Citation Nr: 22017616 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 17-54 401 DATE: March 25, 2022 ORDER Entitlement to service connection for a left ankle disorder is denied. Entitlement to service connection for bilateral heel spurs is denied. REMANDED Entitlement to service connection for residuals of jaw injury is remanded. Entitlement to service connection for a cervical spine disorder is remanded. FINDINGS OF FACT 1. A left ankle disorder was not shown in service or many years thereafter; and the evidence persuasively weighs against finding that a left ankle disorder is etiologically related to active service. 2. A bilateral heel disorder was not shown in service or many years thereafter; and the evidence persuasively weighs against finding that a bilateral heel disorder is etiologically related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left ankle disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for bilateral heel spurs are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Army from October 1995 to March 2000 and February to September 2003. The appeal originates from May 2014 and March 2015 decisions of a Department of Veterans Affairs (VA) Regional Office. The matter was remanded in April 2019 for VA examinations with opinions for the left ankle and heel spurs. The Veteran failed to report for necessary examinations without cause in November 2019 and therefore the claims will be decided on the evidence of record. There has been substantial compliance with the Remand directives. 1. Entitlement to service connection for a left ankle disorder. 2. Entitlement to service connection for bilateral heel spurs. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Veteran contends that he injured his left ankle in service when jumping from a tank and training in air school. See September 2014 NOD. He contends that he has heel pain and discomfort due to physical training and marching in service. See August 2015 NOD. He reports persistent left ankle and bilateral heel pain and discomfort affecting his ability to walk, stand, and exercise. Affording him the benefit of the doubt, element (1) of Shedden is met. While service treatment records are silent for complaints, treatment, or diagnosis of left ankle or bilateral heel disorders, it is plausible that the Veteran underwent considerable physical and air training. Notably, his DD-214 forms reflect a military occupational specialty of armor crewman and receipt of the parachutist badge. Affording him the benefit of the doubt, Shedden element (2) is met. Regarding Shedden element (3) or a nexus, the Veteran's failure to report for the examinations has frustrated VA's attempt to ascertain the nature and etiology of his left ankle and bilateral heel symptoms. He has not submitted a private medical opinion linking a left ankle or bilateral heel disorder to service. In the absence of medical evidence of a nexus to service, Shedden element (3) is not met. The Veteran believes he has left ankle and bilateral heel symptoms that are related to service. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Accordingly, the evidence is persuasively against the claim, and the claims of service connection for a left ankle disorder and bilateral heel spurs must be denied. REASONS FOR REMAND 1. Entitlement to service connection for residuals of jaw injury is remanded. 2. Entitlement to service connection for a cervical spine disorder is remanded. The record indicates that there are relevant outstanding private treatment records. A remand is required to allow VA to obtain authorization and request these records. Specifically, VA treatment records suggest that the Veteran had neck surgery in October 2020 at a private hospital. The November 2017 letter from his dentist indicates that he received treatment there. VA should request authorization from him to obtain these records. The Veteran contends that he has a jaw disorder from an in-service incident when a tank cannon recoiled and struck him on the left side of the face. See August 2015 NOD. He contends that he suffered a neck injury during physical training in service. See September 2014 NOD. A November 2017 letter from his private dentist indicates pain consistent with temporomandibular joint (TMJ) disorder. VA treatment records show that MRI imaging in July 2020 revealed several areas of disc protrusions causing mild cervical stenosis and degenerative changes with neural foraminal narrowing. The Board remanded the jaw and cervical spine issues for VA examinations, for which the Veteran failed to report without cause. Nevertheless, there is medical evidence diagnosing jaw and neck disorders as well as lay evidence regarding their claimed relation to service. Therefore, on remand, nexus opinions should be obtained as to their etiology. The matters are REMANDED for the following action: 1. Request authorization from the Veteran to obtain treatment records for neck surgery at Clear Lake Regional in August 2020 and dental treatment from Tara Rios Dental Group in November 2017. 2. Request an etiology opinion for the Veteran's jaw disorder, to include TMJ disorder. The examiner is asked to opine whether it is at least as likely as not that the Veteran has a jaw disorder, to include TMJ disorder, that had its onset in or is otherwise etiologically related to active service. The examiner must address the service treatment records showing dental treatment following a head injury in August 1997 and the November 2017 letter from a dentist indicating pain consistent with TMJ disorder. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. Request an etiology opinion for the Veteran's neck disorder. The examiner is asked to opine whether it is at least as likely as not that a cervical spine disorder (noted on MRI in July 2020 as disc protrusions causing mild cervical stenosis and degenerative changes with neural foraminal narrowing) had its onset in service or within a year of service discharge or is otherwise etiologically related to active service. The examiner should address the Veteran's contention that he injured his neck due to physical training exercises in service and the July 2014 private treatment record regarding the onset of neck pain. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. K. MARENNA Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alhinnawi 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.