Citation Nr: 22017154 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 16-13 556 DATE: March 24, 2022 ORDER Service connection for a chronic right ankle disability is denied. FINDING OF FACT A chronic right ankle disability was not shown during the July 1993 period of inactive duty for training (INACDUTRA); right ankle arthritis was not diagnosed within a year of the July 1993 period of INACDUTRA; and the weight of the evidence is against a finding that any right ankle disability was due to the July 1993 period of INACDUTRA. CONCLUSION OF LAW The criteria for service connection for a chronic right ankle disability have not been met. 38 U.S.C. §§ 101, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 1981 to February 1981 and reserve service from November 1989 to May 1997 with a period of active duty for training (ACDUTRA) from February 1990 to June 1990 and a period of INACDUTRA from July 24, 1993, to August 7, 1993. This case is before the Board of Veterans' Appeals (Board) on appeal from an October 2013 Department of Veterans Affairs (VA) rating decision. In May 2020, the agency of original jurisdiction (AOJ) granted service connection for a right ankle scar due to residuals from cellulitis. This represents a complete grant of his appeal in regard to this claim. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). This issue is no longer before the Board. In May 2019 and June 2021, the matter was remanded for additional development. Service Connection Legal Criteria Service connection is warranted for disability due to disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To substantiate a claim of service connection there must be competent evidence showing: (1) the existence of a claimed disability; (2) incurrence or aggravation of a disease or injury in active service; and (3) a causal relationship between the present claimed disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases may be presumed to be service connected if manifested as chronic in service or to a compensable degree within a specified period after active service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). For chronic diseases listed in 38 C.F.R. § 3.309(a) service connection may be established by showing continuity of symptomatology. See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Active service includes periods of ACDUTRA when service connection may be granted for disabilities resulting from a disease or injury incurred in or aggravated while performing ACDUTRA. 38 U.S.C. § 101(22), (24); 38 C.F.R. § 3.6(a), (c). Active service also includes periods of INACDUTRA when service connection may be granted for disabilities resulting from an injury incurred in or aggravated while performing INACDUTRA. 38 U.S.C. § 101(23), (24); 38 C.F.R. § 3.6(a), (d). ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). INACDUTRA is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). Active duty also includes authorized travel to or from such duty or service. 38 C.F.R. § 3.6(e). ACDUTRA is not defined as "active" service unless the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). INACDUTRA is not defined as "active" service unless the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. Id. Factual Background The Veteran asserted that he injured his right ankle during the July 1993 period of INACDUTRA and resulted in a chronic right ankle disability. The Veteran's service treatment records (STRs) from his active service do not show complaints, treatment, or diagnosis for a right ankle disability. The Veteran's reserve service STRs show that he injured his right ankle during the July 1993 period of INACDUTRA. A right ankle x-ray was normal. He was diagnosed with a right ankle sprain. He began physical therapy afterwards. The Veteran's medical records show that by September 1993, his right ankle had good range of motion and good strength. Physical therapy was discontinued. He was assessed with a normal right ankle. In March 2003, he denied having any joint pain, weakness, or stiffness. In October 2013, the Veteran was afforded a VA examination. He reported that he injured his right ankle during the July 1993 period of INACDUTRA. He reported being diagnosed with right ankle arthritis in 1996. A VA examiner reviewed the Veteran's claims file, interviewed the Veteran, and conducted an examination. The examiner diagnosed the Veteran with remote history of a right ankle sprain and arthritis. The examiner reported that the Veteran had essentially a normal physical examination. The examiner reported that bilateral ankle x-rays obtained during the VA examination showed degenerative arthritis, and therefore was not isolated to only the Veteran's right ankle. In May 2019, the Board remanded the claim in order to afford the Veteran a new VA examination and obtain a medical opinion regarding the cause of the Veteran's right ankle disability. In January 2020, the Veteran was afforded a VA examination. A VA examiner reviewed the Veteran's claims file, interviewed the Veteran, and conducted an examination. The examiner opined that the Veteran's right ankle disability was less likely than not caused by the ankle injury in July 1993 as there was no continuity of medical records. In June 2021, the Board determined that the January 2020 VA examiner's opinion was not adequate and remanded the claim for further development, to include obtaining an adequate opinion regarding the cause of the Veteran's right ankle disability. In November 2021, the January 2020 VA examiner again reviewed the Veteran's claims file. The examiner opined that the Veteran's right ankle disability was less likely than not due to the July 1993 right ankle injury. The examiner reported that in July 1993, x-rays of the Veteran's right ankle were normal, and on examination, he retained good range of motion and good strength. The examiner reported that the Veteran's right ankle injury was acute and transitory and resolved without any residuals. The examiner reported that the Veteran was not diagnosed with arthritis until the October 2013 VA examination bilateral ankle x-rays. Analysis The Veteran has not submitted any medical evidence supporting his assertion that a right ankle disability was due to or the result of the right ankle injury during the July 1993 period of INACDUTRA. VA obtained a medical opinion in an effort to support the Veteran in establishing his claim. The VA examiner's November 2021 medical opinion is given the greatest weight. The VA examiner opined that the Veteran's right ankle disability was less likely than not due to the July 1993 right ankle injury. Moreover, the VA examiner's November 2021 medical opinion was accompanied by a detailed explanation of how the examiner reached the conclusion. In addition, this opinion has not been undermined or called into question by any competent medical evidence of record. The VA examiner reported that the Veteran's right ankle injury was acute and transitory and that the first evidence of any chronic right ankle disability was not until the October 2013 VA examination when bilateral ankle x-rays showed arthritis. Therefore, after weighing all the evidence, the Board finds great probative value in the VA examiner's November 2021 medical opinion, but also notes that the entirety of the medical evidence weighs against the conclusion that the Veteran's right ankle disability was due to the July 1993 right ankle injury during a period of INACDUTRA. Thus, the evidence fails to establish service connection for the Veteran's right ankle disability. Consideration has been given to the assertions of the Veteran that his right ankle disability was due to a July 1993 right ankle injury during a period of INACDUTRA. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, namely the cause of a chronic right ankle disability, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Ankle arthritis is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding causation, as the evidence shows that physical examinations that include objective medical tests, such as x-rays or MRIs, are needed to properly assess and diagnose the disorder. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). That is, although the Board readily acknowledges that the Veteran is competent to report an ankle injury and pain, to the extent they are identifiable by observation, he has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating musculoskeletal disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, this lay evidence does not constitute competent medical evidence and lacks probative value. The record does not contain evidence of a diagnosis of a continuously ongoing right ankle disability from the Veteran's July 1993 period of INACDUTRA to the present, as the first clinical evidence of a chronic right ankle disability does not appear until at least 2013, two decades after the July 1993 period of INACDUTRA. In addition, the record does not contain evidence that any right ankle injury during the July 1993 period of INACDUTRA resulted in a diagnosis of arthritis within one year. Therefore, the presumption of service connection has not been triggered. Accordingly, the criteria for service connection have not been met for a chronic right ankle disability. That is, the evidence does not show that a chronic right ankle disability was diagnosed during the July 1993 period of INACDUTRA or within a year of that service, the weight of the evidence is against a finding that a chronic right ankle disability has existed continuously since the July 1993 period of INACDUTRA, and the weight of the evidence is against a finding that the Veteran's right ankle disability was due to the July 1993 period of INACDUTRA. [CONTINUED ON NEXT PAGE] Therefore, the claim must be denied. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berryman, 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.