Citation Nr: 21042779 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-25 040 DATE: July 13, 2021 ORDER An initial rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) is granted. A total disability rating based on individual unemployability (TDIU) is granted. Service connection for a lumbar spine (back) disability is granted. Service connection for a right elbow disability is granted. Service connection for a left ankle disability is granted. FINDINGS OF FACT 1. The severity, frequency, and duration of the Veteran's service-connected PTSD most closely approximates "occupational and social impairment with deficiencies in most areas." His PTSD have not resulted in total occupational and social impairment. 2. The Veteran's service-connected disabilities render him unable to maintain gainful employment. 3. Resolving reasonable doubt in the Veteran's favor, his back disability is at least as likely as not related to his military service. 4. Resolving reasonable doubt in the Veteran's favor, his right elbow disability is at least as likely as not related to his military service. 5. Resolving reasonable doubt in the Veteran's favor, his left ankle disability is at least as likely as not related to his military service. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.7, 4.15, 4.16, 4.18, 4.19. 3. The criteria for service connection for a back disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a right elbow disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a left ankle disability have been 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 in the United States Navy from June 1977 to September 1993. These matters come before the Board of Veteran's Appeals (Board) on appeal from a July 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran originally submitted applications for increased compensation based on unemployability in June 2019 and July 2019. In a February 2020 rating decision, the RO, in pertinent part, denied the Veteran's claim of entitlement to a TDIU. Subsequently, the Veteran submitted a VA Form 10182. The VA Form 10182 (also known as a Decision Review Request: Board Appeal) served as his notice of disagreement (NOD) with the February 2020 rating decision and initiated his request to have the claims from that decision adjudicated under the Appeals Modernization Act (AMA) framework. In May 2021, the Veteran testified at a Board hearing before the undersigned. The transcript from that hearing has been associated with the evidence of record. The Board observes that the Veteran's testimony included information pertinent to his claim of entitlement to a TDIU. The Board further notes that appeals for a TDIU can exist in both legacy and AMA systems, depending on the specific circumstances of the appeal, because a TDIU claim can exist independently and also as part and parcel of increased rating claims. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009); Harper v. Wilkie, 30 Vet. App. 356 (2018); Payne v. Wilkie, 31 Vet. App. 373 (2019). Given that the Veteran provided relevant hearing testimony at a legacy Board hearing regarding his TDIU claim, the Board finds it appropriate to address the TDIU claim in this decision as it is part of the Veteran's increased rating claim on appeal and was reasonably raised by the record. See Rice, supra. Increased Rating Disability evaluations are determined by comparing the Veteran's symptomatology with the criteria set forth in the VA's Schedule for Ratings Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Higher ratings are assigned if the disability more nearly approximates the criteria for that rating; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence the benefit of the doubt is to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an initial rating in excess of 30 percent for PTSD. The Veteran asserts that his service-connected PTSD warrants an increased initial rating in excess of 30 percent. His PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411, which applies the criteria set forth in the General Rating Formula for Mental Disorders. A 30 percent rating is assigned when the psychiatric disorder results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). See 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent rating is assigned when the psychiatric disorder results in occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is assigned when the psychiatric disorder results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. Finally, a 100 percent rating is assigned when the psychiatric disorder results in total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The Board has carefully reviewed the evidence of record in its entirety. The Veteran was afforded two VA psychiatric examinations and a private psychiatric examination during the appeal period. The June 2014 VA examiner found that the Veteran's PTSD symptoms included depressed mood; anxiety; panic attacks that occur weekly or less often; and chronic sleep impairment. Based on a review of the claims file and thorough evaluation of the Veteran, the examiner concluded that the Veteran's PTSD symptoms resulted in occupational and social impairment with an occasional decrease ion work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation (i.e., the criteria for the 30 percent rating under the General Rating Formula for Mental Disorders). The January 2020 VA examiner found that the Veteran's PSTD symptoms included depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a worklike setting. Based on a review of the claims file and thorough evaluation of the Veteran, the examiner concluded that the Veteran's PTSD symptoms resulted in occupational and social impairment with reduced reliability and productivity (i.e., the criteria for the 50 percent rating under the General Rating Formula for Mental Disorders). The August 2020 private examiner found that the Veteran's PTSD was manifested by the following symptoms: depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; panic attacks that occur more than once a week; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long term memory; flattened affect; circumstantial, circumlocutory, or stereotyped speech; difficulty in understanding complex commands; impaired judgement; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a worklike setting; inability to establish nad maintain effective relationships; obsessional rituals which interfere with routine activities; impaired impulse control, such as unprovoked irritability with periods of violence; spatial orientation; persistent danger of hurting self or others; and disorientation to time or place. Based on a review of the claims file and thorough evaluation of the Veteran, the examiner concluded that the Veteran's PTSD symptoms resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and/or mood (i.e., the criteria for the 70 percent rating under the General Rating Formula for Mental Disorders). Based on the above, the Board finds that an increased initial rating of 70 percent is warranted. While the June 2014 and January 2020 VA examiners reviewed the electronic claims file and provided the Veteran with thorough examinations, the Board finds the report prepared by the August 2020 private examiner to be most probative in assessing the severity of the Veteran's psychiatric symptoms. The private examiner clearly found that the Veteran's symptoms were productive of occupational and social impairment, with deficiencies in most areas. Moreover, the private examiner found that the June 2014 and January 2020 VA examination reports "lack[ed]...thoroughness in the acceptance and review of evidence, as the VA misses and fails to comment on key criteria." The examiner found that the Veteran presented with many additional symptoms that had been overlooked by the previous examiners and that "important clinical information was either not acquired, or disregarded." The Board finds no reason to doubt the veracity of the private examiner's statements. Likewise, testimony from the May 2021 Board hearing suggests that the Veteran's symptoms can sometimes inhibit the ability of an examiner to properly evaluate his symptoms. The testimony further suggests that the private examiner provided significantly more detail in her assessment than the VA examiners and that the VA examination reports were "very cursory" and did not provide adequate details regarding the Veteran's PTSD symptoms and medical history. The private examiner indicated that "behavioral issues (stemming from many years back) have caused loss of friends, desocialization, and severe psychological issues." The Board believes that there is sufficient evidence demonstrating that the August 2020 private examiner provided a more thorough and detailed assessment of the Veteran's PTSD symptoms and that many of these symptoms were present throughout the appeal period even though they did not manifest when he was examined in June 2014 and January 2020. The Board finds that the August 2020 private examiner's report is more probative than the June 2014 and January 2020 VA examination reports. Accordingly, the Board finds that the Veteran's symptoms throughout the appeal period have most closely approximated the criteria for the 70 percent rating. A higher rating is not warranted. The evidence of record does not indicate the Veteran's symptoms are manifested by gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; or a persistent danger of hurting self or others. In other words, while the Veteran's PTSD symptoms have resulted in occupational and social impairment, with deficiencies in most areas, they have not been productive of total occupational and social impairment. Therefore, an initial rating in excess of 70 percent, for service-connected PTSD, is granted. 2. Entitlement to a TDIU. As mentioned above, the Veteran raised the issue of entitlement to a TDIU during his May 2021 Board hearing. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. In reaching such a determination, the central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The fact that a veteran is unemployed or has difficulty obtaining employment is not enough to warrant a TDIU. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). The law provides that a total disability rating may be assigned where the schedular rating is less than total when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a). Here, the Veteran is currently in receipt of service connection for the following disabilities: PTSD, now rated 70 percent disabling; Tinnitus, rated 10 percent disabling; Chondromalacia Patella of the left knee with knee joint osteoarthritis, rated 10 percent disabling; Chondromalacia Patella of the right knee with knee joint osteoarthritis, rated 10 percent disabling; and Irritable Bowel Syndrome (IBS), rated 0 percent disabling. With the increased rating for the Veteran's service-connected PTSD, as well as the additional grants of service connection for lumbar spine, right elbow, and left ankle disabilities herein, the Veteran meets the scheduler requirement for TDIU. The question for the Board is whether the Veteran's service-connected disabilities prevent him from securing and following substantially gainful employment. The Board has considered the combined effect of the Veteran's service-connected disabilities on his ability to secure and follow substantially gainful employment. When considering the totality of the evidence, the Board finds that the Veteran's service-connected disabilities (including his now service-connected back, right elbow, and left ankle disabilities (see below)), have a significant negative impact on his ability to perform physical or sedentary work. The Veteran's service-connected PTSD results in occupational and social impairment, with deficiencies in most areas. He has significant difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, including work or a worklike setting. And while the Veteran's PTSD does not render him totally disabled, it does prevent him from being able to secure and follow substantially gainful employment. Accordingly, the Board finds that the Veteran's service connected disabilities, particularly his PTSD symptoms, prevent the Veteran from gaining substantial gainful employment. The Veteran is afforded the benefit of the doubt and his claim for TDIU is granted. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 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). 3. Entitlement to service connection for a lumbar spine (back) disability. 4. Entitlement to service connection for a right elbow disability. 5. Entitlement to service connection for a left ankle disability. The Veteran is seeking entitlement to service connection for back, right elbow, and left ankle disabilities. He attributes these disabilities to his military service. Specifically, he asserts that he participated in over 500 parachute jumps during service and that the hard impacts from those landings caused or contributed to his back and left ankle disabilities. He further contends that he injured his right elbow and sustained a puncture wound during a training accident in 1984 and that his elbow disability continued to worsen after he separated from military service. Lastly, he claims that he twisted his left ankle during service and has had ankle problems ever since that initial injury. Back During the appeal period, the Veteran was diagnosed as having a current back disability. See July 2014 VA examination report (dx: lumbar spine herniated disc); January 2020 VA examination report (dx: lumbar spine degenerative disc and degenerative joint disease). Moreover, the Veteran's DD Form 214 shows that he was a Navy Seal and that he earned Navy/Marine Corps Parachute Wings. The Board finds that this evidence corroborates the Veteran's report that he participated in over 500 parachute jumps while serving as a Navy Seal. See May 2021 Board hearing transcript, p 3. Moreover, the Veteran's service treatment records (STRs) reflect that he had one incident of upper back strain in 1975 while on active duty. The Board finds that the first and second elements of service connection have been met. Thus, the question becomes whether his current disabilities are related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes the following: A July 2014 VA medical opinion indicating that the Veteran's lumbar spine condition was "less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran's service treatment record show that he had one incident of upper back strain in 1975 and a health history questionnaire that he filled out in 1993 stating that he had low back pain. The examiner further noted that the medical records showed that the Veteran did not have low back pain with sciatic symptoms until 2012 and that there were no indications in the record that he had chronic back problems for the 19 years after service leading up to having back surgery to correct an L4-L5 disc herniation. The evidence in favor of these claims includes the following: The Veteran's July 2014 NOD where he asserted that his lumbar disc herniation was a direct result of the parachute jumps that he performed during service. A May 2019 private medical opinion where the examiner indicated that "[i]t's a known medical fact that parachuting puts abnormal, traumatic pressure on the joints, especially knees, feet, ankles, hips, and spine, and as a result, chronic joint disabilities usually follow." The examiner noted that the Veteran's early onset degenerative disease conditions were "consistent with trauma...rather than normal age progression." An October 2019 private medical opinion where the examiner indicated that the Veteran's parachute hard landings lead to sciatic injuries, injury to his knees, and general "whole body" vibration trauma. The examiner opined that it is "at least as likely as not" that the Veteran's extensive medical issues have a high probability of being associated with his military service. A January 2020 VA medical opinion where the examiner opines that the Veteran's claimed condition was "at least as likely as not" incurred in or caused by the claimed in-service injury, event, or illness. In support, the examiner explained that the Veteran's toe symptoms were likely due to radiculopathy from his lumbar spine disease, "which is likely due to service." The examiner further explained that the Veteran's activities in service would have led to repetitive significant loading, strain, and impact of the lumbar spine, leading to the lumbar spine conditions that the Veteran developed (degenerative joint disease and degenerative disc disease with radiculopathy), consistent with the symptoms described by the Veteran. A March 2020 VA medical opinion where the examiner indicated, "The lumbar spine condition...was at least as likely as not incurred in service." The examiner further explained, "STRs documented low back/lumbar complaints while in service. The Veteran's activities would have led to repetitive significant loading, strain, and impact of the lumbar spine, leading ot the conditions the Veteran developed, consistent with the symptoms described by the Veteran." The Veteran's May 2021 Board hearing testimony where he described his experiences as a paratrooper and the negative impact that his parachute jumps had on his back. See Board hearing transcript, pp 6-13. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current back disability is related to his military service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a back disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Right Elbow During the appeal period, the Veteran was diagnosed as having a current right elbow disability. See June 2014 private medical report (dx: lateral epicondylitis, right elbow); July 2014 and January 2020 VA examination reports (dx: residuals of a puncture wound to include "mild degenerative changes; no acute fracture dislocation, or bony destruction; and several calcific fragments lateral to the lateral humeral epicondyles). The Veteran's STRs reflect that he sustained a right elbow puncture wound in 1984. The Board finds that the first and second elements of service connection have been met. Thus, the question becomes whether his current disabilities are related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes the following: A July 2014 VA medical opinion indicating that the Veteran's right elbow disability (a right elbow puncture wound with complication of hemorrhagic bursitis, a debridement, and drainage with delayed primary closure) was "less likely than not caused by the claimed in-service injury, event, or illness." The examiner noted that the Veteran's STRs showed a prior history of having two chip fractures to the right elbow and that he sustained a puncture wound in 1984. The examiner further observed that the Veteran underwent an epicondylar release in 2005. The examiner felt that these two conditions were unrelated as there were no records indicating a chronic right elbow problem for 21 years after service. The examiner further opined that the STRs did not reflect that the in-service puncture wound affected the particular area of his elbow that eventually required lateral epicondylar release surgery in 2005 (which is a surgery to correct an unresolving epicondylitis). The examiner concluded that he could not find any medical studies that show that a puncture wound would cause epicondylitis 21 years after the initial occurrence. The examiner felt that the Veteran's condition was akin to tennis elbow which results from overuse of the elbow joint. The evidence in favor of this claim includes the following: The Veteran's July 2014 NOD indicating that his 1984 elbow injury was the precursor event that eventually resulted in epicondylitis, blood clots/tumors, and multiple surgeries to address pain and tingling in his forearm. Diagnostic testing that accompanied the July 2014 VA elbow and forearm examination. Specifically, the examiner found that the "several small calcific fragments lateral to the lateral humeral epicondyles...could represent old ununited fracture fragments or could be related to prior lateral collateral ligament injury." A June 2019 private medical opinion where the examiner stated, "The Veteran has a well-documented in-service history of bilateral elbow injuries. His elbows were also subjected to the impact trauma of his MOD as a Navy Seal and Parachute Jumper. There are no other more compelling etiologies for his bilateral elbow condition found or proposed. Therefore, it is my medical opinion that "at least as likely as not" his bilateral elbow condition is directly related to his military service." An October 2019 private medical opinion where the examiner indicated that the Veteran's parachute hard landings lead to sciatic injuries, injury to his knees, and general "whole body" vibration trauma. The examiner opined that it is "at least as likely as not" that the Veteran's extensive medical issues have a high probability of being associated with his military service. The examiner noted that the Veteran's in-service elbow injury resulted in the tearing/rupture of elbow tendons, arterial puncture wounds, and corresponding blood poisoning to the elbow joint, requiring surgical repair. The examiner stated, "In reference to latent and long-term effects, chronic conditions can manifest due to micro tears that worsen over time, such as in the Veteran's case." Of note, the examiner explained that right elbow epicondylitis occurs when tendons in the elbow are overloaded but can also occur when muscle tissues experience a series of tears in the tendons from other means. It can also be caused by the overuse of the elbow. The Veteran's May 2021 Board hearing testimony where he described his experiences as a paratrooper and the negative impact that his parachute jumps had on his right elbow. See Board hearing transcript, pp 6-13. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current right elbow disability is related to his military service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a right elbow disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Left Ankle During the appeal period, the Veteran was diagnosed as having a current left ankle disability. See July 2014 VA examination report (dx: left ankle sprain); November 2019 VA examination report (dx: left ankle degenerative arthritis). As noted above, the Veteran's DD Form 214 shows that he was a Navy Seal and that he earned Navy/Marine Corps Parachute Wings. The Board finds that this evidence corroborates the Veteran's report that he participated in over 500 parachute jumps while serving as a Navy Seal. See May 2021 Board hearing transcript, p 3. Moreover, the Veteran's STRs reflect that he sprained his left ankle in November 1978 while on active duty. The Board finds that the first and second elements of service connection have been met. Thus, the question becomes whether his current disabilities are related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes the following: A November 2019 VA medical opinion indicating that the Veteran's ankle sprain was "less likely than not" incurred in or caused by his military service because the STRs do not indicate any evidence of recurring or chronic complaints or treatment for any injury secondary to parachuting. The examiner further noted that the Veteran's retirement examination in 1993 was silent for any ankle issues. The evidence in favor of these claims includes the following: The Veteran's July 2014 NOD indicating that he has continued to experience left ankle pain since he initially sprained his ankle in 1978. A July 2014 VA medical opinion indicating that the Veteran's left ankle condition "was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness." Although the examiner noted that there were no records showing that the Veteran had any recurring problems with his left ankle since 1978, the examiner observed that the Veteran's STRs clearly indicated that he had sprained his left ankle in November 1978. A May 2019 private medical opinion where the examiner opined, "It's a known medical fact that parachuting puts abnormal, traumatic pressure on the joints, especially knees, feet, ankles, hips, and spine, and as a result, chronic joint disabilities usually follow." The examiner noted that the Veteran's in-service left ankle injury was documented, the Veteran was not relieved of activities for the duration of his military service to allow for rehabilitation of his ankle, the Veteran did not benefit from immediate intervention or cold therapy, and the Veteran was not provided adequate healing time and it is highly probable that he increased injury to his ankle beyond the initial injury. The examiner opine that the Veteran's ailments have been chronic (active and worsening since the time of service) and "it is highly likely that [the Veteran's] in-service injuries are the causation of his current conditions." An October 2019 private medical opinion where the examiner indicated that the Veteran's parachute hard landings lead to sciatic injuries, injury to his knees, and general "whole body" vibration trauma. The examiner opined that it is "at least as likely as not" that the Veteran's extensive medical issues have a high probability of being associated with his military service. The Veteran's May 2021 Board hearing testimony where he described his experiences as a paratrooper and the negative impact that his parachute jumps had on his left ankle. See Board hearing transcript, pp 6-13. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current left ankle disability is related to his military service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a left ankle disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael L. Marcum, 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.