Citation Nr: 22017382 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 13-01 321 DATE: March 24, 2022 ORDER Entitlement to service connection for a left ankle disability, to include degenerative joint disease and Haglund deformity, is granted. FINDING OF FACT Resolving all doubt in favor of the Veteran, the Veteran's left ankle disability was caused by his service-connected by left knee disability. CONCLUSION OF LAW The criteria for service connection for a left ankle disability, as secondary to service-connected left knee disability, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from April 1964 to August 1967; and had periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) in the Air Force Reserves from 1978 to 1999, including a period of ACDUTRA, for two weeks from March 1985 to April 1985. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a June 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2016, the Veteran testified during a videoconference hearing before the undersigned Veteran's Law Judge (VLJ). A transcript of this hearing has been associated with the claims file. The Veteran's claims were before the Board of Veterans Appeals (Board) in September 2018 wherein the claims were remanded for further development. In an August 2019 decision, the Board denied the Veteran's claims. Thereafter, the Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). Through an August 2020 Joint Motion for Remand (JMR), the Court sent the Veteran's claims to the Board for additional action consistent with the JMR. In March 2021, the Board remanded the Veteran's claims to the agency of original jurisdiction (AOJ) for consideration of the evidence in the first instance. In December 2021, the RO granted the Veteran's appealed claims for service connection for diabetes, disabilities of the eye, and erectile dysfunction. As a grant of service connection is considered a full grant of the benefits sought, these claims are no longer before the Board. Entitlement to service connection for a left ankle disability is granted. The Veteran contends that his left ankle disability is caused or aggravated by his service-connected left knee disability. Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, (2) an already service-connected disability, and (3) that the disability for which secondary service connection is sought was either (a) caused or (b) aggravated by the already service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). The record confirms a current left ankle disability. See June 2021 C&P Exam. He is also service-connected for a left knee disability. Thus, the first two elements for establishing secondary service connection are satisfied. The remaining question for the Board is whether his left ankle disability was caused or aggravated by his service-connected left knee disability. The Board resolves all doubt in favor of the Veteran and finds that service connection is warranted. In November 2006, VA treatment notes document the Veteran's complaint of left ankle and knee pain. He noted that he is able to walk but had a limp. Later in December 2006, the Veteran specifically noted pain in the heel. He was advised to start wearing backless shoes, as the pressure onto his left heel and ankle would exacerbate his symptoms. In the Veteran's December 2012 Form 9, he alleged that he had tenderness in his ankle and heel because he had to wear shoes with a back for his left knee and back disabilities. In November 2015, the Veteran's representative asserted that the Veteran's left ankle disability was the result of wearing shoes with a back as required for his service-connected left knee disability. At the January 2016 hearing, the Veteran testified that he first noticed his left ankle disability after he underwent a left knee replacement. His symptoms included rubbing and pain at the left heel with wearing of "regular shoes". Regarding medical evidence of record, negative opinions were offered for service connection for the Veteran's left ankle disability. However, the Board notes that neither of the medical opinions adequately addressed the Veteran's contention that his wearing of shoes with backs caused his left ankle disability. The Board has made several unsuccessful attempts to obtain a medical opinion to specifically address this point. See September 2018 and March 2021 Board remands. Due to the favorable action noted within, the Board finds that further delay of adjudication of the Veteran's claim, by way of remand, is not warranted. Reviewing the record in the light most favorable to the Veteran, the Board takes notice that at the January 2016 hearing, the Veteran testified that he first noted his left ankle disability presented after his left knee replacement. His symptoms included hurting pain and rubbing of his heel on the back of a regular shoe. Medical evidence of record supports that a Haglund deformity occurs where there is frequent pressure at the back of your heels that may be caused by wearing shoes that are too tight or stiff in the heel. See November 2018 VA Examination and September 2021 C&P Exam. Treatment notes in 2006 also document a recommendation from his treating physician that the Veteran should avoid shoes with a back because doing so would exacerbate his left ankle symptoms. This evidence highly suggests that his left ankle disability is related to the shoes required for the mitigation of his left knee disability, as it did not occur until after his left knee replacement and there is medical evidence supportive that the Veteran's wearing of shoes with backs may have caused his left ankle disability. Resolving all doubt in favor of the Veteran, the record supports that he has a left ankle disability that was caused by his service-connected left knee disability. The Veteran's claim is granted. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.B. Mmeje, 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.