Citation Nr: 21013679 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 17-40 949 DATE: March 10, 2021 ORDER Entitlement to service connection for right knee osteoarthritis is granted. Entitlement to service connection for left knee osteoarthritis is granted. Entitlement to service connection for a right ankle sprain is granted. Entitlement to service connection for a left ankle sprain is granted. Entitlement to service connection for plantar fascia fibromatosis of the right foot is granted. Entitlement to service connection for plantar fascia fibromatosis of the left foot is granted. Entitlement to service connection for groin muscle pain of the right leg is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, right knee osteoarthritis was incurred in active service. 2. Resolving reasonable doubt in the Veteran’s favor, left knee osteoarthritis was incurred in active service. 3. Resolving reasonable doubt in the Veteran’s favor, a right ankle sprain was incurred in active service. 4. Resolving reasonable doubt in the Veteran’s favor, a left ankle sprain was incurred in active service. 5. Resolving reasonable doubt in the Veteran’s favor, plantar fascia fibromatosis of the right foot was incurred in active service. 6. Resolving reasonable doubt in the Veteran’s favor, plantar fascia fibromatosis of the left foot was incurred in active service. 7. Resolving reasonable doubt in the Veteran’s favor, his groin muscle pain of the right leg is a disability for VA service connection purposes and such pain was incurred in active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for right knee osteoarthritis have been met. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 2. The criteria for entitlement to service connection for left knee osteoarthritis have been met. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 3. The criteria for entitlement to service connection for a right ankle sprain have been met. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 4. The criteria for entitlement to service connection for a left ankle sprain have been met. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 5. The criteria for entitlement to service connection for plantar fascia fibromatosis of the right foot have been met. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 6. The criteria for entitlement to service connection for plantar fascia fibromatosis of the left foot have been met. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 7. The criteria for entitlement to service connection for groin muscle pain of the right leg have been met. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1995 to July 1998. He testified before the undersigned Veterans Law Judge at a September 2020 Board hearing. 1. Service Connection – Right Knee Osteoarthritis 2. Service Connection – Left Knee Osteoarthritis Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Generally, in order to establish direct service connection, three elements must be established: (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, which is often referenced as the “nexus” element. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Evidence The Veteran filed a claim in June 2015 and listed a disability of “bilateral knees.” The Veteran’s service treatment records (STRs) included a June 1998 STR that noted a “[complaint of pain] in center of both knees…has been going on for 9 months.” It was also noted that the Veteran reported “that [pain] has gradually increased with time….knees begin to hurt when standing for long or when running…knees don’t swell but do get red when inflamed…also says he has trouble squatting.” An assessment was noted of strain muscle. Also of record are post-service National Guard records. These included a May 2000 Annual Medical Certificate, where the Veteran reported that he did not currently have any medical problems and responded no to a question of “[d]o you have any medical problems that bother you? (Painful knees…).” A medical personnel reviewer noted the Veteran as fully fit. A June 2001 Annual Medical Certificate contained the same information. A September 2001 examination report noted upon clinical evaluation that the lower extremities were normal, noted no defects or diagnoses and noted that the Veteran was qualified for retention. On an accompanying Report of Medical History form, the Veteran reported that he ever had or had now swollen or painful joints and knee trouble. The Veteran elaborated as to these yes responses, stating “painful joints – knees” and “knee trouble – hurts when squatting for a period of time. After runs.” On a February 2002 Annual Medical Certificate, the Veteran reported that he did not have any current medical problems, but he also reported that he did have medical problems that bothered him and he noted painful knees. The section of the form for a medical personnel reviewer to complete (addressing whether the Veteran was fully fit) was left blank. The Veteran was afforded a VA examination in August 2015 and a Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ) was completed. A diagnosis was noted of bilateral knee strain. Under the medical history section, it was noted that the “Vet[eran] states he began to develop problems with his knees around 1997-1998,” that “he can not recall the mechanism of injury,” that “he has not seen the need to have his knee re-evaluated over the past 15+ years,” that the “condition has stayed the same” and also “[r]ecurrent knee pain per Vet[eran].” An opinion was provided as to direct service connection that “[t]he claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness.” It was further stated that: Given the information gathered including Vet[eran’s] statement, review of records, and physical exam, it is in my medical opinion that Vet[eran’s] military service medical records are less likely as not sufficient to support that the claimed bilateral knee condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the pain and pain after running that occurred in service. This is based on the following premise[s]…There is insufficient objective data to support any positive causal relationship between the conditions of his knees in-service with the condition of his knees out-of-service. There is insufficient diagnostic information [i.e. MRIs, Xrays, etc.] in-service compared to that out-of-service to support any causality. Furthermore, the available diagnoses found in service are less likely as not severe enough to lead to any chronicity which can support a causal relationship. To opine causality without definitive objective measures would be to render an opinion based mainly on speculation. Also of record are subsequent relevant VA treatment records. An initial September 2015 VA primary care treatment record included a report of “pain in knee for y[ea]rs.” A March 2017 VA kinesiotherapy consult treatment record noted a complaint of bilateral knee pain and noted “Mechanism of Injury: Injured while serving in the military.” A January 2018 VA orthopedic surgery consult treatment record noted a complaint of bilateral knee pain and stated “a multi-year history of bilateral knee pain that per [Veteran’s] own reports have been bothering him since he was in the Army more than 10 years ago.” An assessment was noted of bilateral knee mild degenerative changes. In addition, the Veteran testified at a September 2020 Board hearing. He reported that he injured his knees “during a exercise running, as well as every day activity.” He also stated that after service “I still suffered. I just didn’t know the process of getting medical attention and I was just still young and motivated.” He also referenced that he went “many years” without medical care and that he treated himself (through massage, over the counter medication, ice and a knee brace that he purchased). The Veteran additionally testified that, after his separation from active service in July 1998, he had “problems with…[his] knees” and that he “continuously had the problems since [he was] on active duty through the present.” The Veteran subsequently submitted a November 2020 private medical record from Dr. R.S., an orthopedic surgeon. This record referenced the Veteran’s active service (though incorrectly noted such service as being from 1995 to 2003) and stated that “[d]uring the time period on active duty in the United States Army and also with active duty with the National Guard, he was undergoing physical training, road marches, and also playing soccer. [The Veteran] stated that he noted the gradual onset of pain in both…knees.” The Veteran’s knees were examined and diagnostic test results were cited. It was noted that the Veteran “denies prior injury…of the knees,” but it was also noted “Prior Injury: Knee.” An assessment was noted of osteoarthritis of the right and left knees. Dr. R.S. provided an opinion stating that “[i]t is my strong opinion that [the Veteran’s] symptoms are directly causally related to the injury that he sustained while on active duty in United States Army,” that “[i]t is also my opinion that more likely than not the injuries that he sustained are directly causally related to the present bilateral knee…symptoms” and that “[t]he progressive pain in the bilateral knee…is directly causally related to the injuries he sustained while on active duty.” Analysis Upon review, and resolving reasonable doubt in the Veteran’s favor, the Board finds that entitlement to service connection is warranted for right and left knee osteoarthritis. As outlined, STRs included a June 1998 complaint of bilateral knee pain. In addition, also as outlined, the Veteran has variously reported, essentially, having bilateral knee pain and problems since active service, to include under oath before the undersigned Veterans Law Judge at a September 2020 Board hearing. The Veteran is competent to make such reports as to what he has experienced. See 38 C.F.R. § 3.159(a)(2) (defining competent lay evidence). The Board acknowledges that there is evidence that weighs against the Veteran’s report of having bilateral knee pain since service. See May 2000 and June 2001 National Guard Annual Medical Certificates. The Board finds that the evidence is at least in relative equipoise (an approximate balance) as to whether the Veteran experienced bilateral knee pain and problems since active service and, resolving reasonable doubt in the Veteran’s favor, the Board finds the Veteran’s reports to be credible and thus that he did experience such pain and problems. See 38 U.S.C. § 5107(b) (“When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, [VA] shall give the benefit of the doubt to the claimant”); 38 C.F.R. § 3.102 (“When…a reasonable doubt arises regarding service origin…or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim”). As noted, a positive November 2020 private opinion is of record. Dr. R.S. noted an assessment of osteoarthritis of the right and left knees and indicated, essentially, that the Veteran’s knee symptoms (presumably due to the assessed osteoarthritis) were directly related to the Veteran’s active service. The Board acknowledges that while this opinion contained a fairly limited rationale, the rationale did reference “progressive pain” and, as discussed, the Board has found credible the Veteran’s lay report of experiencing pain since his active service. On the other hand, the August 2015 VA opinion was negative as to direct service connection. This opinion was based, however, on a diagnosis of bilateral knee strain and did not directly address the diagnosis of osteoarthritis addressed by Dr. R.S. in the November 2020 private opinion. It is also not entirely clear from the August 2015 VA opinion whether the medical professional addressed or considered the Veteran’s competent and credible lay report of pain since service. See generally Miller v. Wilkie, 32 Vet. App. 249, 260 (2020) (“The examiner must address the veteran’s lay statements to provide the Board with an adequate medical opinion”). Overall, and resolving reasonable doubt in the Veteran’s favor, the Board finds the November 2020 private opinion to be sufficient evidence to show that the Veteran’s bilateral knee osteoarthritis had a nexus to his active service. In sum, the Board finds that, resolving reasonable doubt in the Veteran’s favor, right and left knee osteoarthritis were incurred in active service. As such, the Board concludes that the criteria for entitlement to service connection for right knee osteoarthritis and left knee osteoarthritis have been met and, to this extent, the Veteran’s claims are therefore granted. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 3. Service Connection – Right Ankle Sprain 4. Service Connection – Left Ankle Sprain Evidence The Veteran filed a claim in September 2015 and listed a disability of “Bilateral Ankle Condition.” The Veteran’s STRs did not include treatment related to his ankles. Post service National Guard records included May 2000 and June 2001 Annual Medical Certificates, where the Veteran reported that he did not currently have any medical problems and responded no to a question of “[d]o you have any medical problems that bother you?” A medical personnel reviewer noted the Veteran as fully fit on the certificates. A September 2001 examination report noted upon clinical evaluation that the lower extremities were normal, noted no defects or diagnoses and noted that the Veteran was qualified for retention. On an accompanying Report of Medical History form, the Veteran reported that he ever had or had now swollen or painful joints, but the Veteran elaborated as to this yes response by stating “painful joints – knees.” He also reported that he had not ever had bone, joint or other deformity and denied ever having any illness or injury other than those already noted on the form. On a February 2002 Annual Medical Certificate, the Veteran reported that he did not have any current medical problems and while he also reported that he did have medical problems that bothered him, he only noted painful knees. The section of the form for a medical personnel reviewer to complete (addressing whether the Veteran was fully fit) was left blank. Relevant VA treatment records included an initial September 2015 VA primary care treatment record that included a report of “ankle pain for y[ea]rs.” Also, a March 2017 VA kinesiotherapy consult treatment record that noted a complaint of bilateral ankle pain and noted “Mechanism of Injury: Injured while serving in the military.” In addition, an August 2017 VA podiatry consult note that stated that the Veteran “[p]resents with bilateral ankle pain instability becoming progressively worse. Began with multiple ankle sprains during his tour of duty” and an assessment was noted of “[b]ilateral post injury ankle [s]prains residual bilateral ankle pain instability.” Also, a September 2017 VA podiatry note (and various subsequent podiatry notes dating through 2019) stated that the Veteran “injured ankle 22 years” which dates back to approximately 1995 and presumably during the Veteran’s active service. In addition, the Veteran testified at a September 2020 Board hearing. He stated that during his active service “[t]here was times…I don’t know if the boots played a role, or the marches, or even the physical training…but I’ve always had pain in my ankles.” He further stated that “I just didn’t take it further into the Medics…you’re young…To be…more gung ho…I didn’t do much medical for them.” The Veteran additionally testified that, after his separation from active service in July 1998, he had “problems with [his] ankles” and that he “continuously had the problems since [he was] on active duty through the present.” The Veteran subsequently submitted the previously discussed November 2020 private medical record from Dr. R.S. In addition to the information previously discussed, the record referenced that during the Veteran’s active service “he noted the gradual onset of pain in both…ankles.” The Veteran’s ankles were examined and diagnostic test results were cited. It was noted “Prior Injury…ankle.” An assessment was noted of “Sprain of ankles, bilateral.” Dr. R.S. provided an opinion stating that “[i]t is my strong opinion that [the Veteran’s] symptoms are directly causally related to the injury that he sustained while on active duty in United States Army,” that “[i]t is also my opinion that more likely than not the injuries that he sustained are directly causally related to the present…bilateral ankle…symptoms” and that “[t]he progressive pain in the…bilateral ankle…is directly causally related to the injuries he sustained while on active duty.” Analysis Upon review, and resolving reasonable doubt in the Veteran’s favor, the Board finds that entitlement to service connection is warranted for right and left ankle sprains. As noted, while the Veteran’s STRs did not include treatment related to his ankles, the Veteran has variously reported, essentially, injuring his ankles and having pain during his active service. He further reported, under oath before the undersigned Veterans Law Judge at a September 2020 Board hearing, that he had problems with his ankles continuously since his active service. The Veteran is competent to report this. The Board acknowledges that there is evidence that weighs against the Veteran’s report of having ankle problems since service. See National Guard Records. The Board finds that the evidence is at least in relative equipoise (an approximate balance) as to whether the Veteran experienced bilateral ankle problems since active service and, resolving reasonable doubt in the Veteran’s favor, the Board finds the Veteran’s reports to be credible and thus that he did experience such problems. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As noted, a positive November 2020 private opinion is of record. Dr. R.S. noted an assessment of bilateral ankle sprains and indicated, essentially, that the Veteran’s ankle symptoms (presumably due to the assessed sprains) were directly related to the Veteran’s active service. The Board acknowledges that while this opinion contained a fairly limited rationale, the rationale did reference “progressive pain” and, as discussed, the Board has found credible the Veteran’s lay report of experiencing ankle problems since his active service. The Board notes that the Veteran was not afforded a VA examination for these claims and that there is otherwise no competent opinion contrary to the conclusion provided by Dr. R.S. Overall, and resolving reasonable doubt in the Veteran’s favor, the Board finds the November 2020 private opinion to be sufficient evidence to show that the Veteran’s bilateral ankle sprains had a nexus to his active service. In sum, the Board finds that, resolving reasonable doubt in the Veteran’s favor, right and left ankle sprains were incurred in active service. As such, the Board concludes that the criteria for entitlement to service connection for a right ankle sprain and a left ankle sprain have been met and, to this extent, the Veteran’s claims are therefore granted. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 5. Service Connection – Right Foot Plantar Fascia Fibromatosis 6. Service Connection – Left Foot Plantar Fascia Fibromatosis Evidence The Veteran filed a claim in September 2015 and listed a disability of “Bilateral Foot Condition.” The Veteran’s STRs included an August 1995 STR that noted a complaint of blisters, that stated “can’t march, limping. Hurts to stand” and that noted an assessment of “[r]uptured [b]listers.” An April 15, 1997 STR noted “[complaint of] pain on [left] side of f[oo]t” and referenced that the Veteran “had a 12 mi[le] r[oa]d march last w[ee]k.” Also noted was “[complains of] const[ant] sharp pain induces limp has impaired [Veteran’s] performance.” Possible tendonitis was noted and an assessment was made of “Improper Train up for Road March.” A Master Problem List form included as a temporary (minor) problem “foot pain [secondary to] 20k Road March” in April 1997. Post service National Guard records included May 2000 and June 2001 Annual Medical Certificates, where the Veteran reported that he did not currently have any medical problems and responded no to a question of “[d]o you have any medical problems that bother you?” A medical personnel reviewer noted the Veteran as fully fit on the certificates. A September 2001 examination report noted upon clinical evaluation that the feet were normal, noted no defects or diagnoses and noted that the Veteran was qualified for retention. On an accompanying Report of Medical History form, the Veteran reported that he had not ever had foot trouble and denied ever having any illness or injury other than those already noted on the form. On a February 2002 Annual Medical Certificate, the Veteran reported that he did not have any current medical problems and while he also reported that he did have medical problems that bothered him, he only noted painful knees. The section of the form for a medical personnel reviewer to complete (addressing whether the Veteran was fully fit) was left blank. The Veteran was afforded a VA examination in November 2015 and a Foot Conditions DBQ was completed. The DBQ noted that the claimed condition pertaining to the DBQ was the left foot condition, indicating that the examination was for the left foot. Under the diagnosis section, a box was marked for “Other,” without further explanation provided. Under the medical history section, it was stated that “[t]he Veteran reports onset of left foot condition during service. The Veteran reports he completed a ruck march and had alot of pain to his left foot.” An x-ray report was included in the DBQ, which noted as part of the reason for the study “chronic foot pain since military service.” An opinion was provided as to direct service connection that “[t]he condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event, or illness.” The rationale referenced the April 1997 STR discussed above and stated that “[r]eview of available electronic records are silent for any other evaluations, to include follow up evaluations, of the Veteran’s left foot condition from 1997 to 21 Sep 2015, approximately 18 years later” and that “[t]herefore, the Veteran’s left foot condition was less likely than not incurred in or caused by the left foot pain from marching during service.” As referenced by the opinion, an initial September 2015 VA primary care treatment record included a report of “[bilateral] feet pain…for y[ea]rs.” In addition, the Veteran testified at a September 2020 Board hearing. He discussed the 12 mile road march referenced in the April 1997 STRs and stated “I wasn’t properly trained…it was so fast paced…it was a tough march.” Also, the Veteran’s representative asked him if he was “currently experiencing the same thing that you’ve experienced while on active duty” and the Veteran responded “[y]es…To a higher pain level.” The Veteran additionally testified that, after his separation from active service in July 1998, he had “problems with…[his] feet” and that he “continuously had the problems since [he was] on active duty through the present.” The Veteran subsequently submitted private medical records that included an October 2020 note from a podiatrist (Dr. J.F.) that noted a “complaint of bilateral foot pain, particularly the plantar fascia” and that the Veteran “states that this problem has been going on since 04/15/1997.” The Veteran also submitted a November 2020 private medical record from Dr. R.S. In addition to the information previously discussed, the record referenced that during the Veteran’s active service “he noted the gradual onset of pain in both feet.” It was noted that the Veteran “denies prior injury…of the feet,” but it was also noted “Prior Injury…feet.” An assessment was noted of “Plantar fascia fibromatosis, bilateral.” Dr. R.S. provided an opinion stating that “[i]t is my strong opinion that [the Veteran’s] symptoms are directly causally related to the injury that he sustained while on active duty in United States Army” that “[i]t is also my opinion that more likely than not the injuries that he sustained are directly causally related to the present…bilateral foot symptoms” and that “[t]he progressive pain in the…bilateral foot problem is directly causally related to the injuries he sustained while on active duty.” Analysis Upon review, and resolving reasonable doubt in the Veteran’s favor, the Board finds that entitlement to service connection is warranted for plantar fascia fibromatosis of the right and left feet. As outlined, an April 1997 STR clearly referenced a complaint of left foot pain and referenced a 12 mile road march. A Master Problem List form noted “foot pain [secondary to] 20k Road March” in April 1997, without specifying which foot. In addition, also as outlined, the Veteran has variously reported, essentially, having bilateral foot pain and problems since active service, to include under oath before the undersigned Veterans Law Judge at a September 2020 Board hearing. The Veteran is competent to report this. The Board acknowledges that there is evidence that weighs against the Veteran’s report of having feet problems since service. See National Guard Records. The Board finds that the evidence is at least in relative equipoise (an approximate balance) as to whether the Veteran experienced bilateral feet pain and problems since active service and, resolving reasonable doubt in the Veteran’s favor, the Board finds the Veteran’s reports to be credible and thus that he did experience such pain and problems. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As noted, a positive November 2020 private opinion is of record. Dr. R.S. noted an assessment of bilateral plantar fascia fibromatosis and indicated, essentially, that the Veteran’s feet symptoms (presumably due to the assessed plantar fascia fibromatosis) were directly related to the Veteran’s active service. The Board acknowledges that while this opinion contained a fairly limited rationale, the rationale did reference “progressive pain” and, as discussed, the Board has found credible the Veteran’s lay report of experiencing feet pain and problems since his active service. On the other hand, the November 2015 VA opinion was negative as to direct service connection with respect to the left foot claim. This opinion, however, generally referenced a left foot condition and did not directly address the diagnosis of plantar fascia fibromatosis addressed by Dr. R.S. in the November 2020 private opinion. In addition, the November 2015 VA opinion’s rationale stated in part that “available electronic records are silent for any other evaluations, to include follow up evaluations, of the Veteran’s left foot condition from 1997 to 21 Sep 2015, approximately 18 years later.” As addressed above, however, the Board has found that the Veteran competently and credibly reported feet pain and problems since his active service. It does not appear that the negative November 2015 VA opinion considered this lay evidence and thus the Board affords it diminished probative value. With respect to the right foot claim, the Veteran was not afforded a VA examination and no VA opinion was obtained and the Board notes that there is otherwise no competent opinion contrary to the conclusion provided by Dr. R.S. Overall, and resolving reasonable doubt in the Veteran’s favor, the Board finds the November 2020 private opinion to be sufficient evidence to show that the Veteran’s bilateral plantar fascia fibromatosis had a nexus to his active service. In sum, the Board finds that, resolving reasonable doubt in the Veteran’s favor, plantar fascia fibromatosis of the right and left feet were incurred in active service. As such, the Board concludes that the criteria for entitlement to service connection for plantar fascia fibromatosis of the right foot and plantar fascia fibromatosis of the left foot have been met and, to this extent, the Veteran’s claims are therefore granted. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. 7. Service Connection – Groin Muscle Pain of the Right Leg Evidence The Veteran filed a claim in September 2015 and listed a disability of “Groin Muscle Pain, Right Leg condition.” The Veteran’s STRs included an August 1997 STR that noted that the Veteran “[complains of] pulled [right] groin muscle [times] 1 day” and that the Veteran “states he was running began to sprint, when his [right] leg hit the ground he felt pain in his [right] groin muscle[. Veteran] states he only feels ‘aching’ pain when he walks on it for long distance.” Post service National Guard records included May 2000 and June 2001 Annual Medical Certificates, where the Veteran reported that he did not currently have any medical problems and responded no to a question of “[d]o you have any medical problems that bother you?” A medical personnel reviewer noted the Veteran as fully fit on the certificates. A September 2001 examination report noted upon clinical evaluation that the lower extremities were normal, noted no defects or diagnoses and noted that the Veteran was qualified for retention. On an accompanying Report of Medical History form, the Veteran reported that he had not ever had impaired use of the legs and denied ever having any illness or injury other than those already noted on the form. On a February 2002 Annual Medical Certificate, the Veteran reported that he did not have any current medical problems and while he also reported that he did have medical problems that bothered him, he only noted painful knees. The section of the form for a Medical personnel reviewer to complete (addressing whether the Veteran was fully fit) was left blank. The Veteran was afforded a VA examination in November 2015 and a Muscle Injuries DBQ was completed. A diagnosis was noted of right groin muscle strain, with a date of diagnosis noted of June 1997. Under the medical history section, it was noted that “[t]he Veteran reports onset of right groin condition during active duty service [status post] sprinting in PT, Veteran reports onset of pain to his right groin area when his right foot touched the ground.” It was also noted that “[t]he Veteran reports sharp pain at his right medial thigh/groin area, constant” and an aggravating factor was noted as walking greater than five minutes. The examiner noted that the Veteran’s muscle injury did not impact his ability to work, such as resulting in inability to keep up with work requirements due to muscle injury. An opinion was provided that “[t]he condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness.” The provided rationale referenced the June 1997 STR discussed and stated that “[r]eview of available electronic records are silent for additional evaluations/treatments for his right groin condition” and that “[c]urrent examination reveal no tenderness, no erythema/edema/o[]bvious deformities of right medial thigh and groin areas. Veteran had no taut right groin and medial thigh muscles” and concluded that “[t]herefore, the Veteran’s right groin/medial thigh condition is less likely than not incurred in or caused by the pulled right groin muscle during.” In addition, the Veteran testified at a September 2020 Board hearing. He reported that his occupation was “a City Carrier for the United States Postal Service” and stated that “my route is not walking. It’s a majority driving…But when I do have to walk…” The Veteran’s representative referenced the groin pull noted by the June 1997 incident and asked the Veteran how long this continued and the Veteran responded “[t]he groin pull continued since that day.” He also stated that the groin “hinders me with the pain. It hinders me for walking. It hinders me for bending, stretching down. That’s the kind of pain I’m dealing with now.” The Veteran additionally testified that, after his separation from active service in July 1998, he had “problems with…[his] right leg” and that he “continuously had the problems since [he was] on active duty through the present.” Analysis Upon review, and resolving reasonable doubt in the Veteran’s favor, the Board finds that entitlement to service connection is warranted for groin muscle pain of the right leg. A threshold issue is whether the Veteran’s claimed pain is a disability for VA service connection purposes. The United States Court of Appeals for the Federal Circuit has stated that “‘disability’ in [38 U.S.C] § 1110 refers to the functional impairment of earning capacity.” See Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). It was also stated in that case that “pain in the absence of a presently-diagnosed condition can cause functional impairment.” It was additionally stated in Saunders that “to establish a disability, the veteran’s pain must amount to a functional impairment. To establish the presence of a disability, a veteran will need to show that her pain reaches the level of a functional impairment of earning capacity.” In short, Saunders indicated that pain alone may be a disability for VA service connection purposes. The United States Court of Appeals for Veterans Claims subsequently stated that “to establish the presence of a disability pursuant to Saunders, there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level to affect earning capacity.” See Wait v. Wilkie, No. 18-4349, 2020 U.S. App. Vet. Claims LEXIS 1609, at *19 (Vet. App. Aug. 26, 2020). As outlined above, pursuant to Saunders, pain alone may be a disability for VA service connection purposes if the “pain reaches the level of a functional impairment of earning capacity.” It is not entirely clear what is sufficient to demonstrate a functional impairment of earning capacity and, in this regard, in a footnote in Wait it was stated that “the Court expresses no opinion as to the type and extent of the evidence required to demonstrate a functional impairment of earning capacity without regard to the rating schedule, including whether affirmative evidence of difficulty working would meet the Saunders requirement.” In this case, resolving reasonable doubt in the Veteran’s favor, the Board finds that there is sufficient competent evidence specific to the Veteran that tends to show his groin pain rises to a level to affect earning capacity. In this regard, the Board finds probative the Veteran’s lay statements outlined above, as the Veteran is competent to report having groin pain and to describe the impact such pain has on his functional ability. The Veteran reported, as noted, at the September 2020 Board hearing to being a Postal Service carrier and while he referenced his route as “majority driving,” he also stated that “when I do have to walk…,” which indicated that he does, at least at times, walk during work. The November 2015 DBQ noted a report of “sharp pain at his right medial thigh/groin area, constant” and an aggravating factor was noted as walking greater than five minutes and at the Board hearing the Veteran stated that the groin “hinders me with the pain. It hinders me for walking. It hinders me for bending, stretching down.” This evidence indicated that the Veteran’s groin pain was constant, that such was aggravated with walking greater than five minutes and that such hindered walking, bending and stretching. The Board finds that, resolving reasonable doubt in the Veteran’s favor, such pain reaches the level of a functional impairment of earning capacity when considering his occupation as a Postal Service carrier. As such, consistent with Saunders and Wait, the Board finds that the Veteran’s groin pain is therefore a disability for VA service connection purposes. Turning to the issue of nexus, as noted, an August 1997 STR noted a complaint of a pulled right groin muscle. In addition, also as outlined, the Veteran has reported, essentially, having right groin pain and problems since active service, to include under oath before the undersigned Veterans Law Judge at a September 2020 Board hearing. The Veteran is competent to report this. The Board acknowledges that there is evidence that weighs against the Veteran’s report of having groin pain and problems since service. See National Guard Records. The Board finds that the evidence is at least in relative equipoise (an approximate balance) as to whether the Veteran experienced right groin pain and problems since active service and, resolving reasonable doubt in the Veteran’s favor, the Board finds the Veteran’s reports to be credible and thus that he did experience such pain and problems. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board also finds the Veteran’s credible lay report of pain since his active service to be, essentially, a competent opinion as to the issue of nexus. In this regard, the Veteran is competent to report as to the pain he has experienced and that such has continued since his in-service groin pull (at the hearing he stated that “[t]he groin pull continued since that day,” in reference to the in-service groin pull). See 38 C.F.R. § 3.159(a)(2) (“Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person”); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (“Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans’ Court”). On the other hand, the November 2015 VA opinion was negative as to direct service connection. The November 2015 VA opinion’s rationale, however, referenced the June 1997 STR discussed and stated that “[r]eview of available electronic records are silent for additional evaluations/treatments for his right groin condition.” As addressed above though, the Board has found that the Veteran competently and credibly reported groin pain and problems since his active service. It does not appear that the negative November 2015 VA opinion considered this lay evidence and thus the Board affords it diminished probative value. Overall, the Board finds that the evidence is at least in relative equipoise (an approximate balance) as to whether the Veteran’s groin pain (a disability for VA service connection purpose) is related to his active service and, resolving reasonable doubt in the Veteran’s favor, the Board finds such a nexus exists. In sum, the Board finds that, resolving reasonable doubt in the Veteran’s favor, his groin muscle pain of the right leg is a disability for VA service connection purposes and that such pain was incurred in active service. As such, the Board concludes that the criteria for entitlement to service connection for groin muscle pain of the right leg have been met and, to this extent, the Veteran’s claim is therefore granted. 38 U.S.C. §§ 1131, 5017(b); 38 C.F.R. §§ 3.102; 3.303. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Hoopengardner, 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.