Citation Nr: 21032552 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 09-38 416 DATE: May 27, 2021 ORDER Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right ankle tarsal tunnel syndrome is granted. Entitlement to service connection for a left ankle tarsal tunnel syndrome is granted. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's current right shoulder disability is related to his in-service shoulder injury and symptoms. 2. The preponderance of the evidence indicates that any knee issues in service were resolved and not chronic; the Veteran's current right knee disability and left knee disability were not shown for many years after service and are not otherwise etiologically related to active duty service. 3. Resolving reasonable doubt in the Veteran's favor, it is at least as likely as not that his left and right ankle tarsal tunnel syndrome are etiologically related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a right ankle tarsal tunnel syndrome have been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a left ankle tarsal tunnel syndrome have been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1982 to May 1986, from August 1989 to May 1990, from May 1990 to April 1991, and from July 1992 to September 1992. He had additional service with and retired from the Army National Guard effective in May 2005. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2008 Regional Office (RO) rating decision. The Veteran and his wife presented sworn testimony in support of his appeal during a March 2015 hearing before the undersigned Veterans Law Judge. This case has a long procedural history. The Board remanded, in part, the above issues for further development in June 2015, and again in November 2017 to obtain the National Guard (NG) service treatment records (STRs) and to search for any archived VA medical records between 1986 and 2008. The RO searched for archived records and received available medical records; the NG STRs were unable to be fully retrieved and the Veteran was advised of such and given the opportunity to retrieve them on his own. Subsequently, a December 2020 Board decision, in part, remanded the current claims on appeal for service connection for a back disability, right shoulder disability, bilateral ankle disabilities, and bilateral knee disabilities for addendum opinions. First, subsequent to the 2020 Board remand development, in a March 2021 rating decision, the Veteran's claim for service connection for his back disability was granted with a 20 percent rating, effective March 16, 2017, and a 10 percent rating, effective July 23, 2020. As such, this issue is no longer on appeal before the Board. The Veteran has submitted statements that he disagrees with the 2021 decision assigning ratings for hypertension, headaches, and his back disability. However, informal statements such as these can no longer be accepted as a notice of disagreement. As the March 2021 letter informed him, he can submit a supplemental claim, a request for higher-level review, or an appeal to the Board, and these actions require he use the specified VA forms. He has one year from the March 3, 2021 letter to pursue one of these options. Next, as noted in the December 2020 Remand, the RO complied with the remand requests to make attempts at retrieving any missing medical records between 1990 and 2007, and the Veteran was provided the opportunity to provide them himself. He attempted to do so, including providing a letter from L.J, an Admin from the Florida National Guard, who stated upon searching for his missing NG records, that there were documents that had been misfiled and not scanned properly before being destroyed. The RO also scheduled VA medical opinions in February 2021 for the service connection claims for the back disability, right shoulder disability, bilateral ankle disabilities, and bilateral knee disabilities, and they appear adequate. As such, the Board finds substantial compliance with the prior Remands to the extent possible. Stegall v. West, 11 Vet. App. 268, 271 (1998). Other than as mentioned regarding the missing NG records, no arguments were raised concerning the duty to notify, the duty to assist in obtaining documentary evidence, or compliance with the remand instructions. Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Thus, the Board need not discuss any potential issues in this regard. Further, neither the Veteran nor his representative has alleged any deficiency with the conduct of the Board hearing as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition, service connection may be warranted for disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310. Secondary service connection requires (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Certain chronic diseases are subject to presumptive service connection if manifest to a compensable degree within one year from separation from active service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. Gilbert, at 53. 1. Entitlement to service connection for right shoulder disability The Veteran asserts that he has a right shoulder disability that is due to service, specifically from the event that caused his back injury and AC ligament sprain in 1990. It is not in contention that the Veteran sustained an injury to his shoulder and back while in service. Specifically, during service, he provided a statement that in September 1990, he was working with 100-pound bags when he hurt his back and pulled a ligament or joint in his shoulder which gave a popping sensation. In October 1990, he reported right shoulder pain with a popping sensation which had begun a few months prior and had progressively gotten worse. Examination noted full range of motion with pain on elevation and adduction with an assessment of AC ligament strain. He was put on restricted duty for two weeks with return to care if symptoms persisted, but it was noted the injury was likely temporary. The November 1990 follow up to the right shoulder incident showed that during testing, it was noted the right shoulder elicited a popping during range of motion testing, but he had full range of motion. The assessment was an AC ligament sprain rotator cuff sprain and he was referred to orthopedics. The orthopedics consultation to follow up to the right shoulder injury indicated that the popping in the shoulder the last few months resulted in loss of strength with a diagnosis of AC ligament sprain. In a 2019 buddy statement from a fellow servicemember who served with the Veteran between 1989-2000 and worked as a team member/supervisor, he stated that the Veteran's claimed injury to his back and shoulder occurred in 1990, and that the Veteran complained of those injuries "on a constant basis for which he received medical treatment." However, the Board also notes that in the April 1992 report of medical history, the Veteran marked "yes" to back pain, but "no" to painful shoulder. Further, the April 1995 clinical evaluation marked everything was normal, and the Veteran again marked "no" to painful shoulder. In the November 2002 report of medical history, the Veteran marked "yes" to recurrent back pain, but he marked "no" to painful or trick shoulder. There are no further notations of complaints, findings, or diagnoses for the Veteran's shoulder in his STRs following the 1990 injury. Post-service records show that in June 2007, he reported back pain only from his active duty service. The physical examination noted he had muscle spasms and prescribed him a back brace, and he was diagnosed with cervicalgia, lower back pain, muscle spasms, and left shoulder pain. In August 2007, the Veteran had X-ray testing which revealed his left shoulder demonstrated arthritic changes involving the AC joint. In July 2009, he again reported left shoulder pain and he was diagnosed with left shoulder strain following the July 2009 MRI which revealed abnormal left shoulder. (Emphasis added). Further, in March 2013, he again reported the left shoulder pain, stating he has had this pain since service, and September 2013 medical records noted that it was his left shoulder only. That notwithstanding, the Veteran has argued that he has right shoulder pain due to the injury in service, and the March 2013 X-rays for both shoulders revealed early degenerative changes in the AC joint. As such, the Veteran underwent a VA examination in February 2020 where he was diagnosed with degenerative arthritis of the right shoulder. He reported that over time, his right shoulder has chronic pain and decreased range of motion. The examiner opined that the condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The rationale was that while there was an injury in service as documented in 1990, "there is no objective evidence to support residuals or sequelae." Specifically, the examiner noted that there is no evidence "to support current pathology and abnormal ROM is related to the 1990 injury" as the current disability "did not become manifest within appropriate timeframe" since his separation from service. Then, in July 2020, the examiner noted the September 2009 X-ray revealed no radiopaque evidence of any bony or soft tissue injury in the right shoulder; and the March 2013 X-ray first revealed early degenerative changes in the AC joint. His July 2014 physical therapy notes showed that his right shoulder ROM was normal. As such, the examiner opined that "there is no medical evidence to support the current condition was caused by the right shoulder injury during service [as] there is no chronicity of care." The examiner's rationale was based on no medical records between 1990 to 2007. Following the December 2020 Remand, which deemed the above opinions inadequate, a February 2021 addendum opinion was requested. The examiner noted that there was no mention in the STRs of right shoulder pain or injuries outside of the 1990 right shoulder injury. The examiner, again, noted that there is no mention of right shoulder pain or injury in the entrance examinations following the 1990 injury. The examiner further noted the 2007 shoulder X-ray noted degenerative changes but opined that "there was no evidence of [right] shoulder arthritis diagnosed...and arthritis would not develop secondary to an AC strain." Considering the pertinent evidence of record in the above, the Board finds that the claim for service connection for a right shoulder disability is not warranted. First, the 2021 VA examiner offered an opinion that the current disability is not related to the Veteran's in-service event or injury. Specifically, the examiner considered the Veteran's contentions, including his ex-wife's statement, addressed the Veteran's in-service AC joint sprain (which as noted in the STRs was "temporary") and opined that the Veteran's right shoulder disability was less likely than not incurred in or caused by the claimed in-service injury. Although not perfect, as the examiner explained the reasons for his conclusion, his opinion is entitled to some probative weight. Nieves-Rodriguez, 22 Vet. App. at 304. Moreover, his opinion is consistent with the fact that, at the time of the Veteran's in-service injury, imaging testing was done, and an X-ray revealed no significant findings in his shoulder, and it was not until 2007 where an MRI revealed degenerative changes. Importantly, it was the left shoulder that was noted to have pain and arthritic changes in 2007, not the right. The Veteran himself did not complain of right shoulder pain until 2013. Considering he repeatedly sought treatment for the left shoulder prior to 2013, yet raised no complaints concerning his right shoulder, his allegations of continuous symptoms are not credible. This is further supported by the fact that after the 1990 injury, the Veteran completed medical history reports wherein he denied shoulder issues, although he reported other orthopedic concerns. Next, the Board considered the November 2013 and April 2017 statements from Dr. E.D., who submitted letters that the Veteran has been under her care since 2009 for his back, feet, and shoulder issues. She noted in the 2017 letter that he has had multiple X-rays and MRIs done which showed degenerative changes in the right shoulder with additional tendon inflammation. However, again, the medical records specifically noted that it was his LEFT shoulder, not the right, in 2007-2009. He was not diagnosed with degenerative arthritis of the right shoulder until March 2013. Further, Dr. E.D. does not provide a medical opinion but rather simply stated the fact that the Veteran has been seen for these conditions. Finally, the 2013 letter did not indicate which shoulder she was referring to, and, as noted above, the Veteran had had left shoulder issues beginning in 2007 and did not have right shoulder complaints until 2013. There are no other medical opinions to the contrary. The Board acknowledges that the Veteran is competent to state that he has experienced pain in his shoulder since his in-service right shoulder injury. Specifically, during March 2015 Board hearing, the Veteran and his wife testified as to the injury to his shoulder in service, and his continuous pain since, including that since service, he has used a TENS unit, been in therapy, and been given pills for his shoulder pain. However, those statements are not entirely credible in light of his denials of pain on medical history reports completed in the years after the 1990 injury (although he complained of other joint pains) and his complaints of and treatment for left shoulder pain for a few years without raising any concerns about the right shoulder. These more contemporaneous medical records are far more credible than the statements he makes now, since it is reasonable to expect he would report both shoulders were painful if they were both, in fact, painful, when reporting left shoulder issues to his medical providers. Although he states he has had right shoulder pain ever since service, the fact is the Veteran himself consistently reported his left shoulder pain only until 2013. Moreover, the question of whether the current pain is indicative of a nexus between the currently diagnosed right shoulder arthritis and the in-service shoulder injury and symptoms is a complex medical question. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In this case, lay contentions as to the etiology of the right shoulder disability relates to an internal medical process which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. See also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). The Veteran's statements are therefore not competent in this regard. To the extent that these lay statements are competent, the Board finds the specific, reasoned opinions of the VA examiners to be of greater probative weight than the Veteran's more general lay assertions. The examiner clearly opined the nature of the Veteran's in-service diagnosis a strain would not cause the current condition arthritis. For the foregoing reasons, the preponderance of the evidence is against a relationship between the Veteran's current right shoulder arthritis and his in-service shoulder injury and symptoms. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for bilateral knee disabilities The Veteran claims his bilateral knee disabilities are related to service, to include the documented in-service injury. Turning to the evidence of record, service treatment records show that he reported some bilateral knee pain in service. For example, in May 1986, he reported weak knees that were swollen and that he had difficulty moving, and the 1986 report of medical history indicates that the Veteran marked "yes" to swollen or painful joints and painful knees. The June 1986 separation examination for the knees was negative and the clinical evaluation noted that any acute injuries had resolved and were not currently disabling. In the July 1986 VA examination, the Veteran reported that his knees bothered him all of the time, and he was given a diagnosis for knee pain. However, the July 1986 X-ray findings for the knees showed no significant radiographic abnormalities, with some interarticular spaces in the bony and periarticular structures to be preserved, but essentially within normal limits. Post-active duty treatment records show that in the May 1987 report of medical history for enlistment into the National Guard, the Veteran marked he had cramps in his legs, and knee problems; the examiner noted he had a history of pain in both of his knees but no history of locking. A May 1987 consultation done with the Medical Officer in conjunction with enlistment into the National Guard reported a history of supra patellar/posterior knee pain with prolonged standing but no history of locking/buckling. It was noted the Veteran had been having this pain for 3-4 years, but no history of swelling, instability, or locking and no history of medical treatment, and he ambulated normally. The records are otherwise negative for any complaints of, or treatment for, a knee injury. Further, at periodic examinations dated in April 1992, April 1995 and November 2002, clinical evaluation of the lower extremities was normal. In accompanying reports of medical history, the Veteran denied a history of "trick" or locked knee, arthritis, or bone, joint or other deformity. Post-service, in June 2007, the Veteran reported bilateral knee pain, but his extremities were noted to be non-tender and have full range of motion. Thereafter, August 2007 X-rays were taken of the bilateral knees, and the bilateral knees findings were unremarkable for joint space alteration or altered bone architecture. He underwent physical therapy in April 2012 which noted discomfort in his left knee, and in November 2012, he was evaluated for a knee brace. In August 2019, X-rays revealed minimal tibiofemoral degenerative changes in both knees. In October 2019, it was noted he had chronic knee pain and he reported his injuries are from the military and they now flare up. In the 2015 Board hearing sworn testimony, the Veteran stated he was put on limited profile at times due to limitations from knee and ankle pain. He also stated he has pain in his knees with gout attacks. A September 2016 letter from Dr. D.A. stated that the Veteran presented in part with left knee and foot pain with numbness and tingling that he stated he first noticed around 2007 (emphasis added). The Veteran was afforded a VA examination in July 2020, and the examiner noted the Veteran has mild degenerative changes of the bilateral knees. The Veteran reported that he injured his left knee after objects fell on him in service and he was treated conservatively. He stated that as a result of the injury in service, his right knee began hurting over time as well. He described the pain as sharp, coming from his feet to the knees and back. The examiner opined that the Veteran's left and right knee arthritis were less likely than not incurred in or caused by service. The examiner acknowledged the Veteran's reports of injury in service and noted that the Veteran had degenerative joint disease (DJD) in both knees now, but opined there was no evidence this was due to service. The examiner's rationale was that there was "no objective evidence to show the current DJD was incurred in or caused during service." As this was deemed inadequate in the December 2020 Remand, an addendum opinion was requested. In the February 2021 VA addendum opinion, the examiner noted the Veteran's knee pain and weakness and swelling in service in 1986. But he also noted that there was no chronic diagnosis rendered. Further, X-ray findings were normal at that time. The 1987 evaluation noted knee pain, but examination findings showed no instability, locking, or buckling, and his gait was normal, as also noted in subsequent entrance examinations. The examiner considered the Veteran's assertions that he has had knee pain since service, but noted the 2007 imaging results remained unremarkable for the knees, and the first sign of arthritis was not until 2019, which was also noted as minimal. As such, the examiner opined these "findings would have likely been more than minimal if the disease process began during [active duty] in the 1980's" and opined it less likely than not the bilateral knee conditions incurred in or were caused by the claimed in-service injury, event or illness. The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-49 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Here, the February 2021 addendum was provided by a VA medical professional who possesses the necessary education, training, and expertise to provide the requested opinions. Guerrieri, 4 Vet. App. at 470-71. The opinion is also shown to have been based on a review of the Veteran's record, including the lay statements and Board testimony, and is accompanied by a sufficient explanation as to why the Veteran's right and left knee disabilities were not as likely as not related to service. Prejean, 13 Vet. App at 448-49, Nieves-Rodriguez, 229 Vet. App. at 295. Thus, this opinion is probative. Based on the foregoing, the Board finds that service connection for arthritis of either knee is not warranted. Although the Veteran has current knee disabilities and reported that he experienced knee pain in service and thereafter, the earliest notation of knee pain is in 2007, over 15 years after discharge from active duty/ACDUTRA. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Further, as noted above, the Veteran did not report knee pain following the 1986/1987 reports, and he explicitly denied knee symptomatology on multiple subsequent NG examinations over the years. In addition, the Veteran himself reported to his doctor in 2016 that he first began having knee problems in 2007. AZ v. Shinseki, 731 F.3d 1303, 1315 (Fed. Cir. 2013) (recognizing the widely-held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present). All of these facts weigh heavily against any allegations he makes now that he has had continuous knee pain ever since the 1980's. It is reasonable to expect he provided an accurate history to his doctor when he sought treatment for knee pain after service. The Board recognizes that, due to no fault of his own, the Veteran was unable to obtain treatment records from the National Guard. Regardless, the Veteran's knee pain in service was noted to be resolved in the 1986 separation examination, and he did not report pain in any subsequent entrance or separation examinations thereafter. The absence of complaints or treatment within those 20 years suggests that the knee pain did not result in a chronic disability. Again, there is also the fact that after service he told his doctor his knee pain onset in 2007. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced. However, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Finally, as noted above, there is no indication in the record the Veteran had knee arthritis present to a compensable degree within a year following his separation from active service. Rather, he was denied service connection as his knee X-rays in 1986 showed no significant radiographic abnormalities. Therefore, presumptive service connection is not warranted in this case. See 38 C.F.R. § 3.309. In sum, the elements for service connection for left or right knee disabilities have not been met. Accordingly, service connection for the claimed disabilities is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49, 53 3. Entitlement to service connection for bilateral ankle disability The Veteran contends he has bilateral ankle disabilities due to service. The medical records showed the Veteran had gout attacks which caused pain in his ankles. Service connection for gout was previously denied by the Board. However, the records also showed that he had possible residuals from service and/or as due to the cold weather training injury from service which caused poor circulation. First, the Board notes that the Veteran has a current disability of both ankles. VA treatment records show ongoing chronic bilateral ankle pain. In July 2009, the Veteran's private physician opined that the Veteran has tarsal tunnel syndrome. As to an in-service event, the Veteran's STRs reflected that during active duty, the Veteran reported painful and sore ankles. For example, in October 1982 he reported pain from the ankles down through the heels and that he has foot pain nightly with stiffness in the ankles with throbbing and numbness. It was noted that his arches appeared collapsed, and he had abnormal range of motion. In May 1983 he was diagnosed with Morton neuroma and prescribed metatarsal inserts for his shoes. It was noted that he had a "long history of painful feet" and was also diagnosed with mild pes planus with tender heels, metatarsalgia and Morton Neuroma, and plantar fasciitis. In July 1983, he reported that he had twisted his ankle and it was noted that he had inverted ankle with full range of motion with difficulty and swelling. An August 1983 medical report showed he complained of sore left ankle for about one month and reported lateral ankle pain with inversion of the left foot with poor circulation in both feet from cold weather field exercises. The assessment was a left ankle sprain. In October 1983, he was diagnosed with collapsed arches and referred to a specialist. The specialist noted that his feet were no better and was reassessed for Morton neuroma with soreness on dorsal aspect of medial long arch bilaterally. In June 1986, he was diagnosed with plantar fasciitis. In the 1986 report of medical history, the Veteran marked "yes" to swollen or painful joints. The post-service July 1986 VA examination report shows a diagnosis for bilateral ankle pain and the X-ray findings revealed interarticular spaces in the bony and periarticular structures to be preserved. Then, during his time on active duty for training (ACDUTRA), the available STRs show that the April 1992 clinical evaluation marked everything normal except the Veteran's feet which noted he had pes planus. In the report of medical history, the Veteran marked "yes" to swollen or painful joints. In the November 2002 report of medical history, he reported he had recurrent foot trouble. It was also noted he had a history of flat feet and wears arch supports. As noted above, many of the Veteran's NG STRs are missing at no fault of his own. Thus, the question becomes whether the current disabilities are related to service. On this question there are opinions in favor of and against the claim. The evidence in favor of the claim includes the Veteran's lay statements and medical records, where he has consistently described his pain since service, as well as a private medical opinion from a podiatrist connecting the disabilities to his service and service-connected disabilities. For example, in March 2009 private medical records, private podiatrist Dr. D.C. noted the Veteran had pain in both feet. The doctor also noted that he had collapsed arches in military, as well as fungus, frostbite, and circulation problems, and that the Veteran also complains of tenderness along the course of the Achilles Tendon and stated that "this is all military related." Dr. D.C. also noted that the Veteran has difficulty with ambulation and is unable to stand for more than three to five minutes due to this pain. In a follow up in July 2009, Dr. D.C. opined that the Veteran had tarsal tunnel syndrome. The doctor noted the Veteran's foot problems in the military, noting the STRs showed Morton neuroma and collapsed aches with bilateral heel pain, and opined that the current symptoms were "related within a degree of medical certainty from the trauma and injury while in the military...this is service-related injury, still has significant discomfort." The doctor opined that due to the tarsal tunnel, the Veteran could not stand for 4-5 minutes without pain, and that tenderness was noted with pain on the medial band plantar fascia with tenderness at posterior tibial tendon, which was all secondary to the arches in service. Dr. D.C. also noted that the tarsal tunnel syndrome "can be totally disabling...from pinched nerve on medial aspect limiting ability to ambulate normally, secondary to military action." A September 2009 opinion from Dr. D.C. that the Veteran reported shoe inadequacy while in the service and "suffered from what appears to be frostbite and also residual fungus noted both nails...requires continued treatment and follow up care." Dr. D.C. opined "this is part of disability from [service]." In the March 2015 Board hearing, the Veteran testified as to his bilateral ankle pain in service, and stated he was put on limited profile at times due to limitations from his ankle pain. He also stated that he has had ongoing ankle pain and that he eventually developed his gout. The evidence against the claim comes from the July 2020 VA examination report where the examiner opined that the bilateral ankle disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury. During the examination, the Veteran reported that he has had continuous constant swelling and constant pain since service since his ankle and feet injuries, but the examiner only marked that he has bilateral gout despite the Veteran reporting that he currently has bilateral ankle pain with limited motion and is unable to put pressure on either. The rationale for the examiner's opinion was that "there is no objective medical evidence that shows Veteran ankle gout is a residual of his ankle injury" and provides a generic definition of gout. However, as determined in the 2020 Remand, the examiner failed to provide an adequate opinion regarding the left ankle injury in service and the current pain, but rather relied on the condition being normal at discharge which is not an adequate opinion and failed to consider the Veteran's full medical picture of his complaints and reports of ankle/leg pain since 2009. The examiner also failed to provide an opinion as to whether the poor circulation and frostbite from the cold weather training caused his bilateral ankle conditions. As such, the February 2021 examiner provided an addendum opinion. The examiner opined that the bilateral ankle disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury. The Board finds this opinion to also be inadequate. First, the rationale was that the separation examination in 2002 noted normal lower extremities which is blatantly inaccurate rather, the 2002 report of medical history report showed that he reported he had recurrent foot trouble. It was also noted he had a history of flat feet and wears arch supports. Next, the examiner considered the private podiatry medical opinion, but stated that "if the condition was chronic, the 2002 entrance exam would have positive findings for the lower extremities identified." Again, as immediately noted, this is irrefutably inaccurate. Further, the 2021 examiner discussed the Veteran's tarsal tunnel syndrome as requested, but the negative opinion was that the Veteran does not have a diagnosis of pes planus during active duty or at the 2008 VA examination, so "a nexus linking the tarsal tunnel syndrome to the collapsed arches/flat feet in service is not established." This opinion is wholly inaccurate; in October 1982, it was noted that his arches appeared collapsed, and he had abnormal range of motion. In May 1983, it was noted that he had a "long history of painful feet" and he was diagnosed with mild pes planus. In October 1983, it was noted he had collapsed arches and was referred to a specialist. Further, the April 1992 clinical evaluation marked he had pes planus. In addition, in the August 2020 foot condition examination, the examiner marked that the Veteran has pes planus under the diagnosis section. As such, the Board finds that the 2021 examiner's opinions are not persuasive. Moreover, the fact ankle/foot/tendon issues were not factually shown during service is not dispositive. A claimant can still be service connected for a condition diagnosed after service when it is related to an injury from active duty or ACDUTRA. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that a VA opinion was inadequate where the examiner ignores a veteran's lay statements of an injury or event in service unless VA expressly finds that no such injury or event occurred). As discussed above, the 2021 examiner failed to consider the totality of the medical evidence which did, in fact, show collapsed arches and ankle pain in service. Upon review of the record, the Board finds the evidence not in equipoise. The private opinion outweighs the negative VA opinion(s). That doctor, not only a podiatrist so an expert in his field, but also provided a rationale for the opinion and discussed the circumstances of the in-service injuries and medical disorders and the Veteran's medical history. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for the Veteran's right and left ankle tarsal tunnel syndrome is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board notes this grant is for tarsal tunnel syndrome only. Service connection for gout was denied in the Board's prior decision. To the extent the Veteran's gout affects his ankles, that is not part of the grant herein. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G.Hoy, 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.