and X-rays of the right knee were negative. The September VA examiner diagnosed right knee strain by history in 1984, and right ankle sprain by history in 1983. However, medical opinions provided by the VA examiners have been previously found to be inadequate for adjudication purposes for a variety of reasons. As such, the Board will not further discuss those medical opinions in this decision. In a September 2020 VA addendum opinion, a VA examiner opined that the Veteran’s right knee disability and left ankle disability were less likely as not incurred in or caused by his active service. In so finding, the VA examiner noted that the STRs and separation examination report was silent for complaints of, treatment for, or a diagnosis of either a right knee disability or a right ankle disability. Further, the examiner noted that physical examination at separation was normal. The examiner noted that there were no complaints of a right knee disability or a right ankle disability found in the records until over 15 years after the Veteran’s separation from active service. further, the examiner noted that the 2013 right ankle X-rays and the 2014 right knee X-rays were negative, and the current diagnoses consisted of right knee strain and right ankle sprain, which were made at the time of the September 2019 VA examination. The examiner acknowledged that the Veteran is able to report symptoms, the Veteran is not qualified to ascribe a diagnosis to those symptoms. Further, the examiner noted the Veteran’s reports of rigorous exertive physical activity during service, to include playing basketball and football, but that those reports were subjective only as the Veteran did not seek medical attention for any injury to the right ankle or knee during service. Further, the examiner noted that the STRs also showed that the Veteran played football prior to service, and at the collegiate level, and that military exercise and sports do not, by themselves, cause joint trauma or injury. As such, the examiner concluded that a nexus between the Veteran’s right knee and right ankle disabilities and his active service had not been established. The September 2020 VA examiner also opined that it was less likely as not that the Veteran’s right knee disability was caused or aggravated by his service-connected left ankle disability. In so finding, the examiner noted that there was no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact or aggravation on another or opposite joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in a length discrepancy of more than five centimeters so that the individuals gait pattern had been altered to the extent that there was a clinically obvious Trendelenburg gait. The examiner noted that such level of severity was not supported by the record, the Veteran’s history, or physical examinations. The examiner noted that the claims file was silent for any antalgic gait, use of assistive devices for ambulation, findings of muscle atrophy, or any other significant changes to the lower extremities due to left ankle arthritis. The examiner further noted that it was not unusual for two joints to share properties in the same person, but one joint’s disease did not “spread” to another or cause damage to another. As such, the examiner found that the service-connected left ankle disability did not cause or aggravate the Veteran’s right knee disability. The Board finds that the September 2020 VA medical opinions are adequate. In this regard, the examiner thoroughly reviewed and discussed the relevant evidence, considered the contentions of the Veteran, and provided a supporting rationale for the conclusions reached, to include citing to relevant medical literature. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As there are no medical opinions of record to the contrary, the Board finds that the September 2020 VA medical opinions are the most probative evidence of record. Further, the Board acknowledges that a VA examiner’s opinion should not solely be based upon the absence of evidence in a Veteran’s STRs. However, the Board also emphasizes that, while not dispositive, the lapse of time between separation from active service and the earliest documentation of a claimed disability is a factor that weighs against the Veteran’s claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In this case, the earliest documentation of the Veteran’s right ankle and right knee disabilities were March 2013 and October 2014, respectively, approximately 28 years since his separation from active service. As such, even if the Board were to assume arguendo that the Veteran’s injuries did occur in service, there is no evidence of his claimed chronicity of symptoms outside of allegations of continuing pain and swelling made almost three decades after his alleged initial injury. As such, the Board finds that the Veteran’s report of right ankle and right knee symptoms since service are not credible, and are of no probative value. Further, the Board finds that the Veteran is competent to report the observable symptoms of his right knee and right ankle disabilities. However, the Veteran is not competent to provide an etiological opinion as that requires medical expertise and testing, and are outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d. 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide a diagnosis or an etiological opinion in this case. Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for a right knee disability and a right ankle disability is not warranted. 38 U.S.C. § 5107(b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Byrd, 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.