Citation Nr: 22016203 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 18-12 033 DATE: March 21, 2022 ORDER Service connection for right ankle degenerative arthritis is granted. REMANDED The issue of entitlement to service connection for right knee degenerative arthritis is remanded. The issue of entitlement to service connection for a right wrist disability is remanded. FINDING OF FACT The competent, credible, and probative evidence of record establishes that the Veteran's current right ankle degenerative arthritis was incurred during his period of military service. CONCLUSION OF LAW The criteria for service connection for right ankle degenerative arthritis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1977 to November 1980. In October 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ) via video conference. A transcript of the hearing is associated with the claims file. 1. Entitlement to service connection for right ankle degenerative arthritis 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). In April 2013, the Veteran filed a claim seeking service connection for "arthritis" without identifying the specific joint(s) affected by the disability. However, during the October 2021 hearing, the Veteran indicated that he was seeking service connection for arthritis affecting the right ankle and right knee. Therefore, the Board has expanded the Veteran's arthritis claim to include the right ankle and right knee. The Veteran has attributed his claimed right ankle and knee disabilities to an injury that was incurred while performing physical training at Fort Hood. He has explained that, while running, he stepped into a pothole and twisted his ankle and knee. He also testified that he fell after twisting his ankle and hit his knee. The Veteran has reported having ongoing pain and symptoms in his right ankle and knee since service, for which he sought treatment from VA during the 1980s. The Veteran's service treatment records (STRs) show that he sought treatment for right ankle pain in 1979 and, while the record reflects that he reported twisting his ankle while playing basketball (as opposed to stepping in a hole while running), the evidence shows that he sprained his ankle at that time. See January 1979 STRs. The STRs do not contain any subsequent complaints of right ankle problems but, in November 1980, the Veteran reported having swollen and painful joints in addition to foot trouble. Unfortunately, the Veteran did not have an accompanying examination at that time and neither the Veteran nor the examining clinician provided any additional details regarding the reported joint or foot conditions. See November 1980 report of medical history. However, the foregoing evidence establishes a right ankle injury during service. The Veteran sought to establish service connection for right ankle arthritis in August 1985 and reported injuring his ankle in 1978. He was afforded a VA examination in October 1985, at which time he reported that, during service, he stepped in a hole while doing exercises and sprained his ankle. Following physical examination and x-rays, the Veteran was diagnosed with a right ankle injury and arthritis. The next medical evidence of right ankle pain is reflected in an April 2008 VA treatment record, during which the Veteran endorsed having chronic ankle pain, which he attributed to spraining his right ankle after stepping in a pothole at Fort Hood. The Veteran also endorsed having pain since jumping off a truck while on active duty in the late 1970s. He was variously diagnosed with right ankle pain and degenerative joint disease of the right ankle and foot. See e.g., VA treatment records dated April and May 2008. The Veteran's diagnosis of right ankle arthritis has continued to the present. See February 2018 VA ankle examination. The claims file contains conflicting medical opinions that address whether the Veteran's right ankle arthritis is likely related to his period of active service. In February 2018, a VA physician opined that the current right ankle disability was not likely related to service on the basis that the medical evidence failed to document chronicity of the right ankle condition during or after service. This opinion is not adequate, however, because the examiner did not consider or address the Veteran's competent and credible reports of continued right ankle pain following service, to include as reflected in the October 1985 examination report, subsequent VA treatment records, and statements made by the Veteran. In January 2021, a VA physician opined that the Veteran's right ankle arthritis is likely related to the ankle complaints in service, noting that the evidence of osteoarthritis in the ankle noted in 2008 was too advanced for age and contained evidence of an old healed injury, which the physician stated made it likely that the current disability is related to the Veteran's military service. The Board finds the January 2021 VA opinion is competent, credible, and probative, as it considers all relevant facts in this case, including the facts established in the lay and medical evidence of record, and is supported by a complete rationale. Therefore, the Board finds the most competent, credible, and probative evidence of record persuasively supports a finding that the Veteran's current right ankle arthritis was incurred as a result of his military service. Accordingly, service connection for right ankle degenerative arthritis is warranted. REASONS FOR REMAND 1. Entitlement to service connection for right knee degenerative arthritis is remanded. The Veteran has a current diagnosis of right knee degenerative arthritis which he attributes to an in-service injury. As noted, the Veteran has variously reported that he twisted (or hit) his knee after stepping in a pothole while running and after jumping off a truck. He testified that he went to sick call after the injury and was given an ace bandage and sick call. He has also reported having ongoing pain and symptoms in his right knee after service. In January 2018, a VA physician opined that the Veteran's current right knee arthritis was not likely incurred in or caused by the painful joints listed on his separation examination or the fall noted during a parade in service. While the VA examiner noted the evidence of record, the examiner did not provide a rationale in support of the opinion, which renders the opinion inadequate. Therefore, a remand is needed to obtain an adequate medical opinion. 2. Entitlement to service connection for a right wrist disability is remanded. The Veteran is also seeking service connection for a right wrist disability, which he asserts was incurred after falling off a truck during service. During the October 2021 hearing, the Veteran testified that he slipped and fell backwards while climbing onto a truck and hurt his wrist trying to brace the fall. He testified that he went to sick call where he was told to wrap his wrist to accommodate movement of the wrist and allow him to return to duty, but he reports having continued wrist pain since the injury. In January 2018, a VA physician opined that the Veteran's current right wrist disability was not likely incurred in or caused by the painful joints listed on his separation examination or the fall noted during a parade in service. While the VA examiner noted that the STRs do not reflect treatment for a right wrist injury during service, the examiner did not adequately consider the Veteran's reports of incurring a right wrist injury during service or continued wrist pain thereafter. Given the foregoing, the Board finds that the examiner did not consider all relevant facts in this case, which renders the opinion inadequate. Therefore, a remand is needed to obtain an adequate medical opinion. In remanding these issues, the Board makes no credibility determination, expressed or implied, at this juncture. The matters are REMANDED for the following action: 1. Request that an appropriate medical professional review the claims file and provide an addendum opinion regarding the Veteran's right knee and right wrist disabilities. The claims file must be reviewed, and the examination report must reflect that such review was accomplished. The examiner is requested to provide an opinion as to the following: (a) Was the Veteran's current right knee disability incurred during or as a result of his period of active service, to include the right knee injury or other event/injury reflected in the service treatment records or any other injury reported by the Veteran? (b) Was the Veteran's current right wrist disability incurred during or as a result of his period of active service, to include any injury reflected in the service treatment records or otherwise reported by the Veteran? The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. However, if there is a medical reason to doubt its veracity, the examiner should explain why the Veteran's statements or recollection are inconsistent with the evidence in this case, medical principles relating to the onset and progress of the disease, the specific findings in the record, and/or your professional judgment. A complete, well-reasoned rationale must be provided for each opinion offered. The examiner may identify any post-service events or injuries to which the current knee and wrist disabilities may be related. (Continued on the next page.) 2. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.