ANKLE IMPAIRMENT OF

T. RAYMOND · 2025 · Case ID: 25014089

GRANTED

Summary

The Veteran, an Army veteran who served from August 1981 to February 1986, appeals the denial of an increased rating for his right ankle condition and the denial of service connection for secondary conditions affecting his cervical spine, major depressive disorder, left ankle, and lumbar spine. The Board granted an increased rating for the right ankle sprain/calcaneal spurs to 20 percent, effective September 15, 2015, based on marked limitation of motion. The Board also granted service connection for the cervical spine, major depressive disorder, left ankle condition, and lumbar spine disability as secondary to the service-connected right ankle condition. The Board found that the Veteran's right ankle condition caused gait abnormalities and pain, which in turn led to the development of the other claimed conditions. This conclusion was supported by a private medical opinion that provided a detailed explanation of the causal link, outweighing less probative VA medical opinions that did not fully address the Veteran's contentions or the secondary effects of the ankle condition. The Board applied the benefit of the doubt doctrine in granting these secondary service connections, finding the evidence in approximate balance.

Rationale

Right ankle condition manifested by marked limitation of motion.; Plantar flexion limited to less than 10 degrees.; Benefit of the doubt applied to reach 20 percent rating.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5271

Docket No.

17-25 050

Full Decision Text

Citation Nr: 25014089
Decision Date: 11/18/25 Archive Date: 11/18/25

DOCKET NO. 17-25 050
DATE: November 18, 2025

ORDER

Entitlement to an increased, 20 percent disability rating, but not higher, for right ankle sprain/calcaneal spurs is granted for the period beginning September 15, 2015.

Entitlement to service connection for a cervical spine disability, as secondary to the Veteran's right ankle sprain, is granted.

Entitlement to service connection for major depressive disorder, as secondary to the Veteran's right ankle sprain, is granted.

Entitlement to service connection for a left ankle condition, as secondary to the Veteran's right ankle sprain, is granted.

Entitlement to service connection for a lumbar spine disability, as secondary to the Veteran's right ankle sprain, is granted.

FINDINGS OF FACT

1. The Veteran's right ankle condition is manifested by marked limitation of motion.

2. Resolving all reasonable doubt in favor of the Veteran, the Veteran's cervical spine disability is due to or aggravated by his service-connected right ankle sprain.

3. Resolving all reasonable doubt in favor of the Veteran, the Veteran's major depressive disorder is due to or aggravated by his service-connected right ankle sprain.

4. Resolving all reasonable doubt in favor of the Veteran, the Veteran's left ankle condition is due to or aggravated by his service-connected right ankle sprain.

5. Resolving all reasonable doubt in favor of the Veteran, the Veteran's lumbar spine disability is due to or aggravated by his service-connected right ankle sprain.

CONCLUSIONS OF LAW

1. The criteria for an increased, 20 percent disability rating, but not higher, for right ankle sprain/calcaneal spurs have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Code 5271.

2. The criteria for entitlement to service connection for a cervical spine disability, as secondary to the Veteran's right ankle sprain, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to service connection for major depressive disorder, as secondary to the Veteran's right ankle sprain, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for entitlement to service connection for a left ankle condition, as secondary to the Veteran's right ankle sprain, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for entitlement to service connection for a lumbar spine disability, as secondary to the Veteran's right ankle sprain, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 1981 to February 1986.

These issues have been before the Board multiple times. Most recently, the Board remanded the Veteran's claim in the April 2021 Board Decision. The requested development was completed, and the case has now been returned to the Board for further adjudication.

Increased Rating

In general, disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disabilities adversely affect his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set for the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589(1991
and injuries and the residual conditions in civilian occupations. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589(1991).

In increased rating claims, where a claimant seeks a higher rating for a previously service-connected disability, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58(1994).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When a Veteran seeks benefits and the evidence is in relative equipoise, the Veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

1. Entitlement to an increased, 20 percent disability rating, but not higher, for right ankle sprain/calcaneal spurs is granted for the period beginning September 15, 2015.

The Veteran was initially granted service connection for a right ankle sprain in January 2013 and given a rating of 10 percent effective April 2012. See January 2013 Rating Decision.

The Veteran's right ankle sprain is currently rated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5271.

Under Diagnostic Code 5271, limitation of motion of the ankle warrants a 10 percent rating for moderate limited motion (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion). Limitation of motion of the ankle warrants a 20 percent rating for marked limited motion (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). 38 C.F.R. § 4.71a, Diagnostic Code 5271.

Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76453 (November 30, 2020) (codified at 38 C.F.R. § 4.71a).

When a law or regulation changes during the
15 degrees dorsiflexion or less than 30 degrees plantar flexion). Limitation of motion of the ankle warrants a 20 percent rating for marked limited motion (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). 38 C.F.R. § 4.71a, Diagnostic Code 5271.

Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76453 (November 30, 2020) (codified at 38 C.F.R. § 4.71a).

When a law or regulation changes during the course of a claim or appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCREC 3-2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, VA has made clear that its intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied.

The changes effective February 7, 2021, under 38 C.F.R. § 4.71a, DC 5271, were not to the rating schedule itself but added clarifying information. Now moderate limited motion is defined as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion while marked limited motion is defined as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion.

Medical treatment records show the Veteran complained about right ankle pain. He noted he took Tramadol, an opiod pain medication, for pain. See VA Medical Treatment Records.

The Veteran was afforded a VA examination in December 2012. Initial range of motion testing showed plantar flexion to 15 degrees and dorsiflexion to 10 degrees, both limited due to pain. See December 2012 Disability Benefits Questionnaire.

The Veteran provided a private examination report in April 2014. Initial range of motion testing showed plantar flexion to 25 degrees and dorsiflexion to 15 degrees. The Veteran was not about to perform repetition use testing after three repetitions due to pain. See August 2017 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in February 2015. Initial range of motion testing showed plantar flexion to 45 degrees and dorsiflexion to 10 degrees. There was no additional functional loss after three repetitions. When asked about repetitive use over time and during flare-ups, the examiner stated he was unable to express any additional limitation due to pain in terms of loss of range of motion because it would be mere speculation. There was no ankylosis or instability noted. See February 2015 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in November 2015. The Veteran stated he took multiple medications for pain, including a prescription nonsteroidal anti-inflammatory drug, a muscle relaxer, and Tramadol. Initial range of motion testing showed plantar flexion to 45 degrees and dorsiflexion to 10 degrees. There was no additional functional loss after three repetitions. When asked about repetitive use over time and during flare-ups, the examiner stated he was unable to express any additional limitation due to pain in terms of loss of range of motion because it would be mere speculation. There was no ankylosis or instability noted. See November 2015 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in March 2017. The Veteran stated that he was unable to do the range of motion testing because he was concerned about getting hurt during the evaluation. See March 2017 Disability Benefits Questionnaire.

The Veteran provided a private examination report in August 2017. Initial range of motion testing showed plantar flexion to 30 degrees and dorsiflexion to 10 degrees. After three repetitions, plantar flexion was limited to 25 degrees and dorsiflexion to 5 degrees. See August 2017 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in February 2019. Initial range of motion testing showed plantar flexion to 45 degrees and dorsiflexion to 5 degrees. There was no additional functional loss after three repetitions. When asked about repetitive use over time and during flare-ups, the examiner stated he was unable to express any additional limitation due to pain in terms of loss of range of motion because it should be documented during a flare-up period not during a regular medical evaluation. There was no ankylosis or instability noted. See February 2019 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in October 2021. The Veteran stated his pain has increased significantly. Initial range of motion testing showed plantar flexion to 15 degrees and dorsiflexion to 20 degrees. There was no additional functional loss after three repetitions. After repetitive use over time, the examiner estimated plantar flexion to be 15 degrees and dorsiflexion to be 15 degrees. The examiner estimated an additional loss of 5 degrees of both plantar flexion and dorsiflexion during flare-ups. There was no ankylosis or instability noted. See October 2021 Disability Benefits Questionnaire.

Based on the evidence of record, the Board finds that the Veteran's right ankle symptomatology warrants an evaluation of 20 percent under Diagnostic Code 5271 which is the highest rating available. Here, the Veteran had limited motion of the right ankle to at most 10 degrees dorsiflexion and 10 degrees plantar flexion. However, VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, 38 Vet. App. 130 (2025). Here, the beneficial effects of medication are not known. Therefore, the Board has considered the beneficial effects of medication and found that the Veteran would have plantar flexion to less than 10 degrees, which is what is required for a higher 20 percent rating under Diagnostic Code 5271. Thus, resolving all reasonable doubt in the Veteran's favor, he is entitled to a 20 percent disability rating for his right ankle limitation of motion.

Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Here, the VA Form 526EZ, Fully Developed Claim, for an increased rating for the right ankle was received on September 15, 2015.

Therefore, the evidence of record shows the Veteran's right ankle had plantar flexion limited to less than 10 degrees. Accordingly, the Board finds the Veteran is entitled to an increased, 20 percent, disability rating for his right ankle limitation of motion under DC 5271 effective September 15, 2015, the date of receipt of the claim.

2. Entitlement to service connection for a cervical spine disability, as secondary to the Veteran's right ankle sprain, is granted.

The Veteran seeks service connection for a lower back condition secondary to his service-connected right ankle condition. He asserts that his service-connected right ankle caused an imbalance which caused his neck condition. See March 2017 Statement in Support of Claim.

The Veteran was afforded a VA examination in February 2015. The Veteran was diagnosed with cervical spine degenerative disc disease. The examiner opined that the Veteran's neck condition was less likely than not related to his service-connected right ankle condition because the two conditions were in different anatomical regions that have different boney structures and nerve supplies. See February 2015 Disability Benefits Questionnaire. However, the examiner did not address the Veteran's contention that his right ankle caused an altered gait which led to his neck condition. Therefore, the Board assigns this opinion low probative weight.

The Veteran was afforded a VA examination in February 2019. The examiner opined that the Veteran's cervical spine condition was less likely than not proximately due to or the result of the Veteran's service-connected right ankle condition because the Veteran's right ankle condition was not severe enough to cause a great impact in the Veteran's gait. See February 2019 Disability Benefits Questionnaire.

The Veteran submitted a private medical opinion dated December
ical regions that have different boney structures and nerve supplies. See February 2015 Disability Benefits Questionnaire. However, the examiner did not address the Veteran's contention that his right ankle caused an altered gait which led to his neck condition. Therefore, the Board assigns this opinion low probative weight.

The Veteran submitted a private medical opinion dated December 2022. The physician opined that the Veteran's right ankle condition caused the Veteran's cervical spine condition. The examiner explained how the right ankle condition caused instability and an altered gate, which in turn put constant stress on the entire spine including the cervical region. The Board finds the examiner's opinion that the Veteran's cervical spine condition was caused by his service-connected right ankle condition is highly probative because it is based on a review of the record, medical literature, and is supported by an explanation that contains clear conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). See Opinion of Dr. M.S.

Based on the foregoing, the Board finds that the competent and credible evidence is at least in approximate balance that the Veteran's cervical spine condition was caused or aggravated by his service-connected right ankle sprain. Resolving any doubt in favor of the Veteran, the Board finds that service connection for his cervical spine disability is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.

3. Entitlement to service connection for major depressive disorder, as secondary to the Veteran's right ankle sprain, is granted.

The Veteran seeks service connection for major depressive disorder secondary to his service-connected right ankle condition. See March 2017 Statement in Support of Claim.

The Veteran submitted a statement from a childhood friend. He said the Veteran was very communicative, happy, funny, and attentive to others' needs before he went into the military. He stated that the Veteran was isolated, sad, stressed, and depressed after he returned from the military. He said the Veteran loved sports before the military, but he could not participate after due to his injuries. See July 2017 Statement of J.H.

Medical treatment records show that the Veteran was depressed and in severe pain daily. The physician noted that the pain triggered his depression due to the problems with his ankles affecting his ability to walk. See Medical Treatment Records.

The Veteran was afforded a VA examination in March 2015. The Veteran was diagnosed with major depressive disorder. The examiner noted that private psychiatrist notes make reference to the Veteran's neck pain. The examiner opined that the Veteran's major depressive disorder was less likely than not proximately due to or the result of the Veteran's service-connected conditions because there was no history of mental disorders during service and the only note of ankle pain was in the February 2015 VA examination. See March 2015 Disability Benefits Questionnaires 1 and 2.

The Veteran was afforded a VA examination in March 2017. The examiner opined that the Veteran's major depressive disorder was less likely than not proximately due to or the result of the Veteran's service-connected right ankle because there was no mention in VA medical center notes of pain due to the service-connected ankle. However, the examiner did note that there was a note that the Veteran's significant physical disabilities affected his mental health, including his cervical spine disability. See March 2017 Disability Benefits Questionnaire.

The Veteran provided a private medical opinion dated May 2017. The examiner noted that the Veteran's physical condition affected his mental illness. Specifically, the examiner noted the Veteran's right ankle strain affected his mental health. See May 2017 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in February 2019. The examiner opined that the Veteran's major depressive disorder was less likely than not due to, secondary to, or associated in any way with the Veteran's service-connected right ankle condition because the Veteran was diagnosed with major depressive disorder 23 years after his right ankle fracture. The examiner stated that they were not related etiologically or pathophysiologically. The examiner opined that the Veteran's major depressive disorder was not aggravated by his right ankle condition for the same reason. See February 2019 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in October 2021. The examiner opined that the Veteran's major depressive disorder was less likely than not due to, secondary to, or associated in any way with the Veteran's service-connected right ankle condition because the Veteran sought psychiatric treatment
was less likely than not due to, secondary to, or associated in any way with the Veteran's service-connected right ankle condition because the Veteran was diagnosed with major depressive disorder 23 years after his right ankle fracture. The examiner stated that they were not related etiologically or pathophysiologically. The examiner opined that the Veteran's major depressive disorder was not aggravated by his right ankle condition for the same reason. See February 2019 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in October 2021. The examiner opined that the Veteran's major depressive disorder was less likely than not due to, secondary to, or associated in any way with the Veteran's service-connected right ankle condition because the Veteran sought psychiatric treatment 19 years after his right ankle fracture. The examiner stated that the Veteran's major depressive disorder and the service-connected right ankle were in different time frames, had different etiologies, and were different pathophysiology and anatomical systems. See October 2021 Disability Benefits Questionnaire.

The Veteran submitted a private medical opinion dated December 2022. The physician opined that it is at least as likely as not that the Veteran's depression was the direct result of his right ankle issue. The examiner explained that medical literature identifies an association between chronic pain and depression, and that the Veteran related that his depression is, in part, due to not physically being able to do the activities he once enjoyed due to ankle pain. The Board finds this opinion is highly probative because it is based on a review of the record, medical literature, and is supported by an explanation that contains clear conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). See Opinion of Dr. M.S.

Based on the foregoing, the Board finds that the competent and credible evidence is at least in approximate balance that the Veteran's major depressive disorder was caused or aggravated by his service-connected right ankle sprain. Resolving any doubt in favor of the Veteran, the Board finds that service connection for his major depressive disorder is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.

4. Entitlement to service connection for a left ankle condition, as secondary to the Veteran's right ankle sprain, is granted.

The Veteran seeks service connection for a left ankle condition secondary to his service-connected right ankle condition. He asserts that his service-connected right ankle caused an imbalance which caused his left ankle condition. See March 2017 Statement in Support of Claim.

Private treatment records from June 2017 note that the Veteran's right ankle has affected his left ankle because of the pressure he applies trying to change his way of walking to avoid putting any stress on the right ankle. Additionally, medical records note that the Veteran suffers from a left ankle condition due to his posture and effort to not injure the right side. The physician provided multiple medical references that show that an ankle sprain can affect the opposite ankle, and he opined that this was the case with the Veteran. See Medical Records 1 and 2.

The Veteran was afforded a VA examination in February 2015. It was noted that the Veteran had a diagnosis of left plantar spur. The examiner stated that the Veteran's left ankle condition was less likely than not proximately due to or the result of the Veteran's right ankle condition because the left and right ankle are not related pathophysiologically or anatomically. The examiner stated there was no evidence of right ankle instability which could cause a change in gait pattern. See February 2015 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in March 2017. The examiner stated that he was unable to provide an opinion because the Veteran would not complete the examination due to fear of being hurt. See March 2017 Disability Benefits Questionnaire.

The Veteran provided a private examination report in August 2017. The examiner stated that the Veteran's right ankle affected his left ankle which caused ambulation problems. See August 2017 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in February 2019. The examiner opined that the Veteran's left ankle condition was less likely than not proximately due to or the result of the Veteran's service-connected right ankle condition because the Veteran's right ankle condition was not severe enough to cause a great impact in the Veteran's gait. See February 2019 Disability Benefits Questionnaire.

The Veteran submitted a private medical opinion dated December 2022. The physician opined that the Veteran's right ankle condition caused the Veteran's left ankle condition. The examiner explained how the right ankle condition caused instability and an altered gate, which in turn caused the left ankle condition. The Board finds the opinion that the Veteran's left ankle condition was caused by his service-connected right ankle condition is highly probative because it is based on a review of
that the Veteran's left ankle condition was less likely than not proximately due to or the result of the Veteran's service-connected right ankle condition because the Veteran's right ankle condition was not severe enough to cause a great impact in the Veteran's gait. See February 2019 Disability Benefits Questionnaire.

The Veteran submitted a private medical opinion dated December 2022. The physician opined that the Veteran's right ankle condition caused the Veteran's left ankle condition. The examiner explained how the right ankle condition caused instability and an altered gate, which in turn caused the left ankle condition. The Board finds the opinion that the Veteran's left ankle condition was caused by his service-connected right ankle condition is highly probative because it is based on a review of the record, medical literature, and is supported by an explanation that contains clear conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). See Opinion of Dr. M.S.

Based on the foregoing, the Board finds that the competent and credible evidence is at least in approximate balance that the Veteran's left ankle condition was caused or aggravated by his service-connected right ankle sprain. Resolving any doubt in favor of the Veteran, the Board finds that service connection for his left ankle disability is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.

5. Entitlement to service connection for a lumbar spine disability, as secondary to the Veteran's right ankle sprain, is granted.

The Veteran seeks service connection for a lower back condition secondary to his service-connected right ankle condition. He asserts that his service-connected right ankle caused an imbalance which caused his lower back condition. See March 2017 Statement in Support of Claim.

Medical treatment records show that the Veteran was diagnosed with mild spondylosis of the lumbosacral spine and small posterior herniation of the L5-S1 disc in 2008. It was noted that the Veteran's right ankle condition caused a change in posture which affected the spine. See Medical Records 1 and 2.

The Veteran was afforded a VA examination in December 2012. The Veteran stated that he had low back pain for the past 15 years. He stated that he had episodes of low back pain while in the military, but he was able to continue service without going to sick call. The examiner opined that the Veteran's lower back condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness because the file was silent for back conditions during military service. See December 2012 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in February 2015. The examiner opined that the Veteran's lumbar degenerative disc disease was less likely than not caused by or the result of the Veteran's service-connected right ankle sprain because lumbar and ankle conditions are not related pathophysiologically or anatomically. See February 2015 Disability Benefits Questionnaire. However, the examiner did not address the Veteran's contention that his right ankle caused an altered gait which led to his back condition. Therefore, the Board assigns this opinion low probative weight.

The Veteran provided a private examination report in August 2015. The examiner stated that the Veteran's lower back condition was directly caused by his right ankle trauma. See August 2015 Disability Benefits Questionnaire.

The Veteran provided a private examination report in August 2017. The examiner stated that the Veteran's right ankle affected his lower back causing ambulation problems. The examiner also stated that the Veteran's ambulation problems worsened his lower back. See August 2017 Disability Benefits Questionnaire.

The Veteran was afforded a VA examination in February 2019. The examiner opined that the Veteran's lower back condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness because service treatment records were silent for low back pain complaints, evaluation, and/or treatment during service or within two years of separation. The examiner opined that the Veteran's lower back condition was less likely than not proximately due to or the result of the Veteran's service-connected right ankle sprain because they have different anatomical sites with different pathophysiological processes unrelated to each other. The examiner additionally stated that there was no objective evidence that the lower back condition had been aggravated beyond its natural progression by his right ankle. See February 2019 Disability Benefits Questionnaire.

The Veteran submitted a private medical opinion dated December 2022. The physician opined that the Veteran's right ankle condition caused the Veteran's lumbar spine condition. The examiner
illness because service treatment records were silent for low back pain complaints, evaluation, and/or treatment during service or within two years of separation. The examiner opined that the Veteran's lower back condition was less likely than not proximately due to or the result of the Veteran's service-connected right ankle sprain because they have different anatomical sites with different pathophysiological processes unrelated to each other. The examiner additionally stated that there was no objective evidence that the lower back condition had been aggravated beyond its natural progression by his right ankle. See February 2019 Disability Benefits Questionnaire.

The Veteran submitted a private medical opinion dated December 2022. The physician opined that the Veteran's right ankle condition caused the Veteran's lumbar spine condition. The examiner explained how the right ankle condition caused instability and an altered gait, which in turn put constant stress on the spine. Additionally, the examiner stated that the Veteran's right ankle condition caused his weight gain which put more stress on his spine. The Board finds the physician's opinion that the Veteran's lumbar spine condition was caused by his service-connected right ankle condition to be highly probative because it is based on a review of the record, medical literature, and is supported by an explanation that contains clear conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). See Opinion of Dr. M.S.

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Based on the foregoing, the Board finds that the competent and credible evidence is at least in approximate balance that the Veteran's lumbar spine condition was caused or aggravated by his service-connected right ankle sprain. Resolving any doubt in favor of the Veteran, the Board finds that service connection for his lumbar spine is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ho, Ashley M.

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.

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