Citation Nr: 21022141 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-40 809 DATE: April 14, 2021 ORDER Service connection for a right ankle disability is denied. Service connection for a left ankle disability is denied. Service connection for a right knee disability is denied. Service connection for a left knee disability is denied. Service connection for a right foot disability is denied. Service connection for a left foot disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a right or left ankle disability at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence is against finding that the Veteran’s right or left knee disabilities began during active service or are otherwise related to her in-service injuries. 3. The preponderance of the evidence is against finding that the Veteran’s right or left foot disabilities began during active service or are otherwise related to her in-service injuries. CONCLUSIONS OF LAW 1. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a right foot disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a left foot disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1980 to November 1982. The Board remanded the issues of entitlement to service connection for bilateral knee and foot conditions for additional development in November 2019. As part of the same decision, the Board denied the Veteran’s claims for service connection for bilateral ankle disabilities. The Veteran appealed the denied claims to the United States Court of Appeals for Veterans Claims (Court). In September 2020, the Court granted a Joint Motion for Partial Remand (JMPR) and vacated the Board’s November 2019 decision as to these two issues. The Court directed the Board to obtain treatment records identified by the Veteran before readjudicating her claims. As discussed in the JMPR, the records identified by the Veteran were the same VA treatment records the Board directed the agency of original jurisdiction (AOJ) to obtain as part of its directives for the remanded claims. The AOJ has completed the requested development and an additional remand to address the requirements of the JMPR is not necessary. As a preliminary matter, the Board previously denied the Veteran’s claims for entitlement to service connection for bilateral ankle disabilities on the basis that no new and material evidence had been received to warrant reopening the claims. The Veteran’s claims were denied in an April 2003 rating decision, but VA treatment records created within one year of the rating decision, constructively placing them before the AOJ. Yet the AOJ never determined whether the evidence was new and material, the issues therefore remained pending, and any discussion regarding reopening of the claims is unnecessary. 38 C.F.R. § 3.156(b); Beraud v. McDonald, 766 F.3d 1402, 1406-07 (Fed. Cir. 2014); Lang v. Wilkie, 971 F.3d 1348, 1354-55 (Fed. Cir. 2020). Service Connection Generally, to establish a right to compensation for a present disability, a claimant must show: (1) a present disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Ankles The Veteran asserts that she is entitled to service connection for bilateral ankle conditions she contends are related to in-service fractures of her ankles in 1980. See November 2014 and November 2020 Veteran Statements. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. November 1980 service treatment records include complaints of ankle pain when running and a diagnosis of mild Achilles tendonitis. The Veteran’s service treatment records do not include any medical records documenting any ankle fracture as described by the Veteran. However, in December 1980 the Veteran was placed on physical profile and was prohibited from running or marching. The DA Form 3349 notes the Veteran had stress reactions in both heels and notes that she was to keep cast clean and dry. The Board therefore concedes the Veteran’s asserted in-service ankle injuries. However, the Board concludes that the Veteran does not have a current ankle disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The July 2003 VA examiner evaluated the Veteran and determined that, while she experienced subjective symptoms of intermittent pain, swelling, and stiffness brought on by prolonged standing and ambulation, she did not have an ankle disability. The Veteran had normal range of motion in both ankles and imaging showed normal ankles bilaterally. The only pain noted on the examination report was in the right ankle at 20 degrees of distal flexion. The Veteran reported that she used a cane at times but, even with her reported symptoms, was able to walk up to 20 blocks with or without the cane. A March 2015 VA examiner made similar findings. On examination, the Veteran’s ankles were normal, there were no abnormal findings in imaging, and the Veteran did not have any complaints at the time. The examiner acknowledged the Veteran’s in-service bilateral ankle trauma, which was treated with long casts, but opined that the Veteran did not have any current ankle conditions related to the in-service injuries. The examiner further opined that the Veteran did not have any functional impairment resulting from her claimed ankle conditions. Further, while VA treatment records include complaints of left ankle pain in November 2001, the Veteran reported no associated injury or functional impact. She later complained of right ankle pain in December 2008, but imaging showed no acute process and the Veteran did not report any functional limitations resulting from the reported pain. Finally, imaging in December 2012 showed a normal left ankle. In sum, while the Veteran has intermittently reported pain in her bilateral ankles, there is no documented ankle disability and there is no indication that her reported symptoms have resulted in any functional impairment of her earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). Upon careful review and weighing of the evidence, with reasoning as detailed above, the Board finds that the preponderance of the evidence is against the claim for service connection for bilateral ankle disabilities and the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). The appeal must therefore be denied. 2. Knees The Veteran contends that her current bilateral knee disabilities are related to her active service, including physical training in combat boots and in-service tendonitis. She has alternatively asserted her knee disabilities are secondary to her claimed ankle disabilities; however, the Veteran is not entitled to service connection for any ankle conditions and the Board will not address this assertion further. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of bilateral degenerative arthritis and has undergone bilateral meniscectomies, and evidence shows that the Veteran was treated for tendonitis in January 1981 and March 1981, the preponderance of the evidence weighs against finding that the Veteran’s current disabilities began during service or are otherwise related to her in-service injuries. VA treatment records show the Veteran first complained of left knee pain in November 2006 and was diagnosed with a complex tear of the body/posterior horn, medial and patellofemoral cartilage loss, then underwent a left knee meniscectomy in March 2007. She first complained of right knee pain in February 2008 and was diagnosed with a medial meniscal tear and anterior horn lateral meniscal tear, then underwent a meniscectomy in April 2008. More recently, the Veteran was diagnosed with arthritis bilaterally. See March 2015 VA Examination Report; January 2020 VA Examination Report. These complaints, diagnoses, and treatments did not occur until decades after her separation from service. While the Veteran is competent to report having experienced symptoms of knee pain since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of meniscal tears or arthritis. The issue is medically complex, as it requires knowledge and understanding of the relationship between injuries to the tendons of the knee and the development of meniscal tears and arthritis decades later. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, both the March 2015 and January 2020 VA examiners opined that the Veteran’s current knee disabilities were not at least as likely as not related to her in-service tendonitis. The March 2015 examiner explained that there was no evidence the Veteran’s in-service knee problems continued, and the Veteran’s current knee problems only began in 2006. However, the examiner did not consider the Veteran’s assertion that her knee disabilities were caused by physical training in combat boots. The January 2020 VA examiner similarly explained that while the Veteran’s service treatment records documented one episode of bilateral knee pain in January 1981 and an episode of right knee pain in March 1981, there was no history of trauma, the impression was tendonitis, and the veteran was treated with analgesics. The examiner found no further complaints or treatment of bilateral knee problems while the Veteran was in service and noted the October 1982 service separation examination documented no bilateral knee complaints and normal examination. The examiner reviewed the Veteran’s treatment records beginning in 1997 and noted the first mention of left knee pain was on in November 2006, when the Veteran presented to the ER with a one-week history of left posterior knee pain, which, after a subsequent work up, showed a medial meniscal tear and the Veteran underwent left medial meniscectomy in March 2007. The first mention of right knee pain was in February 2008, when the Veteran reported having the same symptoms in right knee as she had in the left. An MRI showed meniscal tears and the Veteran underwent right knee arthroscopy, partial medial meniscectomy, patella chondroplasty and partial synovectomy in April 2008. The examiner therefore concluded the bilateral knee problems started several years after discharge from military service and opined there was no nexus between the bilateral knee problems that started in 2006 and 2008 and the transient episodes of knee problems the Veteran experienced while in service in 1981 that resolved with no chronic residuals. The examiner addressed the Veteran’s assertion that her knee disabilities resulted from performing physical training in combat boots, opining that doing so would not lead to development of meniscal tears several years later and the contention was not supported by the preponderance of established scientific and medical evidence. Finally, the examiner noted a detailed review of the record showed no evidence of any chronic abnormal stresses on the knees during military service and reiterated that it was less than likely that the right and left knee disabilities were related to, or caused by, an in-service injury or disease, to include performing physical training in combat boots, as theorized by the Veteran. Taken together, the VA examiners’ opinions are probative because they are based on an accurate medical history and provide explanations that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes her bilateral knee disabilities are related to her in-service knee injuries or were caused by physical training in combat boots. But she has not shown she is competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the pathology of meniscal tears and arthritis. Therefore, it is outside the competence of the Veteran. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the two VA examiners’ opinions. Upon careful review and weighing of the evidence, with reasoning as detailed above, the Board finds that the preponderance of the evidence is against the claim for service connection for bilateral knee disabilities and the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). The appeal must therefore be denied. 3. Feet The Veteran contends that her current bilateral foot disabilities are related to her active service, including physical training in combat boots and in-service foot injuries. She has alternatively asserted her foot disabilities are secondary to her claimed ankle disabilities; however, the Veteran is not entitled to service connection for any ankle conditions and the Board will not address this assertion further. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of bilateral flatfoot, degenerative arthritis of the right foot, and has undergone multiple surgeries and arthroplasties on the toes of her right foot, and evidence shows that the Veteran was treated for tendonitis and a dyshidrotic eruption on her left foot while she was in service, the preponderance of the evidence weighs against finding that the Veteran’s current disabilities began during service or are otherwise related to her in-service injuries. The Veteran underwent a VA examination in March 2015; however, the examiner only provided an opinion regarding the Veteran’s assertion that her current foot disabilities were secondary to her claimed ankle conditions. The examination and opinion are therefore not relevant to the Board’s current analysis. The January 2020 VA examiner diagnosed the Veteran with bilateral flat foot, degenerative arthritis of the right foot, and bilateral post-surgical changes. The examiner noted the Veteran’s assertion that her painful feet began within a few years of her discharge from service. After a review of the record, the examiner opined that it was not at least as likely as not that the Veteran’s current disabilities were incurred in or caused by her service, including physical training in combat boots. The examiner noted that in January 1981, the Veteran reported a painful left heel in association with her ankle tendonitis and was issued shoe inserts, then in September 1982 she had a dyshidrotic eruption on her left foot, but an October 1982 separation examination reflected a normal clinical evaluation of the feet. The Veteran’s post-service treatment records, which began in 1997, were reviewed in detail. The examiner reported the Veteran was treated for a paronychia left big toe in July 1999, calluses on both feet in 1999 and 2000, a right bunion in 2003, underwent a right bunionectomy in 2004, a left foot bunion was noted in 2013, she had left a bunionectomy in June 2013, and, finally, mild bilateral pes planus was noted in 2019. The examiner explained that all the Veteran’s foot conditions developed several years after discharge from military service and there was no evidence of chronic or recurring foot problems during military service or for several years after her discharge from service. The examiner addressed the Veteran’s assertion that her foot disabilities resulted from performing physical training in combat boots, opining that doing so would not lead to the development of calluses, bunions, or pes planus several years later and the contention was not supported by the preponderance of established scientific and medical evidence. Hence, the examiner reiterated, it was less than likely that the current right and left foot disabilities were related to, or caused by, an in-service injury or disease, to include performing physical training in combat boots as, theorized by the Veteran. The January 2020 VA examiner’s opinion is probative because it 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). (Continued on the next page)   Upon careful review and weighing of the evidence, with reasoning as detailed above, the Board finds that the preponderance of the evidence is against the claim for service connection for bilateral foot disabilities and the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). The appeal must therefore be denied. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Mine, 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.