Citation Nr: 22015079 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 19-09 028 DATE: March 16, 2022 ORDER Entitlement to service connection for a left ankle disability is granted. FINDING OF FACT The Veteran's left ankle disability is etiologically related to an in-service injury. CONCLUSION OF LAW The criteria for service connection for a left ankle disability have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2018); 38 C.F.R. § 3.102, 3.303 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active Naval service from August 1988 to October 1988, and from August 1992 to August 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office. In October 2020, the Veteran appeared before the undersigned Veterans Law Judge. A transcript of that proceeding has been associated with the Veteran's claims file. Service Connection Left Ankle Disability The Veteran contends that his left ankle disability is related to his active-duty service. Specifically, the Veteran reported that he injured his left ankle during physical training in active service in December 1993 and has experienced pain and physical limitations from his left ankle condition since that date. Service treatment records (STRs) reflect that the Veteran was diagnosed with and treated for a left ankle sprain in December 1993, confirming the Veteran's consistent reporting of such injury. In addition, STRs confirm that the Veteran's injury was treated with the placement of a hard cast over his left ankle, with the use of a splint and crutches to assist in ambulating. After removal of the hard cast, he underwent a period of physical therapy. Accordingly, the Board finds that the element of service connection of an in-service injury has been met. As to a current diagnosis, the records are less clear. The Veteran underwent a VA examination in November 2017. Upon review of the Veteran's claims file and completion of an in-person examination, the examiner found that the Veteran did not have a current diagnosis of a left ankle disability. However, the examiner's opinion was not based upon current imaging studies but relied upon X-rays completed in 1993 at the time of the injury, which were reportedly "normal." Moreover, the examiner's opinion did not consider private medical records from 2001, which demonstrated updated imaging after re-injury from a work-related incident. Those records reflect a diagnosis of another ankle sprain. Based upon these records and the November 2017 VA examiner's rationale being based, in part, on an inaccurate factual finding that the Veteran has not had any documented left ankle complaints, examinations, or diagnoses since 1997, the Board finds that the VA examination opinion offers no probative value. During the Veteran's hearing before the Board, he candidly and credibly testified that he has not sought continuous treatment, despite experiencing continuous pain. The Veteran explained that his desire to continue working and to provide a living for his family, outweighed the discomfort and functional impairment that he has continued to live with since his in-service injury. He has taken it upon himself to utilize self-care methods of treatment, such as the use of ankle stabilizing footwear and over-the-counter pain medication to mitigate his symptoms. Nevertheless, his symptoms persist, and as documented by the VA examiner, have resulted in instability of the left ankle with reported flare-ups which require the Veteran to modify and limit his personal activities due to his left ankle condition. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018) (holding that to constitute a disability, subjective pain must result in some functional impairment; subjective pain in and of itself will not establish a current disability). In resolving reasonable doubt in favor of the Veteran, the Board finds that such reported incidents of pain, accompanied by the documented instability of the left ankle, along with the Veteran's reported functional impairments, amounts to a recognized disability. Id.; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). As to a nexus between the documented in-service injury and the current disability, the Veteran has credibly reported the ongoing pain and symptomatology presented by his left ankle ever since his December 1993 injury. The Board is mindful that earlier reported symptoms which lead to a later diagnosis of those same symptoms may, in some cases, establish the necessary medical nexus for service connection. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (establishing that lay evidence may be competent insofar as describing symptoms from an earlier time which support a later diagnosis by a medical professional). Conversely, as in this case, the same principles hold true. The Veteran was diagnosed with a left ankle sprain in service and reports that the symptoms of such disability continued to present, where the Board has found that the functional impairment due to pain of the left ankle amounts to a recognizable disability. (Continued on the next page) Given the foregoing, the Board finds that the evidence for and against the claim is in approximate balance. Therefore, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for a left ankle disability is warranted. 38 U.S.C. § 5107 (b) (2018); Lynch, 21 F.4th at 776. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Sutherell, 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.