Citation Nr: 22017005 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 15-07 120 DATE: March 23, 2022 ORDER Entitlement to service connection for a chronic disability manifested by difficulty walking and abnormal gait is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran has had a chronic disability manifested by difficulty walking and abnormal gait at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a chronic disability manifested by difficulty walking and abnormal gait are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from May 1997 to May 2001. This case initially came before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, February 2020, March 2021, and July 2021, the Board remanded the claim for additional development. This case has now been returned to the Board for further appellate action. Service Connection Claim The Veteran contends that he has difficulty walking and an abnormal gait resulting from physical stress and injury caused by his time on active duty. He has not singled out a specific event or injury during service that caused the claimed disability. The Veteran's service treatment records (STRs) are silent for complaints of difficulty walking and abnormal gait. However, he did have problems with his knees during service and he is currently service connected for bilateral patellofemoral pain syndrome. He is also service connected for a right quad muscle tear and for chronic fatigue syndrome. The Veteran noted in a July 2014 statement that he has suffered from chronic knee pain since active duty. He indicated that he wore a knee brace and had done so for several years. A review of the Veteran's medical history reveals that the vast majority of the time since his discharge from service, his gait was noted as normal. There are two exceptions to this. In August 2018, a VA physical therapy record noted that the Veteran's gait was "unremarkable antalgic gait." At that time, he reported that he was running in May 2017 and felt a sharp pain in his anterior thigh. He stated that he stopped running due to right leg pain. He indicated that he still had right thigh pain with standing or even sitting at times and recalled that he had a tear during service at the same location. He stated that he had to walk differently and shy away from a normal stride due to leg pain. In June 2019, a VA physical rehabilitation record noted that the Veteran's gait was "a little Trendelenburg" on the right side. At that time, he was being seen for low back pain with mechanical glute/sacroiliac joint/hip girdle dysfunction; bilateral knee pain; right thigh pain; and right shoulder pain. He stated that his hips were painful when he walked, especially up or down stars and with twisting motions. He also stated that he developed right lateral hip pain a couple of months prior and that his right anterior thigh still felt tight. He indicated that he was most concerned with his right hip and anterior right thigh pain. On examination, there was tenderness to palpation of the right greater trochanter and taut band of the right rectus femoris. The assessment was right hip myofascial pain and right thigh muscle strain. In June 2019, a VA examiner noted that the Veteran had a quadricep injury from playing soccer while in active service that also caused residual right knee pain. The examiner opined that the injury was at least as likely as not the cause of the difficulty walking/abnormal gait. In August 2019, a VA physical rehabilitation record noted that the Veteran's right hip pain was a bit less. It was noted that he was still using a stick roller to work on his thigh, which felt much better. He stated he had been working on correcting his gait, which helped a lot and that he felt his gait was more normalized. On examination, the clinician noted that his gait appeared more equal. The Veteran underwent a VA examination in April 2021 for the possibility of a Parkinson's Disease diagnosis. No diagnosis was offered at the time. It was noted that the Veteran was told that his abnormal gait was due to his hips. In October 2021, the Veteran underwent another VA examination. His gait was found to be normal and his symptoms were found to be subjective only. The Veteran was diagnosed with a hip strain. Following this VA examination, an addendum opinion was sought and obtained in January 2022. The addendum was to determine if either the Veteran's lumbar radiculopathy or bilateral hip strain could be the cause of the Veteran's difficulty walking and abnormal gait. Regarding the lumbar radiculopathy, the examiner noted that the Veteran's claims file was silent for complaints of abnormal gait or difficulty walking during service associated with lumbar radiculopathy and that there was no evidence indicating that the lumbar radiculopathy was incurred in or caused by service. As rationale, the examiner noted that a December 2017 VA treatment record indicated that the Veteran's lower back pain was relatively new and occurred after the Veteran, an endurance runner, took up high intensity interval training followed by a sedentary job. The examiner also addressed whether the bilateral hip strain was the cause of the Veteran's abnormal gait/difficulty walking. The examiner noted that the Veteran's separation examination was silent for any hip complaints and that his service treatment records were silent for any abnormal gait/walking difficulty. The examiner noted that the claims file was silent for any hip condition until August 2019, when it was noted that the Veteran had right hip myofascial pain and was treated with trigger point injections. Therefore, the examiner opined that it was less likely than not that the Veteran's bilateral hip condition was incurred in or caused by military service. Finally, the examiner looked at the totality of the Veteran's conditions and provided an opinion on the most likely cause of the Veteran's difficulty walking/abnormal gait. The examiner noted that the Veteran was an endurance runner and was being followed for bilateral knee pain due to patellofemoral pain syndrome. The examiner stated that during flare ups of knee pain, it was conceivable that his symptoms would cause difficulty walking and an altered gait. It was also noted that a 2021 podiatry record indicated that the Veteran believed his foot pain caused his gait to be off. The examiner noted that there were no treatment records showing chronic altered gait or difficulty walking and that a separate or standalone diagnosis of difficulty walking/altered gait was not appropriate as his symptoms were caused by other conditions, i.e., foot and knee pain. Based on the foregoing, the most probative evidence does not indicate that the Veteran has a chronic disability manifested by difficulty walking or an abnormal gait. The Board notes that he has had occasional episodes of an altered gait; however, those symptoms have been attributed to a variety of other conditions, including knee pain, right thigh/hip pain, and foot pain. As noted above, the Veteran is already service connected for a bilateral knee disability and a right thigh muscle tear. To separately compensate the Veteran for the same symptoms of another service-connected disability would constitute impermissible pyramiding. 38 C.F.R. § 4.14. In this regard, the Board notes that the criteria used to evaluate those service-connected disabilities contemplate functional impairment resulting from limitation of motion. The Veteran has not put forth any lay evidence that his difficulty walking/altered gait has caused additional symptoms that are not already contemplated by the disability ratings under Diagnostic Codes 5252 and 5260. Accordingly, to separately service connect the Veteran for those symptoms would violate the rule against pyramiding. Regarding any difficulty walking/altered gait caused by the Veteran's hip and foot pain, the evidence does not indicate that those disabilities were incurred in or caused by service. As noted by the January 2022 examiner, the evidence does not indicate that the Veteran's hip pain manifested during service or for many years after service. Furthermore, the is no evidence that a foot disability manifested during service or may be caused by service. Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance, and entitlement to service connection for a chronic disability manifested by difficulty walking/abnormal gait is not warranted. 38 U.S.C. § 5107(b) (2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). SONJA A. MISHALANIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.