Citation Nr: 21025410 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 13-25 926 DATE: April 28, 2021 ORDER Entitlement to service connection for a bilateral knee disability is granted. Entitlement to service connection for a bilateral ankle disability is granted. Entitlement to service connection for a bilateral hip disability is granted. Entitlement to service connection for a lumbar spine disability is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in favor of the Veteran, his bilateral knee disability is related to military service. 2. Resolving reasonable doubt in favor of the Veteran, his bilateral ankle disability is related to military service. 3. Resolving reasonable doubt in favor of the Veteran, his bilateral hip disability is related to military service. 4. Resolving reasonable doubt in favor of the Veteran, his lumbar spine disability is related to military service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral knee disability have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. The criteria for entitlement to service connection for bilateral ankle disability have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 3. The criteria for entitlement to service connection for bilateral hip disability have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 4. The criteria for entitlement to service connection for lumbar spine disability have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from July 1973 to July 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. In August 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is contained in the record. In a January 2018 decision, the Board remanded the issues on appeal for additional development. That development has been substantially completed and the matters are again before the Board for adjudication. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board acknowledges that the Veteran has also separately appealed claims for service connection for a psychiatric disorder, meningitis, diabetes mellitus, and bilateral lower extremity peripheral neuropathy. See June 2020 VA Form 9. In his substantive appeal, however, the Veteran requested a videoconference hearing. Therefore, these claims will be addressed in a separate Board decision after the Veteran has been afforded the requested hearing. Service Connection A veteran is entitled to VA disability compensation if there is a current disability resulting from a personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1131. Generally, to establish a right to compensation for a present disability, a veteran 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). Service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). A Veteran is competent to describe symptoms that she experienced in service or at any time after service when the symptoms he perceived or experienced, were directly through the senses. 38 C.F.R. § 3.159; Layno v. Brown, 6 Vet. App. 465, at 469-71 (1994). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate each claim and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). 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; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a bilateral knee disability is granted. 2. Entitlement to service connection for a bilateral ankle disability is granted. 3. Entitlement to service connection for a bilateral hip disability is granted. 4. Entitlement to service connection for a lumbar spine disability is granted. The Veteran is seeking service connection for a bilateral leg disability and a back disability. Specifically, he testified at an August 2017 Board hearing that he injured his legs, ankles, and back in service. He described one injury occurring when he was “swept” off his feet during a martial arts class or tournament. He also described an incident of stepping or falling into a hole. His description indicated that the hole was large enough that his entire leg went into the hole. He stated that his ankle to thigh was swollen for six weeks, and that he was treated at Camp Humphreys in Korea. See also August 2013 VA Form 9. After a review of the entire evidentiary record, and in light of the applicable legal criteria, the Board affords the Veteran the benefit of the doubt and finds that service connection is warranted for bilateral knee, ankle, and hip disabilities, and for a lumbar spine disability. Regarding the first element of service connection, the Veteran has been diagnosed with bilateral hip osteoarthritis, trochanteris pain syndrome, and iliopsoas tendinitis; bilateral knee tendonitis and knee joint osteoarthritis; bilateral ankle lateral collateral ligament sprain and arthritic conditions; and lumbsacral stain, degenerative arthritis of the spine, and intervertebral disc syndrome. See July 2018 VA Examinations. Accordingly, the first element of service connection for a bilateral knee, ankle, hip disability and a back disability has been met. Concerning the second element of service connection, in a January 1975 service treatment record (STR), the Veteran sought treatment for a lump on his left shin bone. He denied any trauma to the area. He returned five days later with no improvement in symptoms but was “reassured” and sent back to duty. A February 1975 STR reveals that he had pain in his left shin due to trauma during “karate school.” X-rays were negative. He was given a 10-day profile. Follow-up treatment indicated that he appeared to have a “torn ligament.” He was given an Ace wrap and an extension of his profile for two additional days. In a March 1975 STR, the record shows that he again sought treatment for a knot on his left tibia. It was noted to likely be “bruised ligaments” from his taekwondo class. He was given a 10-day profile again. In May 1975, the Veteran sought treatment for a second knot on his left leg. He stated he fell on steps and injured his left leg. The impression was of a hematoma of the left leg. He was instructed to continue using a heating pad to treat the knot. Accordingly, the Board finds that the second element of service connection, that of an inservice injury, has been met. The salient question is thus whether the Veteran’s currently diagnosed disabilities are related to service. In July 2018 VA examinations, an examiner found that the Veteran’s bilateral knee, ankle, and hip disability and that his back disability were at least as likely as not proximately due to or the result of his inservice left lower leg/tibial shin/tibialis anterior injury, which occurred during military service. He explained that the disabilities were the result of compensatory alteration in biomechanics of joint movements during ambulation due to antalgic gate caused by the chronically painful contralateral left lower leg condition. In October 2020, the AOJ obtained new VA opinions. The examiner opined that the Veteran’s bilateral knee strain and DJD is less likely than not incurred in or related to service. By way of explanation, the examiner asserted that a 1988 rating decision notes that the left lower leg/tibial shin/tibialis anterior injury was acute and transitory and that there are no further in-service records of complaints of or treatment for a bilateral knee condition. Accordingly, the bilateral knee strain and degenerative arthritis noted 40 plus years post service are a result of the natural progressive aging process. In addition, there are no in-service records of complaints of or treatment for a bilateral ankle or hip condition. Accordingly, the bilateral lateral collateral ligament sprain and bilateral trochanteric pain syndrome are less likely than not incurred in or caused directly related to military service during service. Moreover, there is no continuity of care for claimed bilateral ankle disability and lumbar disability for 45 years after injury to left lower leg, and therefore, they are more likely due to natural aging process and less likely than not proximately due to or the result of the veteran’s left lower leg status post contusion with residual chronic tibialis anterior tendonitis. (Continued on the next page)   Reviewing the evidence of record, the Board finds the July 2018 VA opinions are persuasive and of significant probative value. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner reviewed the Veteran’s medical history, service history, and lay assertions. Contrastingly, the Board finds the October 2020 VA opinions are inadequate for adjudicative purposes and of little, if any probative value. In particular, the Board notes that the October 2020 VA examiner relies in part of a lack of post service treatment records. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The examiner’s opinion also appears to be based on an inaccurate factual premise given his assertions that the Veteran was only treated once inservice complaints of a left leg condition. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Based on the foregoing, the Board finds that the evidence of record as to whether the Veteran’s bilateral knee, ankle, and hip disabilities and his back disability are related to service is, at the very least, in relative equipoise. As such, the Board resolves reasonable doubt in the Veteran’s favor and finds that the Veteran’s bilateral knee, ankle, and hip disabilities and that his back disability, are related to service. The third element of service connection has therefore been met. Because the three elements of service connection have been met, service connection for the Veteran’s bilateral knee, ankle, and hip disabilities, and for a lumbar spine disability is warranted. Gilbert, supra. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kaufer, 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.