Citation Nr: 22018406 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 17-63 565 DATE: March 29, 2022 ORDER Entitlement to service connection for degenerative joint disease of the right ankle is granted. Entitlement to service connection for degenerative joint disease of the left ankle is granted. Entitlement to service connection for degenerative joint disease of the right knee is granted. Entitlement to service connection for degenerative joint disease of the left knee is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, right ankle degenerative joint disease is at least as likely as not related to the right ankle injuries noted during his period of active duty service. 2. Resolving reasonable doubt in the Veteran's favor, left ankle degenerative joint disease is at least as likely as not related to the left ankle injuries noted during his period of active duty service. 3. Resolving reasonable doubt in the Veteran's favor, right knee degenerative joint disease is at least as likely as not related to his period of active duty service. 4. Resolving reasonable doubt in the Veteran's favor, left knee degenerative joint disease is at least as likely as not related to his period of active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for degenerative joint disease of the right ankle have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for degenerative joint disease of the left ankle have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for degenerative joint disease of the right knee have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for degenerative joint disease of the left knee have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1988 to June 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In a June 2019 decision, the Board reopened the claims of service connection for right and left knee and right and left ankle disabilities and remanded the case for further development which has been completed. In November 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript is of record. At the hearing, the Veteran also provided testimony on the issue of entitlement to service connection for major depression. Subsequent to the hearing, in a January 2022 rating decision, the RO granted service connection for unspecified anxiety disorder with recurrent depressive disorder; thus, that issue is no longer before the Board. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303 (b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may be established for a current disability on the basis of a presumption under the law that certain chronic diseases, to include arthritis, manifesting to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). 1. Entitlement to service connection for degenerative joint disease of the right ankle 2. Entitlement to service connection for degenerative joint disease of the left ankle 3. Entitlement to service connection for degenerative joint disease of the right knee 4. Entitlement to service connection for degenerative joint disease of the left knee The Veteran contends that he has chronic disabilities of both ankles and knees as a result of injuries incurred in service, particularly as part of the Navy wrestling team. The service treatment records note multiple complaints of ankle sprains and one complaint of left knee pain. Left ankle sprain was noted following wrestling in February 1991. Follow-up treatment was noted in March 1991. Mild bilateral ankle sprains were noted in May 1991. In July 1991 he was seen with continued ankle pain. The examiner noted possible degenerative joint disease of the bilateral ankles. Left knee tendonitis was noted in March 1992. On a report of medical history completed by the Veteran prior to service separation in June 1992, he noted ankle problems. Following service, in April 1993, the Veteran was seen with "chronic ankle pain." Degenerative joint disease was noted. A VA examination in August 1993 noted the Veteran reported bilateral ankle pain and loss of mobility that he attributed to wrestling in service. The examiner noted no abnormalities. A July 2012 VA examination noted right knee degenerative changes. The Veteran reported onset of right knee pain in 1991. The examiner provided a negative nexus opinion, noting there were no documented right knee complaints in service. A Disability Benefits Questionnaire dated in June 2017 noted the Veteran reported onset of knee and ankle pain in service. A VA examiner in September 2017 stated that the in-service knee and ankle complaints were acute only. Pursuant to the Board's remand, a VA examination was conducted in December 2019. The examiner stated that the Veteran's claimed ankle and knee conditions were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale was as follows: X-rays done 27 years after separation show mild osteoarthritis of knees and ankles most likely due to morbid obesity. No workup is done. A nexus has not been established. No new info regarding the possibility of service connection. This Veteran lists his ankle and knee pain and "disability" in every visit to a provider. There has been no real workup done and usually ibuprofen treatment is suggested. He basically presents no new information not previously considered. His ankle and knee pain and "disability" would seem to be more related to his morbid obesity(BMI = 40) than to any episode while in service. The Veteran submitted statements from his treating physician, Dr. Foster. In March 2020, Dr F. stated: [The Veteran] has been under my care for his chronic medical conditions....advanced DJD of knees and ankles. It is my opinion that this is more likely than not due to his military service where he was a member of the Navy wrestling team and as such was subject to rigorous physical training with impact jogging. In October 2020, Dr. F. stated: [The Veteran] has been under my care for degenerative joint disease of his knees and ankles. This is likely to have been caused by his four years of military service which included intensive physical training as a member of the US Navy wrestling team. He has bone enlargement of his knee and ankle joints as well as crepitus of his range of motion. This patient's degenerative joint disease has worsened over time. It is well accepted In medicine that pain from degenerative joint disease is often out of proportion to any X-ray changes. This is the case in regard to this patient's painful disease. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current right and left ankle and right and left knee disabilities, degenerative joint disease, are related to his in-service wrestling team activities, which were shown in the service treatment records to have caused bilateral ankle sprains and left knee tendonitis. The Board notes that degenerative joint disease of the ankles was suspected in service and noted on the April 1993 VA examination shortly after service. The Veteran has consistently reported that he injured his ankles and knees in service, and that he has had ongoing knee and ankle pain since service. Dr. Foster's private opinions attributed the Veteran's current degenerative joint disease of the knees and ankles to his inservice wrestling team activities. The negative VA opinions did not adequately address the inservice wrestling activities and the notations of degenerative joint disease in service and on the April 1993 VA examination. Thus, the Board does not find these opinions to be entitled to more weight than the private opinions. Accordingly, after resolving all doubt in favor of the Veteran, service connection for degenerative joint disease of both ankles and knees is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102, 3.303. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Mazzucchelli, 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.