ANKLE IMPAIRMENT OF

Summary

The veteran, who served from November 1984 to September 1990, with subsequent National Guard service, appeals the denial of service connection for a back condition and the grant of service connection for left ankle arthritis. The Board found the evidence sufficient to grant service connection for left ankle arthritis on a presumptive basis. The veteran has a current diagnosis of left ankle arthritis, with service treatment records showing treatment for ankle pain and swelling following an in-service injury. The veteran credibly stated that symptoms began in service and have persisted, with continuous self-treatment and VA treatment for ankle pain since separation. The Board found the July 2024 VA ankle examination and May 1989 service treatment records to be probative, establishing continuity of symptomatology. For the back condition, the veteran claimed it was related to strenuous MOS duties and in-service injuries, asserting he was discouraged from seeking care. However, the Board found the evidence persuasively weighed against service connection. While the veteran has a current back disability and reported in-service back pain, service treatment records from 1990, 1995, 1999, and 2004 were negative for back abnormalities, and the veteran denied back problems at separation. A February 2026 VA negative nexus opinion concluded the current disability was likely due to post-service stress and aging, not an in-service strain, and found the veteran's statements about symptom onset decades later not credible in light of the negative service records and lack of in-service structural compromise. The Board afforded the February 2026 opinion great probative weight, denying service connection for the back condition.

Rationale

Presumptive service connection for chronic disease; Continuity of symptomatology from service to present; Credible lay statements regarding in-service injury and persistent symptoms

Full Decision Text

Citation Nr: 26004944
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 20-10 011
DATE: April 24, 2026

ORDER

Service connection for left ankle arthritis is granted.

Service connection for a back condition is denied.

FINDINGS OF FACT

1. The Veteran has experienced ankle pain related to left ankle arthritis since separation from service.

2. The evidence of record persuasively weighs against finding that any current back condition began during active service or is otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left ankle arthritis are met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for a back condition are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1984 to September 1990, with additional periods of National Guard service.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office, which is the agency of original jurisdiction (AOJ).  In June 2024, the Board remanded the claims of entitlement to service connection for a back disability and a left ankle disability for development.  The Board then remanded the claims again in June 2025 for additional development.  Regrettably, an additional remand was required in February 2026 for the AOJ to obtain adequate opinions regarding direct service connection for each claim.  The AOJ obtained a nexus opinion regarding each claim in February 2026.  These nexus opinions were adequate with regard to the claims for service connection for a left ankle condition and back condition because they were based upon consideration of the Veteran's pertinent medical history as well as lay assertions and current complaints, and they contained adequate rationale to allow the Board to make fully informed determinations.  The Board therefore finds that the AOJ has substantially complied with all previous remand directives.  See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999).

The Veteran was afforded a VA examination in connection with the claim for service connection for a back condition in January 2020.  That examination is adequate with regard to the claim because it was based upon consideration of the Veteran's pertinent medical history as well as lay assertions and current complaints, and because it describes his back disability symptoms in detail sufficient to allow the Board to make fully informed determinations.  Barr v. Nicholson, 21 Vet. App. 303 (2007) (citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994)).

Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.  Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service.  38 C.F.R. § 3.303(d).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Presumptive service connection is another pathway to entitlement.  Certain chronic diseases, including arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38?U.S.C. §§?1101, 1112, 1113, 1137; 38?
 or injury.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Presumptive service connection is another pathway to entitlement.  Certain chronic diseases, including arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38?U.S.C. §§?1101, 1112, 1113, 1137; 38?C.F.R. §§?3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 

Arthritis is a chronic disease under 38?C.F.R. §?3.309(a).  As such, the presumptive service connection provisions under 38?C.F.R. §?3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable to the question of service connection for these claims.  Walker, 708 F.3d at 1338. 

With a chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes.  For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time.  If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection.? 38?C.F.R. §?3.303(b). 

The benefit of the doubt rule provides that an appellant will prevail in a case where the positive evidence is in approximate balance with the negative evidence.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  It is only when the weight of the evidence is persuasively against the claim that the claim must be denied.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Service connection for left ankle arthritis is granted.

The Veteran and his attorney assert that his current left ankle disability is related to injuries in service, including an injury in a softball game.  See February 2019 Notice of Disagreement.  The Veteran further asserts that his ankle pain began with an injury on active duty and has continued since that time.  See July 2024 VA ankle examination.

Because the issue of presumptive service connection for a chronic disease is dispositive, the Board need not reach the issue of direct service connection.

The Veteran has a current diagnosis of left ankle arthritis as evidenced by the July 2024 VA ankle examination.  The July 2024 VA examiner noted that pain was a symptom of the Veteran's left ankle arthritis.

Service treatment records show the Veteran was treated for symptoms of left ankle pain and swelling following an injury on active duty.  See May 1989 service treatment records.  The Veteran competently and credibly stated that he was generally discouraged from seeking medical care on active duty and that when he did so his superiors accused him of attempting to shirk his duties, causing him to avoid or delay care.  See March 2020 Form 9.

While no treatment records are associated with the file from during the applicable presumptive period, the Veteran competently and credibly stated that the symptoms of his left ankle arthritis, including left ankle pain and recurrent further injuries, began for the first time on active duty in the 1980s with an injury and have persisted since that time.  See July 2024 VA ankle examination.  The Veteran further stated that he has self-treated for his recurrent ankle pain continuously since his separation from service and that he has been seen by a VA provider for ankle pain.  See id.  VA treatment records reveal the Veteran has been treated for ankle pain.  See August 2018, September 2020, September 2022, September 2023, and December 2024 VA treatment records.  The Board therefore finds that the Veteran continued to experience the same symptoms of ankle pain from discharge to the present.  The Veteran's statement is credible and entitled to probative weight, as it is internally consistent and consistent with other evidence, including May 1989 treatment records showing treatment for ankle pain after an injury in the 1980s.

There is no medical opinion of record addressing the issue of presum
 since his separation from service and that he has been seen by a VA provider for ankle pain.  See id.  VA treatment records reveal the Veteran has been treated for ankle pain.  See August 2018, September 2020, September 2022, September 2023, and December 2024 VA treatment records.  The Board therefore finds that the Veteran continued to experience the same symptoms of ankle pain from discharge to the present.  The Veteran's statement is credible and entitled to probative weight, as it is internally consistent and consistent with other evidence, including May 1989 treatment records showing treatment for ankle pain after an injury in the 1980s.

There is no medical opinion of record addressing the issue of presumptive service connection.  

The Board is thus left with the adequate, probative history as documented in the July 2024 VA ankle examination that the Veteran has experienced continuous left ankle pain?since service, culminating in the formal diagnosis of left ankle arthritis.  

For the above reasons, the evidence is sufficient to decide the claim, as it persuasively demonstrates that the Veteran's left ankle pain, which is attributable to his left ankle arthritis disability, began prior to discharge and have continued since that time.  See, e.g., July 2024 VA headaches examination; May 1989 service treatment records.  Therefore, service connection for left ankle arthritis is warranted on a presumptive basis. ?38 C.F.R. § 3.102, 3.303, 3.309(a).  

2. Service connection for a back condition is denied.

The Veteran and his attorney assert that his current back disability is related to climbing and carrying heavy equipment on active duty.  See February 2019 Notice of Disagreement.  They further assert that his current back disability is related to duties of his military occupational specialty (MOS), such as setting up and tearing down communications systems and performing heavy lifting.  See March 2020 Form 9 and May 2025 brief.  They also assert that he was discouraged from seeking medical care on active duty.  See March 2020 Form 9.

The question for the Board is whether the Veteran has a current disability that began during service or is related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of a low back disability, and evidence shows that the Veteran performed strenuous duties and complained of back pain on active duty, the evidence of record persuasively weighs against finding that any current back disability began during service or is otherwise related to an in-service injury, event, or disease.  See October 1986 service treatment records; January 2020 VA back examination.

The Veteran initially complained of back pain to his VA treatment providers in August 2018 and was not diagnosed with lumbosacral strain until the January 2020 VA back examination, both of which occurred decades after separation from service.  While the Veteran is competent to report having experienced symptoms of back pain since service, the Veteran is not competent to provide a diagnosis in this case or to determine that these symptoms were manifestations of lumbosacral strain or another particular back disability.  The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). 

Reports of Medical Examination in January 1990, March 1995, November 1999, and May 2004 were negative for abnormalities of the back or spine.  See January 1990, March 1995, November 1999, and May 20024 service treatment records.  The Veteran denied back problems at the time of his separation from active duty.  See January 1990 Report of Medical History.  These standardized examinations were based on physical examinations as well as his reports of medical history, and the Board therefore affords them significant probative weight.

The Veteran was afforded a VA back examination in January 2020, along with VA nexus opinions in January 2020, July 2024, August 2025, and February 2026.  The Board has previously found the January 2020, July 2024, and August 2025 VA negative nexus opinions inadequate and cannot afford them any probative weight.

At the January 2020 VA examination, the Veteran reported that his current back symptoms began in the mid-1990s, years after separation from active duty.  The Veteran is competent to report his observable symptoms and their history, and his reports are credible.  Jandreau, 492 F.3d at 1377 n.4 (Fed. Cir. 2007).  The Board therefore affords the Veteran's statements that his
 in January 2020, July 2024, August 2025, and February 2026.  The Board has previously found the January 2020, July 2024, and August 2025 VA negative nexus opinions inadequate and cannot afford them any probative weight.

At the January 2020 VA examination, the Veteran reported that his current back symptoms began in the mid-1990s, years after separation from active duty.  The Veteran is competent to report his observable symptoms and their history, and his reports are credible.  Jandreau, 492 F.3d at 1377 n.4 (Fed. Cir. 2007).  The Board therefore affords the Veteran's statements that his current symptoms began years after active duty significant probative weight.

Turning to the February 2026 VA negative nexus opinion, the February 2026 VA clinician opined that the Veteran's current back disability is not related to an in-service injury, event, or disease, including heavy lifting and other duties as a communication systems operator or signal operator.  The rationale was that the Veteran's mechanical back pain in service represents an acute, self-limited strain because there is no indication that it resulted in persistent functional limitation, recurrent evaluation, or structural evaluation, and that the Veteran denied recurrent back pain at his January 1990 separation examination and again at a May 2004 military examination.  The February 2026 VA clinician further opined that the Veteran's current back disability is likely due to cumulative post-service biomechanical stress and aging rather than a resolved in-service mechanical strain.  The February 2026 VA clinician stated that while heavy lifting during military service can cause transient strain, a temporary muscular strain does not biologically evolve decades later into a persistent chronic condition without evidence of ongoing structural compromise and that a single documented 1986 episode of back pain is consistent with an acute strain event rather than the onset of a chronic spine disorder.  The February 2026 VA negative nexus opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  It also contains detailed and clear explanations of the clinician's reasoning.  The February 2026 VA clinician adequately considered and addressed the Veteran's lay statements, as well as the medical evidence of record.  The Board therefore affords the February 2026 VA negative nexus opinion great probative weight. 

The Board explicitly acknowledges the Veteran's credible assertions that as part of his MOS duties as a communication systems operator he climbed on communication equipment, carried heavy loads, set up and tore down communications equipment, and was discouraged from seeking medical treatment.  See Department of Defense Form 214, February 2019 Notice of Disagreement, September 2019 Notice of Disagreement, March 2020 Form 9, and May 2025 brief.  The Veteran and his attorney believe the claimed back disability is related to an in-service injury, event, or disease, including performance of his MOS duties.  However, the Veteran and his attorney in this case are not competent to provide a nexus opinion regarding this issue.  The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing, as well as knowledge of how physical activity and aging impact the body, and inquiry into biological processes, pathology, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable.  Therefore, providing a medical opinion is outside the competence of the Veteran and his attorney in this case because the record does not show that either of them has the medical training or credentials to make such a determination.  Jandreau, 492 F.3d at 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).  Consequently, the Board gives more probative weight to the February 2026 VA medical opinion and other medical evidence of record than to the Veteran and his attorney's lay contentions.

The Board finds that the most probative evidence of record, including the February 2026 VA medical opinion; the Veteran's own statements at the January 2020 VA back examination; and the January 1990, March 1995, November 1999, and May 2004 Reports of Medical Examination, persuasively weighs against finding that the Veteran's current back condition began during active service or is otherwise related to an in-service injury or disease.  Because the evidence weighs persuasively against the claim, the benefit of the doubt rule does not apply.  Lynch, 21 F.4th 776.

 

D. Martz Ames

Veterans Law Judge

Board of Veterans