Citation Nr: 21017135 Decision Date: 03/24/21 Archive Date: 03/24/21 DOCKET NO. 16-08 499 DATE: March 24, 2021 ORDER Entitlement to service connection for a left ankle disorder, to include as secondary to service connected right knee degenerative joint disease and/or left knee degenerative joint disease, is denied. FINDING OF FACT The Veteran’s left ankle disorder was not incurred in service, is not otherwise causally or etiologically related to service, arthritis did not manifest to a compensable degree within one year of service separation and was not caused or aggravated by service connected right knee degenerative joint disease and/or left knee degenerative joint disease. CONCLUSION OF LAW The criteria for service connection for a left ankle disorder, to include as secondary to service connected right knee degenerative joint disease and/or left knee degenerative joint disease, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1979 to April 1986. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). This appeal was previously before the Board in September 2018, when it was remanded for further adjudication. Specifically, the Board instructed that a VA examination be conducted to determine the nature and etiology of the claimed left ankle disorder. Such an examination was conducted in June 2019. The Board therefore determines that there has been substantial compliance with its previous remand. Stegall v. West, 11 Vet. App. 268 (1998). 1. Left Ankle The Veteran seeks service connection for a left ankle disorder as the result of in-service accident which occurred when the Veteran was playing ball and twisted her ankle. See service treatment records, November 15, 1982. In the alternative, she alleges that her left ankle disorder is the result of her service-connected right and left knee degenerative joint disease. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which a Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran has a current diagnosis of a left ankle disorder. Namely, she has a diagnosis of left ankle lateral collateral ligament sprain (chronic/recurrent), with which the Veteran was diagnosed in 2015, and left ankle degenerative arthritis, diagnosed in July 2019. See Ankle Conditions Disability Benefits Questionnaire (DBQ), July 24, 2019. Thus, the first element of service connection is met. The Veteran’s service treatment records show that the Veteran was diagnosed with a left ankle sprain. She injured her left ankle while playing ball and found it painful to walk. See service treatment records, November 10, 1982. She was seen for a follow-up six days after spraining her ankle and it was noted that X-rays were negative for a fracture. There was no swelling present, the range of motion was reduced, and decreased pain with weight bearing. See service treatment records, November 15, 1982. A February 1983 periodic examination showed no left ankle issues. See service treatment records, February 25, 1983. No left ankle issues or complaints were noted on her April 1986 separation examination. See service treatment records, April 9, 1986. The Veteran underwent a back examination in April 2012. See Back Conditions DBQ, April 6, 2012. As part of the examination, her left ankle muscle strength testing was normal, reflex exams were normal, and sensory exams were normal. The Veteran underwent a muscle examination in April 2019. See Muscle Injuries DBQ, April 20, 2019. Ankle muscle testing was normal. The Veteran’s VA medical records showed reports of left ankle pain. See VA treatment records, June 11, 2019. The records did not speak to the etiology of the Veteran’s left ankle disorder, or any relation of the claimed disorder to her active service. The Board has first considered whether service connection for a left ankle disorder is warranted on a presumptive basis. However, the record shows that the Veteran’s current left ankle arthritis did not have its onset during service or for many years thereafter. The diagnosed arthritis did not manifest within one year of separation from service, but rather about 23 years after separation from service. The Board also observes that while the Veteran’s left ankle disorder (a sprain) was “noted” in service, there is no medical evidence to show that the Veteran’s left ankle sprain symptoms continued after her sprain had healed. As the Veteran’s arthritis was not diagnosed until 2008, and did not manifest during service or within one year of separation, the provisions of 38 C.F.R. §§ 3.307, 3.309 are not for application in this matter. The Veteran underwent an ankle examination in June 2019. See Ankle Conditions DBQ, June 27, 2019. The Veteran reported left ankle pain to the examiner. The examiner diagnosed the Veteran with left ankle lateral collateral ligament sprain (chronic/recurrent), with which the Veteran was diagnosed in 2015, and left ankle mild to moderate degenerative arthritis, diagnosed in 2019. The examiner opined that the Veteran’s left ankle disorder was less likely as not related to her active service, as the left ankle sprain she experienced in active service was acute only. The examiner stated that the April 1986 discharge examination showed no left lower extremity conditions. The examiner related that there were no left ankle conditions reported in the Veteran’s medical treatment records from the time she separated from service to November 2013. The examiner also opined that the Veteran's left ankle disorder was less likely than not (less than 50 percent probability) proximately due to or the result of her service connected condition and was less likely than not (less than 50 percent probability) not aggravated beyond its natural progression as a result of her service connected condition. The examiner reported that there was no medical literature that related an acute ankle sprain sustained over 25 years ago being later related to the claimed bilateral knee condition and that there was no relationship between the Veteran’s clamed left ankle disorder and her knee conditions. The June 2019 opinion is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). This opinion is therefore afforded great probative weight. There is no contrary probative opinion of record. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as right ankle pain. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of having left ankle pain, she is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to her active service. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a left ankle disorder. As such, that doctrine is not applicable in the instant claim, and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lech, 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.