ANKLE IMPAIRMENT OF

Summary

The Veteran, a U.S. Marine Corps Reserve Veteran who served with active duty for training periods between September 1971 and July 1973, appeals the denial of service connection for a left ankle disability manifested by pain. The Veteran asserts the condition began during service in 1971, though service treatment records are silent regarding left ankle complaints. Post-service records from 2005 noted ankle swelling, and a 2013 VA examination diagnosed bilateral ankle edema and flat feet. A November 2022 VA examination noted bilateral ankle pain since service, with mild left ankle pain during boot camp, causing difficulty with prolonged standing, walking, kneeling, and squatting. The examiner opined this pain was at least as likely as not secondary to the Veteran's service-connected right ankle condition, bilateral knee degenerative arthritis, and bilateral flat feet. The Board found the Veteran's current left ankle disability manifested by pain, causing functional impairment, was sufficiently shown, citing Saunders v. Wilkie. Although a February 2023 VA examiner found no pathology and attributed swelling to systemic disease, the Board found this opinion less persuasive than the November 2022 opinion, especially given the lack of imaging and the Veteran's credible testimony of pain causing functional limitations. The Board granted service connection for the left ankle disability manifested by pain, finding it warranted and not requiring further development.

Rationale

Current disability shown by pain causing functional impairment; November 2022 VA exam opinion links pain to service-connected conditions; Service treatment records silent, but post-service and later VA exams noted ankle issues

Full Decision Text

Citation Nr: 26003453
Decision Date: 03/17/26	Archive Date: 03/17/26

DOCKET NO. 16-52 904
DATE: March 17, 2026

ORDER

Entitlement to service connection for a left ankle disability manifested by pain is granted.

FINDING OF FACT

The Veteran is shown to have a left ankle disability manifested by pain that is proximately due to or aggravated by service-connected disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a left ankle disability manifested by pain have been met.  38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2024).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Marine Corps Reserve, including periods of active duty for training from September 1971 to March 1972, and in July 1972 and July 1973.  See DD Form 214; Personnel records, January 2021 at p.14 and 32 of 56.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision by the Regional Office (RO).

In April 2020 and March 2022, the Board remanded the claim for further development, and this matter is now returned to the Board for further appellate review.

Entitlement to service connection for a left ankle disability manifested by pain is granted.

The Veteran asserts that he has a left ankle disability manifested by pain and swelling that had its onset during his active service in 1971.  See Form 21-526EZ, April 2012.  

In light of the medical evidence of record, discussed in greater detail below, the Board will also address whether service connection is warranted as secondary to his service-connected right ankle condition, bilateral knee degenerative arthritis, and bilateral flat feet (pes planus) with hallux valgus.

His service treatment records are silent for any left ankle complaints or treatment.  A March 1972 examination report (release from active duty) and a July 1972 examination report (annual) shows examination of his lower extremities and musculoskeletal examination was normal.  See STR at p.18 and 34 of 48.  A July 1972 annual report of medical history shows he denied arthritis, bone, joint, or other deformity.  See STR at p.15 of 48.  

Post-service, his Social Security Administration (SSA) records show he reported experiencing ankle swelling since 2005 (but did not specify which ankle).  See SSA, July 2012 at p.75 of 148.  

A June 2013 VA examination report (general medical) shows the Veteran reported ankle swelling with prolonged standing, and bilateral ankle edema was diagnosed, as well as flat feet.

A November 2022 VA examination report shows the Veteran reported bilateral ankle pain since service.  For the left ankle, he reported the pain started during boot camp, but it was mild compared to the right ankle, and therefore he did not complain about it in service.  He reported the pain was sharp, aching, and intermittent in service.  He reported current difficulty with prolonged walking, standing, kneeling, and squatting.  He reported that flare-ups of the left ankle occur two to three times per week, they are moderate, last two to three hours, and are alleviated by rest and elevation.  The examiner estimated that during flare-ups, range of motion would be limited to 30 degrees of plantar flexion, and 15 degrees of dorsiflexion.  No imaging studies of the left ankle were performed.  The examiner opined that difficulty with prolonged walking, standing, kneeling, and squatting mildly to moderately affect the Veteran's ability to perform physical activities of employment.  The examiner opined that it is at least as likely as not that the left ankle pain is due to compensation for his right leg (knee), right ankle, and pes planus disabilities.  

As noted above, the Veteran is service connected for a right ankle condition, bilateral knee degenerative arthritis, and bilateral flat feet (pes planus) with hallux valgus.

The Board is mindful that although subjective pain in and of itself is not sufficient to establish a current disability, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it may constitute a disability.  Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain.  Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018).  In
 leg (knee), right ankle, and pes planus disabilities.  

As noted above, the Veteran is service connected for a right ankle condition, bilateral knee degenerative arthritis, and bilateral flat feet (pes planus) with hallux valgus.

The Board is mindful that although subjective pain in and of itself is not sufficient to establish a current disability, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it may constitute a disability.  Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain.  Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018).  In this case, the November 2022 VA examination report clearly shows that there is functional loss due to pain - difficulty with prolonged walking, standing, kneeling, and squatting mildly to moderately affect the Veteran's ability to perform physical activities of employment shown.  Therefore, the Board finds that a current left ankle disability manifested by pain is shown.

Because the Veteran is shown to have a current left ankle disability manifested by pain that causes functional impairment, and in light of the November 2022 VA examiner's opinion that it is caused by service-connected disability, the Board finds that entitlement to service connection for a left ankle disability manifested by pain is warranted, and the claim is granted.

The Board acknowledges that a February 2023 VA examiner opined that there was no pathology for a left ankle disability, and further opined that the edema or swelling found on examination back in 2013 was likely due to systemic disease, such as venous insufficiency, rather than an ankle disability.  As explained above, however, pathology is not required where there is pain that causes functional impairment.  Moreover, no imaging has ever been performed in connection with an examination of the left ankle.  The Board has considered whether a remand would be appropriate to obtain imaging.  Ultimately, however, because a current disability for VA compensation purposes is already sufficiently shown with pain that causes functional impairment, and because this appeal has been pending for nine years, the Board finds that a remand for imaging would only serve to unreasonably delay the delivery of benefits to this Veteran and is therefore unnecessary.  Also, where two VA medical opinions conflict as in the instant case, such that there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board must afford all reasonable doubt in the Veteran's favor.  See 38 U.S.C. § 5107(b).

In summary, the Board concludes that entitlement to service connection for a left ankle disability manifested by pain is warranted, and the claim is granted.

 

 

Paulette Vance Burton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Juliano, 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.