Citation Nr: 21030229 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 13-07 418 DATE: May 18, 2021 ORDER Service connection for a left ankle disorder is denied. Service connection for a left knee disorder is denied. Service connection for a left hip disorder is denied. Service connection for a right hip disorder is denied. FINDINGS OF FACT 1. The Veteran had active duty from August 1991 to October 1992; he has been rated 100 percent disabled since May 29, 2014. 2. The most probative evidence reflects that left ankle, left knee, and bilateral hip disorders were not shown in service, are not causally or etiologically related to service and have not been medically associated with a service-connected disability. CONCLUSIONS OF LAW 1. The criteria to establish service connection for a bilateral hip disability are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.303, 3.310 (2020). 2. The criteria to establish service connection for a left ankle disability are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.303, 3.310 (2020). 3. The criteria to establish service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.303, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) 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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Turning to the evidence, the Veteran contends that left ankle, left knee, and bilateral hip disorders were incurred in service and/or were caused or aggravated by a service connected disability. As the appeals are essentially based on the same theory of entitlement, they will be discussed together. Initially, the Board observes that the evidence unambiguously reflects diagnoses of left ankle, left knee, and hip disabilities during the appeal period. Therefore, the first element to establish service connection under the theories of direct and secondary service connection are met. As to an in-service incurrence, the Veteran contends that he injured the left ankle, left knee, and hips in service while playing football. However, service treatment records (STRs) are absent of complaints, diagnoses, or treatment for the left ankle. Specifically, while STRs show that he injured the right ankle in service while playing football, there is no documented treatment for left ankle, left knee, and bilateral hip injuries. To the extent that the Veteran reported that these disorders began in service at the September 2019 and November 2019 VA examinations, he stated that left ankle, left ankle, and bilateral hip pain resulted from an in-service right ankle injury. Upon examination, the examiner opined that these disorders were less likely than not incurred in service. The examiner reasoned that STRs were absent of complaints, diagnoses, or treatment for these disorders and that the Veteran did not seek treatment for these disorders for a number of years. This evidence is probative against a direct nexus and weighs against the claims. Further, in a November 2020 VA opinion, the clinician opined that these disorders were less likely than not incurred in service. The clinician reasoned that there was no objective evidence that these disorders were incurred in service, as STRs were absent of complaints, diagnoses, or treatment for these disorders and clinical evidence was absent of continuity or chronicity of care. This evidence also weighs against the appealed issues. Based on the above, the medical evidence weighs against a finding that left ankle, left knee, and bilateral hip disorders were incurred in service. Therefore, the medical evidence does not support the claims of direct service connection. As to secondary service connection, service connection has been established for right knee and right ankle disabilities. Therefore, the second element to establish of secondary service connection is met. As to a secondary nexus by way of causation or aggravation, in an August 2013 VA examination report, the examiner opined that these disorders were not caused or aggravated by service connected low back, right ankle, and right knee disabilities. He reasoned that the pathology noted in the low back, right knee, and right ankle was of insufficient severity to reasonably believe it would result in increased strain of the left knee, left ankle, and hips. The examiner also noted that, if there had been degenerative changes present in the back, right knee, and right ankle, it would be more reasonable to believe that it had resulted in pathology of the left ankle, left knee, and hips. However, no degenerative changes were present. In addition, the examiner explained that the in-service distal fracture of the right fibula had fully healed and therefore would not reasonably result in a hypothetical compensatory gait that could in turn result in pathology in distant joints. This evidence weighs against the Veteran's appeal. Further, in August 2016, the Veteran underwent VA examinations to evaluate the severity of the right knee and right ankle disabilities. Upon examination, the examiner wrote that the Veteran's left knee and left ankle disorders were not a progression of his right knee and right ankle disabilities. This evidence weighs against the Veteran's appeal. In addition, in September 2019 and November 2019 VA examinations, the examiner opined that these disorders were not caused or aggravated by service connected disabilities. The examiner reasoned that the Veteran's right leg fracture had healed and that there was no evidence that it had done any damage to the left knee, left ankle, or hips. This evidence weighs against the Veteran's appeal. In a November 2020 VA opinion, the clinician opined that these disorders were not caused or aggravated by service connected disabilities. The clinician reasoned that medical literature showed that an injury in one leg rarely caused a problem in the other except when damage to one leg resulted in a major displacement of the center of gravity of the body while walking. However, the clinician noted that clinical records did not show any indication of major displacement of the center of gravity of the Veteran's body while walking, as his gait was normal. This evidence weighs against the Veteran's appeal. Based on the above, the medical evidence does not support the claims that left ankle, left knee, and bilateral hip disorders were caused or aggravated by service-connected disabilities. In sum, the medical evidence does not support the claims that left knee, left ankle, and bilateral hip disorders were incurred in service and/or caused or aggravated by service-connected disabilities. The Board has considered the Veteran's lay statements that these disorders began in service and/or is related to a service-connected disability. He is competent to report symptoms because this requires only personal knowledge, as it comes to him through his senses; however, he is not competent to offer an opinion as to the etiologies of his current disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to the lay statements that have been submitted. Therefore, the appealed issues are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). SCOTT W. DALE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ragofsky, Danielle 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.