Citation Nr: 22012125 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 14-28 000A DATE: March 2, 2022 ORDER Entitlement to service connection for a right ankle disability, to include arthritis, is denied. Entitlement to service connection for a left ankle disability, to include arthritis, is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that the Veteran's current right ankle disability, to include arthritis, was incurred in active service or within one year of separation from active service. 2. The weight of the evidence is against a finding that the Veteran's current left ankle disability, to include arthritis, was incurred in active service or within one year of separation from active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right ankle disability, to include arthritis, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). 2. The criteria for service connection for a left ankle disability, to include arthritis, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from September 1977 to September 1981. In May 2018, the Veteran testified before the undersigned at a Board of Veterans' Appeals (Board) hearing regarding issues that since been resolved. He declined the option of a Board hearing with respect to his claimed ankle disabilities, as noted on a July 2019 VA Form 9 which he filed in response to the May 2019 Statement of the Case (SOC) adjudicating those claims. The Board remanded the issues on appeal in August 2018, September 2019, May 2020, and December 2020. Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. § 3.159. The Veteran has not raised any issues pertaining to VA's duties in this regard. See 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). Service Connection The Veteran contends that his current bilateral ankle disabilities originated in active service, specifically from injuries incurred during helicopter jumps. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In addition, for veterans who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain chronic diseases, including arthritis, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). The Veteran has been diagnosed with bilateral ankle arthritis and tendonitis, including most recently at a February 2021 VA Compensation and Pension (C&P) examination. The "current disability" element has therefore been met. See 38 C.F.R. § 3.303(a). As for the "in-service incurrence" element, the Veteran has reported that he injured his ankles when repelling down from a helicopter. The Board has no reason to doubt the veracity of this account. The question on appeal is whether there is a "nexus" between the in-service injury and the Veteran's current disabilities. In this regard, the Veteran's service treatment records show several instances of treatment for foot problems but do not reflect any complaints or treatment for ankle pathology. His separation examination report is negative for any ankle-related symptomatology. In June 1981, the Veteran denied any arthritis or bone or joint deformity. The first objective evidence of treatment for ankle problems was in March 2016, when the Veteran reported bilateral foot and ankle pain to a VA podiatrist. (A VA medical " problem list" from 2012 does not show ongoing treatment for ankle disability. The Veteran filed the instant claim for service connection in January 2018.) The Veteran was afforded VA C&P examinations in March 2018, February 2020, and August 2020 to evaluate his claims. The reports from these examinations include negative nexus opinions authored by the examiners; however, the Board's most recent remand, in December 2020, determined that these examinations and opinions were collectively inadequate because they failed to meaningfully discuss the Veteran's lay reports of bilateral ankle pain in service with continuous symptoms since his discharge from service. In February 2021, the Veteran was afforded another VA C&P examination. The report notes the Veteran's complaints of ankle pain in service resulting from helicopter jumps, for which he sought treatment in service. The report further acknowledges the Veteran's current diagnosis of bilateral ankle arthritis. However, the examiner opined that it was unlikely that the Veteran's current arthritis was incurred in or caused by the claimed in-service injury. By way of rationale, the examiner noted that the service treatment records were negative for ankle symptoms, notwithstanding the Veteran's reports of receiving medical care and a profile at the time. Moreover, there were no objective complaints during the year after the Veteran's discharge from service. Ankle pain was documented in the early 2000s, which was more than 20 years after discharge. In December 2021, the VA examiner issued an addendum (the RO having found inadequacies in the February 2021 opinion). The examiner clarified that, regardless of the Veteran's subjective report of ankle pain during service, the fact that there were no further complaints noted in the treatment records combined with the negative findings noted on the separation examination indicated the condition was acute and not chronic in nature. The examiner continued: Furthermore, Veteran's post-service records are silent to any complaints or treatment of a bilateral ankle condition to support Veteran's claim their ankle condition has been ongoing since service. Veteran's left ankle imaging notes minimal degenerative changes which would indicate the Veteran's arthritis had its onset in recent years, not several decades prior, during service. Finally, on 05/11/2017 Veteran reports ankle pain began a few months prior, which would indicate inconsistency in the Veteran's reported onset of ankle condition. The Veteran is deemed competent to provide a history of his symptoms. The lay/buddy statements regarding the Veteran's symptoms were also considered. However, the Veteran is not capable of diagnosing the medical condition related to those symptoms. A nexus has not been established. The Veteran has not disputed this opinion, nor has he submitted any additional evidence in support of his claim since the December 2021 addendum. In this case, the positive evidence of record consists of the Veteran's lay statements describing an in-service injury and continuous symptoms of ankle pain thereafter. As to these statements, the Board accepts that he is competent to report matters which he personally observed or experienced, as well as what has been related to him by medical professionals. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He is certainly competent to report ankle pain, for example. However, the Veteran is not competent to offer opinions on complex medical questions requiring specialized knowledge, such as the physiological causes of his current bilateral ankle disability, to include arthritis. The Veteran has not actually alleged that he was diagnosed with arthritis (or any other chronic condition) in service or within one year of separation from servicenor indeed for many years thereafter. He has not provided any medical evidence in support of his claim that his current ankle pathology is linked to any specific, in-service injuries. He has never reported being told by any medical professional that his ankle disabilities were related to an in-service injury. See Jandreau, supra at 1377. Conversely, a VA medical professional has reviewed the record and opined that the Veteran's bilateral ankle disabilities were not at least as likely as not associated with any in-service causes. The examiner reviewed the Veteran's medical history, including his service treatment records and his lay contentions (the examiner acknowledged that the Veteran reported continuous ankle pain since service). The examiner discussed the medical significance of imaging results, noting the development of the Veteran's arthritis appeared to be more recent than would be consistent with a decades-old injury, and evaluated the likelihood that the Veteran's in-service injury (which the examiner accepted had occurred) was acute and not chronic in nature. The examiner, furthermore, noted correctly that the Veteran did not have the specialized training necessary to opine as to whether his specific current ankle disability was incurred in service, given the lack of objective evidence supporting that claim. In light of the detailed, fact-specific, and logical nature of the December 2021 VA addendum, the Board finds that it is entitled to significant probative weight. See, e.g., Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). For the reasons discussed above, the Board concludes that the weight of the evidence is against a finding that the Veteran's current bilateral ankle disabilities were incurred in service or are otherwise related to service. The evidence does not establish a combination of manifestations indicating the development of arthritis in service nor continuity of symptomatology of arthritis-related symptoms following discharge. See 38 C.F.R. § 3.303(b). In so finding, the Board reiterates that the December 2021 VA examiner's addendum thoroughly addressed the Veteran's medical history, including his service treatment records and lay contentions, and determined that it was not at least as likely as not that the Veteran's current ankle disabilities, to include arthritis, developed in service or within one year of separation therefrom. The Board acknowledges the Veteran's reports of continuous ankle pain since service; however, he is not competent to substantiate the specific contention that his current disabilities are related to service. Thus, there is no credible evidence of record calling the December 2021 VA examiner's findings into question. The Board is not free to ignore or disregard the medical conclusions of a VA physician, and is not permitted to substitute its own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The claim for service connection for bilateral ankle disabilities must be denied. The Board is grateful for the Veteran's honorable service, and this decision in no way is meant to detract from that service. The Board is constrained by law, however, and unfortunately there is no basis on which to award the benefits sought. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Minot, 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.