Citation Nr: A25035893 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 241015-483110 DATE: April 18, 2025 ORDER Entitlement to service connection for a left knee disorder is denied. Entitlement to service connection for lower back disorder is denied. Entitlement to service connection for migraines is denied. Entitlement to service connection for right plantar fasciitis is denied. Entitlement to service connection for left plantar fasciitis is granted. Entitlement to service connection for left pelvis stress fracture is denied. FINDINGS OF FACT 1. The competent and credible evidence of record persuasively establishes a finding that there is evidence of current left knee pain, and an in-service left knee injury; however, the Veteran showed no good cause for missing the examination. 2. The competent and credible evidence of record does not persuasively establish a finding that there is a current lumbar disability, or in-service event. 3. The competent and credible evidence of record does not persuasively establish a finding that there are any current migraine headaches, or in-service event. 4. The competent and credible evidence of record does not persuasively establish a finding that there is any current right plantar fasciitis. 5. The competent and credible evidence of record does not persuasively establish a finding that there is any current left plantar fasciitis, or in-service event. 6. The competent and credible evidence of record does not persuasively establish a finding that there is any current left hip fracture. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left knee disorder have not 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 lower back disorder have not 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 migraines have not 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 right plantar fasciitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for left plantar fasciitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for left pelvis stress fracture have not 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 April 2014 to August 2014, from September 2014 to December 2014, from February 2015 to October 2015, and from August 2023 to September 2023, with additional National Guard service. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2024 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In the October 2024 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 April 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 1. Entitlement to service connection for a left knee disorder 2. Entitlement to service connection for lower back disorder 3. Entitlement to service connection for migraines 4. Entitlement to service connection for right plantar fasciitis 5. Entitlement to service connection for left plantar fasciitis 6. Entitlement to service connection for left pelvis stress fracture Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Discussion The Veteran alleges that she has disorders related to the left knee, low back, migraine headaches, the left pelvis, and bilateral feet which began during service and have existed since that time. Unfortunately, grants of service connection for these issues are not possible at this time. Regarding the left knee, indeed, service treatment records (STRs) noted a left knee injury in July 2014 when the Veteran overextended it while playing softball. January 2024 Army Medical Center records noted continued reports of left knee pain. As for the pelvis, May 2013 STRs indicated there was a stress fracture to the medial lower right pubic ramus. And an undated physical profile showed there was a right foot injury and pain after a fall, slip, or trip. At this time, that is the only evidence in support of the Veteran's claims. The record is silent for any current diagnosis of the lumbar spine, bilateral feet, to include plantar fasciitis, the left pelvis, or migraine headaches beyond the mere assertion that she has these conditions on her October 2023 application. For the knee and pelvis, she only indicated that they were related to an in-service injury. Regarding the remaining claims, she simply wrote that they were, "service related." She did not provide any further details, or argument. The Board acknowledges that there is evidence in the Veteran's favor that she had injuries to the left hip, left knee, and right foot during service. The AOJ attempted to schedule the Veteran for examinations to assess the nature of these conditions, and verify their connection to military service; however, they canceled these examinations when the Veteran informed them that she was unavailable to attend them. The record is silent for good cause for missing these examinations. The duty to assist a claimant is not a one-way street, and in the instant case, the Veteran must cooperate by responding to the full extent in the development of the claim. See Wood v. Derwinski, 1 Vet. App. 406 (1991) (noting that VA's duty to assist is a two-way street, and the Veteran cannot wait passively in those situations where their assistance to VA is necessary). Thus, there is not a pre-decisional duty to assist error here to warrant remand for new examinations. The Board acknowledges the Veteran's statements regarding these conditions. As she is not shown to have medical education or experience, she is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., knee pain; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). She is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, these lay assertions do not constitute evidence upon which service connection can be granted. To be clear, the Board is not casting doubt on the Veteran's credibility regarding these claims at this time; however, the evidence of record is simply insufficient for a grant of service connections. Without a medical nexus opinion which demonstrates a connection between a current disability, and a service-related event, injury, or illness, service connection is not possible at this time. The Board has also considered whether presumptive service connection can be established where there is evidence of continuity of symptomology of a chronic condition since service. See 38 C.F.R. § 3.309. While there is evidence of current left knee pain, the record is not clear whether this is related to the in-service left knee injury. The record also does not demonstrate that there are current diagnoses for any other claim on appeal. The record does show that the Veteran filed a new application for some of these conditions after the rating decision on appeal, and did attend some VA examinations; however, it does not appear that any medical opinions have been obtained, and the AOJ has not yet issued a new rating decision. Nonetheless, the Board may not consider any evidence added to the claims folder after the rating decision presently on appeal. Accordingly, the criteria for the claims of entitlement to service connection a left knee disorder, a lumbar disorder, a migraine headaches disorder, bilateral plantar fasciitis, and a left hip disorder have not been met, and the appeal is denied. ? In reaching this decision the Board considered the doctrine of reasonable doubt. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence persuasively favors the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the evidence persuasively weighs against the claim, in which case the claim is denied. In other words, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021). Here, however, as the evidence is persuasively against the claim and the positive and negative evidence is not in approximate balance, the doctrine is not for application. Id. Thomas L. English Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Rogos, J. 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.