ANKLE IMPAIRMENT OF

Summary

The veteran, who served in the U.S. Army from July 2008 to October 2015, appealed the denial of service connection for a right ankle scar and a right ankle sprain. The Board granted service connection for a right ankle pain condition, finding it secondary to the Veteran's service-connected lumbar spine disability. The Board noted that while a VA examiner initially provided a negative opinion regarding secondary connection to a left ankle condition, the same examiner provided a favorable opinion linking the right ankle condition to gait changes caused by the service-connected lumbar spine disability. The Board found the evidence regarding the secondary connection to the lumbar spine to be in approximate balance, thus affording the Veteran the benefit of the doubt and granting service connection for the right ankle pain. The Board denied service connection for a right ankle scar, finding no current diagnosis or compensable symptoms documented in the service treatment records, VA treatment notes, or multiple VA examinations. The evidence persuasively weighed against the existence of a right ankle scar, rendering the benefit of the doubt doctrine inapplicable to this claim.

Rationale

Current diagnosis of right ankle pain with functional limitation; Service-connected lumbar spine disability; Favorable VA examiner opinion linking right ankle to lumbar spine via gait changes; Evidence in approximate balance, affording benefit of the doubt

Full Decision Text

Citation Nr: A26013883
Decision Date: 02/17/26	Archive Date: 02/17/26

DOCKET NO. 250310-522827
DATE: February 17, 2026

ORDER

Entitlement to service connection for a right ankle pain condition, caused as secondary to the Veteran's service-connected lumbar spine disability, is granted.

Entitlement to service connection for a right ankle scar disability is denied.

FINDINGS OF FACT

1. The evidence of record is at least approximately balanced regarding whether the Veteran's claimed right ankle pain condition was caused by his service-connected lumbar spine disability.

2. The weight of the evidence persuasively shows that there is no currently diagnosed right ankle scar condition that was incurred or caused by service and that any reported symptoms do not amount to a functional impairment of earning capacity.

CONCLUSIONS OF LAW

1. The criteria for establishing entitlement to service connection for a right ankle condition, caused as secondary to the Veteran's service-connected lumbar spine disability, have been met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.310.

2. The criteria for establishing entitlement to service connection for a right ankle scar disability have not been met.  38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from July 2008 to October 2015.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).

In March 2024, the RO issued a rating decision denying entitlement to service connection for the Veteran's claimed right ankle scar and right ankle sprain.  A September 2024 rating decision continued the denial for the Veteran's right ankle sprain claim.  Thereafter, on September 20, 2024, the Veteran filed a VA Form 20-0996, Decision Review Request, seeking Higher-Level Review of the March 2024 and September 2024 decisions' denials of service connection.  Pursuant to this Decision Review Request, a Higher-Level Review rating decision was issued in January 2025.  In this January 2025 rating decision, VA continued the prior denials.

In March 2025, the Veteran disagreed with the January 2025 Higher-Level Review rating decision and filed a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)).  The Veteran selected the Direct Review Docket by submitting notice of disagreement under the Appeals Modernization Act (AMA).  38 C.F.R. § 19.2(d).  Accordingly, based on the Veteran's selections of the Higher-Level Review and the Direct Review option, the Board is limited to review of the evidence in the record up and until the date of notification of the March 2024 and September 2024 rating decisions for the issues on appeal.  See 38 C.F.R. §§ 3.2601, 20.301.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the above claim.  38 C.F.R. § 20.300.  If the Veteran would like VA to consider any evidence that was added to the claims file 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.

Service Connection-Legal Criteria

Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability.  See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 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.  
, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection-Legal Criteria

Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability.  See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 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 may be granted on a secondary basis for a disability which is aggravated by, due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310.  Allen v. Brown, 7 Vet. App. 439 (1995); Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (the language "resulting from" in 38 U.S.C. § 1110 requires but-for causation, and that this is broader than proximate causation).  In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability.  See Wallin v. West, 11 Vet. App. 509, 512 (1998).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the weight of the evidence is against the claim, in which case the claim is denied.  38 U.S.C. § 5107.  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 the claimant.  

To deny a claim on its merits, the weight of the evidence must persuasively stand against a finding that the evidence is in "approximate balance" or "nearly equal" to the favorable evidence.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Right Ankle Pain-Analysis

The Veteran is seeking service connection for his right ankle condition, to include as secondary to his service-connected disabilities.  For the reasons explained below, the Board finds that service connection for this disorder is warranted.  

Initially, the Board notes that the Veteran has current diagnoses of acute right ankle sprain, resolved.  See May 2024 VA Ankle Conditions examination.  While the examiner indicated that the Veteran's ankle sprain had resolved, the Veteran reported ankle pain during the examination, and the examiner recorded functional limitation of the Veteran's right ankle.  The Board notes that pain alone, even without an underlying pathology or diagnosis, can constitute a disability under VA law where such pain results in functional impairment.  Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).  As such, the Veteran has a currently diagnosed condition.

Additionally, service connection is in effect for lumbosacral strain with degenerative disc disease and residuals of a left ankle fracture.  See December 2025 Rating Decision Codesheet.  As such, the first two requirements of secondary service connection are met.  See Wallin, 11 Vet. App. at 512.  For secondary service connection, all that remains to be resolved is whether the medical evidence of record establishes a link between the Veteran's claimed right ankle pain and his service-connected disabilities. 

The Veteran was initially provided with a March 2024 VA Ankle Conditions examination.  Here, the examiner diagnosed the Veteran with an acute right ankle sprain that had resolved.  During the examination the Veteran reported pain to his right ankle with weight bearing.  Further, the examiner recorded functional impairment in the Veteran's right ankle.  The examiner opined that the right ankle condition was less likely than not due to or the result of the Veteran's service-connected left ankle condition.  However, in the rationale of the opinion, the examiner noted that lumbar disc degeneration and gait change significantly predispose an individual to ankle issues.  Further, the examiner opined that the Veteran's right ankle condition was more likely than not related to loading pressure abnormalities from gait changes due to the Veteran's service-connected lumbosacral strain with degenerative joint disease.  Thus, while the examiner provided
 had resolved.  During the examination the Veteran reported pain to his right ankle with weight bearing.  Further, the examiner recorded functional impairment in the Veteran's right ankle.  The examiner opined that the right ankle condition was less likely than not due to or the result of the Veteran's service-connected left ankle condition.  However, in the rationale of the opinion, the examiner noted that lumbar disc degeneration and gait change significantly predispose an individual to ankle issues.  Further, the examiner opined that the Veteran's right ankle condition was more likely than not related to loading pressure abnormalities from gait changes due to the Veteran's service-connected lumbosacral strain with degenerative joint disease.  Thus, while the examiner provided a negative rationale and opinion with regard to secondary service connection due to the Veteran's left ankle, the examiner provided a favorable opinion for secondary service connection due to the Veteran's lumbar spine.

The Veteran was next provided with a May 2024 VA Ankle Conditions examination.  As noted above, he was diagnosed with a right ankle sprain which had resolved, but functional limitations of the right ankle, and right ankle pain, were noted.  The examiner opined that the Veteran's claimed right ankle condition was less likely than not etiologically related to his active duty service.  The rationale provided was there was no evidence of chronicity from service to present day.  The examiner did not provide an opinion on secondary service connection.

In this case, the Board must determine the value of all evidence submitted, including lay and medical evidence.  Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).  The evaluation of evidence generally involves a three-step inquiry.  First, the Board must determine whether the evidence comes from a "competent" source.  The Board must then determine if the evidence is credible, or worthy of belief.  Barr v. Nicholson, 21 Vet. App. 303 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible).  The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record.  

The Board also notes that under certain circumstances, lay evidence may be sufficient to establish a nexus.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994).  Lay evidence has been found to be competent with regard to a disease that has "unique and readily identifiable features" that are "capable of lay observation."  See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007); see also Petitti v. McDonald, 27 Vet. App. 415, 427-28 (2015) (where the United States Court of Appeals for Veterans Claims found objective evidence of pain need not come from a medical professional; a lay person may provide the requisite confirmation).

The Board has considered the evidence of record.  The Board notes that the May 2024 VA examiner provided a negative etiological opinion.  However, the VA examiner's opinion was for direct service connection and did not encompass secondary service connection.

Further, the Board notes that the March 2024 VA examiner noted a negative etiological opinion, but that negative opinion was specifically for whether the Veteran's left ankle caused the Veteran's right ankle condition.  Indeed, as explained above, in the examiner's rationale they ultimately provided a positive etiological opinion for the Veteran's right ankle as due to his service-connected lumbar spine.  The Board notes that the March 2024 VA examiner is a medical professional competent to opine as to the etiology of the Veteran's right ankle condition.  There is no evidence that the examiner is not credible.  Moreover, the examiner provided an analysis based upon both subjective and objective information to form an opinion based upon medical expertise.  

Given the evidence discussed above, the Board finds that the evidence of record is approximately evenly balanced as to whether the Veteran's right ankle pain condition is due to, or aggravated by, his service-connected lumbar spine condition.  The reasonable doubt created by this approximate balance must be resolved in favor of the Veteran.  As such, the third prong of secondary service connection is met.  See Wallin, 11 Vet. App. at 512.  

Accordingly, service connection for the Veteran's right ankle pain condition is granted as caused by the Veteran's service-connected lumbar spine disability.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.
 discussed above, the Board finds that the evidence of record is approximately evenly balanced as to whether the Veteran's right ankle pain condition is due to, or aggravated by, his service-connected lumbar spine condition.  The reasonable doubt created by this approximate balance must be resolved in favor of the Veteran.  As such, the third prong of secondary service connection is met.  See Wallin, 11 Vet. App. at 512.  

Accordingly, service connection for the Veteran's right ankle pain condition is granted as caused by the Veteran's service-connected lumbar spine disability.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

Right Ankle Scar-Analysis 

The Veteran seeks service connection for a right ankle scar disability.  However, for the reasons addressed below, the Board finds that he is not entitled to service connection for a right ankle scar condition.  As such, the claim is denied.

Initially, the Board notes that pain alone, even without an underlying pathology or diagnosis, can constitute a disability under VA law where such pain results in functional impairment.  Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).  Saunders is not limited to pain, such that a disability for VA purposes includes any condition that results in functional impairment of earning capacity.  Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020).  

The Board finds that the probative evidence of record does not document that the Veteran has any current diagnoses of any right ankle scar disabilities.  Further any symptoms experienced do not rise to compensable levels, result in impairment of functional capacity, or are compensated under other diagnostic codes.  As such, service connection is not warranted on direct, secondary, or presumptive bases for the claimed disabilities.  Martinez-Bodon, supra.

The Board has thoroughly reviewed the Veteran's medical records.  The Veteran's service treatment records (STRs) do not contain any complaints, treatment, or diagnoses for any right ankle scar conditions.  Further, the Veteran's VA treatment notes of record do not document any right ankle scar conditions.  The Board notes that the Veteran reported right ankle pain; however, the right ankle pain is not reported as being associated with any right ankle scars.  Additionally, the Veteran's right ankle pain has been service-connected above.

The Veteran was provided with a December 2015 VA Scars examination.  Here, while scars on the Veteran's left ankle were documented, no scars on the Veteran's right lower extremity were reported.  Additionally, a March 2024 VA Scars examination also documented no scars to the Veteran's right lower extremity.  Again, only scars on the Veteran's left ankle were reported.

A March 2024 VA Ankle Conditions examination documented residuals of scars on the Veteran's left ankle, but no right ankle scars were noted.  Again, a May 2024 VA Ankle Conditions examination documented no scars on the right ankle.

The Board has carefully considered the lay and medical evidence of record.  Based on the above, the Board does not find evidence of any current right ankle scar conditions at any time during the pendency of the appeal.  Additionally, the Board does not find that the Veteran experiences any compensable symptoms, or functional impairment, thereof.  The Board notes that the VA examiners of record are medical professionals, competent to opine as to the Veteran's claimed scars.  There is no evidence that the examiners are not credible. Moreover, the examiners provided their analyses based upon both subjective and objective information to form an opinion based upon medical expertise.

The Board has considered the Veteran's lay contentions and finds the lay statements are competent insofar as they report observable symptoms.  See Layno v. Brown, 6 Vet. App. 465, 469 (1994).  However, to the extent that the Veteran asserts that his claimed disability is related to his active service such statements are of no probative value, as the Veteran lacks the medical expertise to diagnose complex conditions or to render medical nexus opinions.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  Moreover, to the extent the Veteran asserts that he has any current conditions, such statements are inconsistent with the medical evidence of record that does not document any relevant diagnoses at any time during the pendency of the appeal.  See Caluza v. Brown, 7 Vet. App. 498, 506 (1995); see also Martinez-Bodon, supra. 

The evidence of record persuasively is against finding that the Veteran has any right ankle scar condition, or any functional impairment that is not
 medical expertise to diagnose complex conditions or to render medical nexus opinions.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  Moreover, to the extent the Veteran asserts that he has any current conditions, such statements are inconsistent with the medical evidence of record that does not document any relevant diagnoses at any time during the pendency of the appeal.  See Caluza v. Brown, 7 Vet. App. 498, 506 (1995); see also Martinez-Bodon, supra. 

The evidence of record persuasively is against finding that the Veteran has any right ankle scar condition, or any functional impairment that is not already being compensated by other diagnostic codes.  Accordingly, the evidence is persuasively against the claim.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a right ankle scar is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

A.	C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Gresham, Trevor

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.