Citation Nr: A25035662 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 230328-334216 DATE: April 17, 2025 ORDER Entitlement to service connection for a gastrocnemius strain (claimed as "grom" strain and lower leg strain) is denied. FINDING OF FACT The evidence of record does not show that the Veteran has a current diagnosis of a gastrocnemius strain. CONCLUSION OF LAW The criteria for service connection for gastrocnemius strain have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active air service from January 1980 to January 1984. This case comes before the Board of Veterans' Appeals (Board) on appeal of a January 2023 Higher-Level Review (HLR) rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Initially, the Veteran was denied service connection for a "grom" strain (lower leg strain) in an August 2022 rating decision. In November 2022, the Veteran submitted a VA Form 20-0996, Decision Review Request: HLR of the August 2022 rating decision. The January 2023 HLR rating decision on appeal was issued in response to that request. In the March 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the August 2022 agency of original jurisdiction (AOJ) rating decision, which was subsequently subject to HLR. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the August 2022 rating decision, that was subsequently subject to HLR, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Board initially acknowledges that the Veteran filed a claim for service connection for a "GOM strain" on the VA Form 21-526EZ that was filed in April 2022. The Board notes that later, in April 2022, the Veteran clarified that "GROM strain" stood for gastrocnemius strain during a phone conversation with a VA employee. Additionally, in the August 2022 rating decision, the AOJ added "lower leg strain" to describe the claimed issue of entitlement to service connection for a "grom strain." Further, at the time of the August 2022 rating decision, the AOJ noted a VA examiner's opinion that the Veteran's "GROM strain" was a typo to mean groin strain. The Board also notes that the Veteran filed a separate claim for entitlement to service connection for right groin pain at the time he submitted his April 2022 VA Form 21-526EZ. Additionally, the Board highlights that in the August 2022 rating decision the AOJ listed, as a favorable finding for the Veteran's claimed GOM strain, that he had been diagnosed with right groin adductor strain. The Board further notes that in the November 2022 HLR request, the January 2023 HLR rating decision, and the March 2023 VA Form 10182, the issue on appeal was characterized as service connection for a "grom strain (lower leg strain)." Based on the above, the Board finds that the use of "GOM strain" and "GROM strain" have created much confusion as to the identity of Veteran's claimed disability, despite his clarification in April 2022. As such, the Board has recharacterized the claim on appeal to entitlement to service connection for a gastrocnemius strain to prevent any further confusion or mislabeling of the Veteran's claimed disability. Service Connection - Gastrocnemius Strain The Veteran asserts that his claimed lower leg strain is the result of his active service, and that the approximate date his disability began was in March 1982. The Veteran's service treatment records (STRs) are absent of any complaints of, treatment for, or diagnosis of a gastrocnemius strain, to include any symptoms that could be related to such a diagnosis. In February 1991, during his time in the Air National Guard, the Veteran reported that he had cramps in his legs after working out on a Report of Medical History. Further review of the STRs shows that in a March 1982 specimen report, a "gram stain" revealed that the Veteran only had slight discharge and that no microorganisms were seen. The signature block of the March 1982 "gram stain" was from a microbiologist. The Board notes that this record may be the cause of the confusion in the Veteran's claimed disability. At first glance, it does appear that the record states "grom strain" but on closer review, it is clearly stating "gram stain". A gram stain is a laboratory test used to check for bacteria at the site of an infection or in bodily fluids, and does not have any relation to a muscle injury. Gram Stain: What It Is, Purpose, Procedure & Results, https://my.clevelandclinic.org/health/diagnostics/22612-gram-stain (last visited Apr. 17, 2025). Such a finding is consistent with the context of the treatment note, and the fact that the test was signed by a microbiologist. The Board further notes that an in-service gram stain does not establish the presence of a current disability. As noted, the gram stain is used to detect bacterial infection, which with the correct treatment, would completely resolve. Further, there is no indication from the record that the Veteran has a bacterial infectious process that has continued since service. The Veteran's post-service treatment records are absent of any complaint of, treatment for, or diagnosis of a gastrocnemius strain. During VA examinations from May 2022 and June 2022, for knee and lower leg conditions, the Veteran solely reported that he injured his right knee during service. At those times, the VA examiner reported that the Veteran's only diagnosis related to knee and lower leg conditions, was gout. Additionally, in an August 2022 VA medical opinion, the VA examiner stated that the muscle group that includes the gastrocnemius, muscle group XI, had functions that included propulsion, plantar flexion of the foot, stabilization of the arch, and flexion of the toes. The examiner also reported that the Veteran did not claim any issues with his feet and concluded that there were no issues to document regarding muscle group XI. Ultimately, based on the evidence above, the Board finds that the Veteran does not have a current diagnosis of a gastrocnemius strain. Specifically, the Board finds that the evidence shows that the "gom strain" the Veteran referred to on his April 2022 VA Form 21-526EZ was seemingly related to the in-service gram stain, that was performed to determine the nature of his reported symptoms at the time, as opposed to a physical injury, based on the March 1982 specimen report and treatment note in his STRs. Further, the Board highlights that the VA examinations of record fail to show that the Veteran has a diagnosis of anything other than gout, in regard to either of his lower legs. The Board notes that entitlement to service connection for gout was separately adjudicated and not part of this appeal. Additionally, the Board acknowledges the Veteran's report of leg cramps, in February 1991, and that he is competent to identify that observable symptom. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Board notes that the Veteran is not competent to provide a medical diagnosis of gastrocnemius strain, or attribute his reported leg cramps to a diagnosis of gastrocnemius strain, as that requires medical expertise outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Moreover, the Board finds that there are no other documented reports of leg cramps or pain in the evidence since that 1991 complaint. In order for a disability to be service-connected, it must be present at the time a claim for VA disability compensation is filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence weighs persuasively against the claim and is not in approximate balance. Therefore, entitlement to service connection for a gastrocnemius strain is not warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Randall, Alexandria G. 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.