FOOT IMPAIRMENT OF

L. BARSTOW · 2022 · Case ID: 22037017

MIXED

Summary

The veteran, who served from December 1972 to September 1976, appeals the denial of service connection for a left foot disability, a right knee disability (including chondromalacia), and a right hip disability. The Board denied service connection for the left foot, finding the evidence persuasively weighed against a current disability, citing normal findings in service treatment records and a lack of functional impairment. The Board also denied service connection for the right knee, noting normal lower extremity findings in service treatment records and attributing post-service knee pain to automobile accidents rather than service. The Veteran's lay statements regarding the onset of knee pain were found not credible due to inconsistencies with contemporaneous medical records. Service connection for the right hip was also denied, as service records showed normal lower extremities and no in-service complaints, with post-service hip pain attributed to motor vehicle accidents and general degenerative changes occurring decades after service. The Board found no nexus between the claimed hip disability and service. The claim for a left hip disability was remanded for a new VA examination to determine the nature, extent, and etiology of the claimed disability, as the existing private nexus opinion was deemed inadequate for failing to address service records and the Veteran's own statements about in-service hip pain and subsequent compensation.

Rationale

Evidence persuasively weighs against current disability; Service treatment records show normal findings; Lay statements regarding etiology found nonprobative

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-65 350

Full Decision Text

Citation Nr: 22037017
Decision Date: 06/28/22 Archive Date: 06/28/22

DOCKET NO. 17-65 350
DATE: June 28, 2022

ORDER

Entitlement to service connection for a left foot disability, and as secondary to service-connected disability, is denied.

Entitlement to service connection for a right knee disability, to include chondromalacia, and as secondary to service-connected disability, is denied.

Entitlement to service connection for a right hip disability, to include right hip joint degeneration, and as secondary to service-connected disability, is denied.

REMANDED

Entitlement to service connection for a left hip disability, and as secondary to service-connected disability, is remanded.

FINDINGS OF FACT

1. The evidence is persuasively against a finding that the Veteran has a current left foot disability.

2. The Veteran's right knee disability did not have its onset in service and is not otherwise related to service, to include as caused or aggravated by service-connected disability.

3. The Veteran's right hip disability did not have its onset in service and is not otherwise related to service, to include as caused or aggravated by service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a left foot disability, to include as secondary to service-connected disability, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.310.

2. The criteria for entitlement to service connection for a right knee disability, to include as secondary to service-connected disability, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.310.

3. The criteria for entitlement to service connection for a right hip disability, to include as secondary to service-connected disability, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served from December 1972 to September 1976.

In the Veteran's November 2017 Form 9, he requested a hearing before the Board of Veterans' Appeals (Board). In a September 2019 statement, the Veteran requested a videoconference hearing before the Veterans Law Judge. In a May 2021 statement, the Veteran's attorney waived his request for a hearing for all pending appeals before the Board and requested a continuance for 120 days. Thus, Board will now consider the Veteran's claims on the merits.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 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. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).

Service connection may also be granted on a secondary basis for a current disability which is proximately due to or the result of a service-connected disability. Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the
more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).

The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran's claim on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein.

As a preliminary matter, the Veteran contends that his disabilities are secondary to his right foot/ankle disability, to include right foot drop and ankle strain. A June 2014 VA treatment record showed that the examiner assessed the chronic right foot drop caused pain in the right knee, left knee, and right hip. However, the Board previously denied service connection for right foot disability. Additionally, the Veteran is only service connected for a left ankle disability. He has not contended that his left foot, right knee and right hip disabilities are secondary to his service-connected left ankle disability. Thus, the Board will evaluate the Veteran's claims for entitlement to service connection under other theories of service connection.

1. Entitlement to service connection for a left foot disability

The Veteran contends that his left foot disability had its onset during service or is otherwise related to service. In an October 2016 statement, the Veteran said because of his foot drop, he is using his left leg more, which causes knee and left ankle pain. He also said he is losing strength in his left ankle (foot).

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for a left foot disability. The reasons follow.

As to evidence of a current disability, the evidence is persuasively against such a finding. For example, the August 2017 VA examination shows that the Veteran had normal motor strength of left foot including toes. Additionally, the Veteran had normal superficial sensation and deep tendon reflexes of the left foot. The Board finds the diagnostic findings within the August 2017 VA examination report is probative evidence against a finding that the Veteran has a current left foot disability. Treatment records during this appeal period also fail to show a diagnosis of a left foot disability.

The Board is mindful of Saunders v. Wilkie, 886 F.3d 1356 (2018), in which the U.S. Court of Appeals for the Federal Circuit explained that where pain alone results in functional impairment that affects earning capacity, even if there is no identified underlying diagnosis, can constitute a disability. The Veteran does not contend that that he has had functional impairment affecting his earning capacity related to a left foot disability, and the evidence of record does not show that he has had such functional impairment. The VA examination report and VA treatment records reflects that the Veteran did not report left foot pain that impacts functional impairment of the left foot. Thus, even considering the holding in Saunders, the Board finds the evidence persuasively is against a finding that the Veteran has a current disability that causes functional impairment of earning capacity.

While the Veteran believes he has a left foot disability that had its onset in service or is otherwise related to service or a service-connected disability, he is not competent to offer opinions as to the etiology of a left foot disability, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. At the present time, there is no competent evidence of a current disability or a nexus between a left foot disability and service or a service-connected disability to weigh against the negative VA examination.

The Veteran submitted a statement from his cousin, D.C., in May 2021. D.C. said that she remembered hearing from family that the Veteran had hurt his feet and ankles while he was in service. She said that she did not recall exactly how it happened as this was several decades ago. She said his physical problems
an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. At the present time, there is no competent evidence of a current disability or a nexus between a left foot disability and service or a service-connected disability to weigh against the negative VA examination.

The Veteran submitted a statement from his cousin, D.C., in May 2021. D.C. said that she remembered hearing from family that the Veteran had hurt his feet and ankles while he was in service. She said that she did not recall exactly how it happened as this was several decades ago. She said his physical problems have worsened and he continues to have headaches, insomnia, as well as problems with his feet, ankles, legs, and back. However, the Board finds that what is documented in the VA examination is more credible than a statement written decades after service discharge while the Veteran is seeking compensation benefits.

Without evidence of a current left foot disability, entitlement to direct and secondary service connection is not warranted.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for a left foot disability is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

2. Entitlement to service connection for a right knee disability

The Veteran asserts that his right knee disability is related to his service. In an October 2016 statement, the Veteran said because of his right foot drop, he was using his left leg more which caused his knee and left ankle pain. In a December 2021 statement, the Veteran said he cannot stand long enough because of his ankles, back, and knees.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for a right knee disability. The reasons follow.

As to evidence of a current disability, an April 2010 private treatment record showed that the examiner felt the Veteran's right knee was chondromalacia. Thus, the first element of a service-connection claim is met.

As to evidence of an in-service disease or injury, the service treatment records do not show the Veteran was treated or diagnosed with a right knee disease or injury in service. For example, in the June 1972 Report of Medical Examination, the Veteran was found to be clinically normal in all areas. The August 1976 Report of Medical Examination shows that the Veteran was found normal in most areas, including lower extremities. At this time, the Veteran was assigned a PULHES rating of "1" for the lower extremities. An individual having a numerical designation of "1" under this factor is deemed to have bones, muscles, and joints that are normal, and is capable of performing long marches, continuous standing, running, climbing, and digging without limitation. The designation of "1" indicates a high level of fitness. This shows that the Veteran was found to be clinically normal with a high level of fitness in his lower extremities. Additionally, the August 1976 Report of Medical History shows that the Veteran reported he was in good health. He specifically denied having or ever having arthritis, rheumatism, or bursitis; lameness; bone, joint, or other deformity; or a "trick" or locked knee.

The Board finds that the service treatment records, which documentation was created contemporaneously with the time period in question, are more probative than statements made decades after service. In light of the foregoing, the Board finds the evidence persuasively is against a finding of complaints or symptoms related to a right knee disability during service, and the in-service disease or injury element is not met.

Furthermore, the evidence persuasively weighs against a nexus between a right knee disability and service. Post-service treatment records show that the Veteran attributed his right knee pain to a post-service automobile accident and not to an in-service event or illness. For instance, Veteran filed for Social Security disability indicating that he first had knee problems, among other ailments in February 2000, and he became unable to work in October 2003. He later updated his Social Security disability records to indicate he had knee problems from car accidents in 2004 and 2005. A March 2005 VA treatment record shows that the Veteran reported right knee pain. He reported that he had a car accident in October 2004 that impacted his right knee. A separate March 2005 VA
asively weighs against a nexus between a right knee disability and service. Post-service treatment records show that the Veteran attributed his right knee pain to a post-service automobile accident and not to an in-service event or illness. For instance, Veteran filed for Social Security disability indicating that he first had knee problems, among other ailments in February 2000, and he became unable to work in October 2003. He later updated his Social Security disability records to indicate he had knee problems from car accidents in 2004 and 2005. A March 2005 VA treatment record shows that the Veteran reported right knee pain. He reported that he had a car accident in October 2004 that impacted his right knee. A separate March 2005 VA treatment record showed that the Veteran related the onset of his knee pain to an automobile accident in October 2004. He also had an injury to the knee many years ago playing baseball. He said he hyper-extended it and that it swelled tremendously at that time. He has had no locking or swelling in the recent past. He had an MRI done locally since the automobile accident that demonstrates a torn medial meniscus. In July 2008, the Veteran reported that he has had bilateral knee and back pain since a 2003 motor vehicle accident. A February 2010 private treatment record shows that the Veteran reported having knee pain bilaterally dating back to a motor vehicle accident in 2001. A February 2019 VA record notes the Veteran had a right knee injury and arthroscopy of the right knee due to a 2004 motor vehicle accident.

In a July 2018 statement, the Veteran said it was his contention that he did not suffer any injury from the vehicle accident that occurred in 2004. However, this statement is inconsistent with what the Veteran reported at the time he was seeking medical treatment between 2005 and afterwards. The Board finds that the July 2018 statement regarding the onset of his pain is not credible. The Veteran's statements between 2005 and 2010 were made within the context of a medical evaluation, and the Veteran would have been motivated to provide accurate information to medical treatment providers. His statements to the examiners that his right knee was bothering him after motor vehicle accidents is consistent with what is documented within the post-service treatment records, which show complaints for multiple medical symptoms. Therefore, the Board finds that the facts reported at the time of the post-service treatment records to be more reliable and are, therefore, credible. Accordingly, the Veteran's lay statements that he did not sustain an injury to his right knee following the post-service motor vehicle accident is not credible.

Instead, the Board affords more probative value to the facts documented within the Veteran's service treatment records, VA treatment records, and private treatment records, as those records were created contemporaneously with the relevant time period. These records were made within the context of seeking medical treatment, which are the types of records deemed to be highly reliable, as the Veteran would be motivated to provide the most accurate information to medical treatment providers. The fact that he reported his right knee disability to post-service motor vehicle accidents is evidence against the Veteran having a right knee disability related to service.

The Veteran was not afforded a VA examination in connection with the claim for service connection for right knee disability. The Board finds that the facts of this case do not establish entitlement to a VA examination or medical opinion. For example, VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the Board finds as fact that the record does not show evidence establishing that an event, injury, or disease related to right knee disability occurred in service, which is explained above. For a VA examination to be warranted, all the criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for the claim for service connection for right knee disability.

While the Veteran believes that the right knee disability is related to service or a service-connected disability, he is not competent to attribute the right knee disability to service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion is nonprobative evidence
. For a VA examination to be warranted, all the criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for the claim for service connection for right knee disability.

While the Veteran believes that the right knee disability is related to service or a service-connected disability, he is not competent to attribute the right knee disability to service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion is nonprobative evidence. At the present time, there is no competent evidence of a nexus between the Veteran's right knee disability and service or a service-connected disability, and the nexus element of a service-connection claim is not met.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for a right knee disability, to include chondromalacia, is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch, 21 F.4th 776.

3. Entitlement to service connection for a right hip disability

The Veteran contends that his right hip disability had its onset during service or is otherwise related to service. In his December 2017 VA Form 9, the Veteran stated that his hip pain increased because he had to compensate for the right foot drop.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for a right hip disability. The reasons follow.

As to evidence of a current disability, a June 2018 VA medical treatment record showed that there was right hip joint degeneration, with acetabular subchondral signal changes and joint chondropathy. Thus, the first element of a service-connection claim is met.

As to evidence of an in-service disease or injury, the service treatment records do not show the Veteran was treated or diagnosed with a right hip disease or injury in service. For example, in the June 1972 Report of Medical Examination, the Veteran was found to be clinically normal in all areas. The August 1976 Report of Medical Examination shows that the Veteran was found normal in most areas, including lower extremities. At this time, the Veteran was assigned a PULHES rating of "1" for the lower extremities, indicating a high level of fitness. This shows that the Veteran was found to be clinically normal with a high level of fitness in his lower extremities. Additionally, the August 1976 Report of Medical History shows that the Veteran reported he was in good health. He specifically denied having or ever having arthritis, rheumatism, or bursitis; lameness; or bone, joint, or other deformity.

The Board finds that the service treatment records, which documentation was created contemporaneously with the time period in question, are more probative than statements made decades after service. In light of the foregoing, the Board finds the evidence persuasively is against a finding of complaints or symptoms related to a right hip disability during service, and the in-service disease or injury element is not met.

Furthermore, the evidence persuasively weighs against a nexus between a right hip disability and service. Post-service treatment records show that in November 2001, the Veteran's musculoskeletal system examination had no unusual joint pain, extremity immobility, or loss of function. An August 2008 private medical treatment record showed that the Veteran's range of motion of all joints was full and normal. The first documented complaint of hip pain was in February 2010, where the Veteran reported pain with standing and walking in both hips, low back, and left knee, which is more than 30 years after service discharge and does not lend to a finding of a right hip disability having its onset during service.

The Board affords more probative value to the facts documented within the Veteran's service treatment records, VA treatment records, and private treatment records, as those records were created contemporaneously with the relevant time period. These records were made within the context of seeking medical treatment, which are the types of records deemed to be highly reliable, as the Veteran would be motivated to provide the most accurate information to medical treatment providers. The fact that he did not report right hip pain is evidence against the Veteran having an in-service disease or injury involving the right hip and continuing symptoms after service.

The Veteran was not afforded a VA examination in connection with the claim for service connection for right hip disability. The Board finds that the facts of this case do not establish entitlement to a
Board affords more probative value to the facts documented within the Veteran's service treatment records, VA treatment records, and private treatment records, as those records were created contemporaneously with the relevant time period. These records were made within the context of seeking medical treatment, which are the types of records deemed to be highly reliable, as the Veteran would be motivated to provide the most accurate information to medical treatment providers. The fact that he did not report right hip pain is evidence against the Veteran having an in-service disease or injury involving the right hip and continuing symptoms after service.

The Veteran was not afforded a VA examination in connection with the claim for service connection for right hip disability. The Board finds that the facts of this case do not establish entitlement to a VA examination or medical opinion. For example, VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon, 20 Vet. App. 79. In this case, the Board finds as fact that the record does not show evidence establishing that an event, injury, or disease related to right knee disability occurred in service, which is explained above. For a VA examination to be warranted, all the criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for the claim for service connection for right hip disability.

While the Veteran believes that the right hip disability is related to service or a service-connected disability, he is not competent to attribute the right hip disability to service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion is nonprobative evidence. At the present time, there is no competent evidence of a nexus between the Veteran's right hip disability and service or a service-connected disability, and the nexus element of a service-connection claim is not met.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for a right hip disability, to include right hip joint degeneration, is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch, 21 F.4th 776.

REASONS FOR REMAND

1. Entitlement to service connection for a left hip disability

A review of the Veteran's service treatment records show that the Veteran complained of left hip pain during service, but he was not provided a VA examination related to the left hip. The Board finds that given the low threshold of an indication that the current disability or symptoms may be associated with service, there is insufficient competent medical evidence on file for VA to make a decision on the claim. McLendon, 20 Vet. App. 79. As such, the Board concludes that a remand is needed to afford the Veteran a VA examination to determine whether the Veteran's current left hip disability had its onset during service or is otherwise related to service.

The Board notes that the Veteran submitted a nexus opinion in May 2015. However, the Board finds the private nexus opinion to be inadequate, as the examiner did not address the Veteran's separation Report of Medical History, where the Veteran specifically denied having arthritis, rheumatism, or bursitis; or bone, joint, or other deformity. Additionally, the examiner did not address the August 1976 Report of Medical Examination, which showed the Veteran was found clinically normal in the lower extremities. The examiner also did not discuss if the Veteran's left hip injury from 1973 is the same as the current left hip disability.

In remanding this issue, the Board makes no credibility determination, expressed or implied, at this juncture.

The matter is REMANDED for the following action:

1. Schedule the Veteran for a VA examination for the claimed left hip disability, to determine the nature, extent, and etiology of the claimed disability. A copy of this remand should be provided to the VA examiner. The examiner is asked to review the record. Any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. The agency of original jurisdiction (AOJ) is asked to provide a copy of the below facts to the examiner.

To assist in a review of the
1973 is the same as the current left hip disability.

In remanding this issue, the Board makes no credibility determination, expressed or implied, at this juncture.

The matter is REMANDED for the following action:

To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, when applicable:

The Veteran served from December 1972 to September 1976.

The Veteran is only service-connected for a left ankle disability.

The June 1972 Report of Medical History showed that the Veteran denied having arthritis, rheumatism, or bursitis; bone, joint, or other deformity; or lameness. See VBMS entry type, "STR Medical," receipt date 07/01/2014, pp. 83-85.

The accompanying June 1972 Report of Medical Examination showed that the Veteran was found to be clinically normal in all areas. See VBMS entry type, "STR Medical," receipt date 07/01/2014, p. 86-88.

A September 1973 service treatment record showed that the Veteran complained of pain to the left hip. Upon examination, it was noted that the Veteran had pain in adductors. See VBMS entry type, "STR Medical," receipt date 07/01/2014, p. 22.

The Veteran was seen again in October 1973 for pain in his left hip. See VBMS entry type, "STR Medical," receipt date 07/01/2014, p. 22.

The August 1976 Report of Medical Examination shows that the Veteran was found normal in most areas, including lower extremities. At this time, the Veteran was assigned a PULHES rating of "1" for the lower extremities, indicating a high level of fitness. This shows that the Veteran was found to be clinically normal with a high level of fitness in his lower extremities. See VBMS entry type, "STR Medical," receipt date 07/01/2014, pp. 30-32.

The August 1976 Report of Medical History shows that the Veteran reported he was in good health. He specifically denied having or ever having arthritis, rheumatism, or bursitis; lameness; or bone, joint, or other deformity. See VBMS entry type, "STR Medical," receipt date 07/01/2014, p. 35-36.

A February 2010 private treatment record shows that the Veteran complained of pain in his hips, low back, and left knee while standing and walking. See VBMS entry type, "Medical Treatment Record Non-Governmental Facility," receipt date 02/26/2010, p. 1.

The Veteran submitted a nexus opinion in May 2015. The examiner concluded that the Veteran's left hip disability was most likely caused by or a result of service. The examiner noted problems with the left hip and left ankle injury and pain while in the miliary. See VBMS entry type, "Medical Treatment Record Non-Governmental Facility," receipt date 06/04/2015, p. 1.

The Board found the May 2015 private opinion inadequate.

In the December 2017 VA Form 9, the Veteran stated that his hip pain increased because he had to compensate for the right foot drop. See VBMS entry type, "Form 9," receipt date 12/08/2017, p. 1.

A June 2018 VA medical treatment records notes the Veteran complained of left hip to ankle and back pain. X-rays showed on the frontal view of the pelvis, the left hip is intact with mild degenerative changes along the left hip joint. See VBMS entry type, "CAPRI," receipt date 02/12/2019, pp. 55-56.

A February 2019 VA treatment record show the Veteran complained of continued right knee and left hip pain. See VBMS entry type, "CAPRI," receipt date 02/12/2019, p. 3.

In a December 2021 statement, the Veteran said he cannot stand long enough because of his ankles, back, and knees. See VBMS entry type, "Other," receipt date 12/16/2021, pp. 3-4.

The examiner's review
of the pelvis, the left hip is intact with mild degenerative changes along the left hip joint. See VBMS entry type, "CAPRI," receipt date 02/12/2019, pp. 55-56.

A February 2019 VA treatment record show the Veteran complained of continued right knee and left hip pain. See VBMS entry type, "CAPRI," receipt date 02/12/2019, p. 3.

In a December 2021 statement, the Veteran said he cannot stand long enough because of his ankles, back, and knees. See VBMS entry type, "Other," receipt date 12/16/2021, pp. 3-4.

The examiner's review of the record is NOT restricted to the evidence listed above. This list is provided to assist the examiner in locating potentially relevant evidence.

Following a review of the complete claims file, including, but not limited to the evidence discussed above, the examiner is asked to opine:

Does the Veteran have a current left hip disability that had its onset during active service from December 1972 to September 1976; is otherwise related to active service, to include Veteran's in-service left hip pain in September 1973; or is caused or aggravated by the service-connected left ankle disability? Please explain upon what facts, medical principles, and/or medical literature the opinion is based.

A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question.

L. BARSTOW

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board N. Griffin, Associate 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.

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