ANKLE IMPAIRMENT OF

Summary

The veteran, who served in the Army and Air Force intermittently between 1984 and 2006, appeals the denial of service connection for bilateral ankle and foot strains. The veteran claims these conditions are secondary to other service-connected disabilities and that their onset occurred during service, exacerbated by military rigors. Service treatment records from a 1984 fall documented pain proximal to the left tibia, and the veteran consistently reported pain in her back, hips, knees, and ankles since that injury, exacerbated by military activities. While VA examinations in 2016, 2022, and 2025 provided negative nexus opinions, citing lack of objective findings or chronicity, the Board found these opinions inadequate for failing to consider functional impairment under Saunders v. Wilkie, the veteran's reports of pain, or the possibility of resolved conditions. The Board found the veteran competent and credible to report the onset and persistence of bilateral ankle and foot pain during and since service, though not competent to opine on etiology. Given the history of inadequate VA opinions and the veteran's credible lay statements, the Board applied the benefit of the doubt, finding direct service connection for bilateral ankle and foot strains.

Rationale

Veteran's lay statements regarding onset and persistence of pain during and after service found credible.; Benefit of the doubt applied due to inadequate VA medical opinions and credible lay evidence.; Direct service connection established based on continuity of symptomatology.

Full Decision Text

Citation Nr: 26005010
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 18-30 067
DATE: April 28, 2026

ORDER

Service connection for a left ankle strain is granted. 

Service connection for a right ankle strain is granted. 

Service connection for a left foot strain is granted. 

Service connection for a right foot strain is granted. 

FINDINGS OF FACT

1. The Veteran's left ankle pain began during active service and has been chronic and continuous since that time.

2. The Veteran's right ankle pain began during active service and has been chronic and continuous since that time.

3. The Veteran's left foot pain began during active service and has been chronic and continuous since that time. 

4. The Veteran's right foot pain began during active service and has been chronic and continuous since that time. 

CONCLUSIONS OF LAW

1. The criteria for service connection for a left ankle strain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 

2. The criteria for service connection for a right ankle strain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 

3. The criteria for service connection for a left foot strain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 

4. The criteria for service connection for a right foot strain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1984 to September 1989, January 2004 to December 2004, June 2005 to August 2005, and March 2006 to September 2006. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 2016 and March 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office. This matter has been remanded several times by the Board, most recently in August 2025. 

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Where a veteran served continuously for 90 days or more during active service, service connection for certain chronic diseases, including arthritis-related diseases, may also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service.  38 C.F.R. § 3.307(a).  

Furthermore, if evidence of a chronic disability is shown in service or during the presumptive period, but is later diagnosed, such disability may still be service connected based on continuity of symptomatology. In this regard, evidence of a chronic disease shown either in service (or within an applicable presumptive period under 38 C.F.R. § 3.307, usually one year) and with chronic and continuous manifestations either beginning in service or since discharge from service, may permit service connection on the basis of continuity of symptomatology, unless otherwise attributable to an intercurrent cause. See 38 C.F.R. § 3.303(b). The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology, however, can be applied only in cases involving those conditions explicitly enumerated under
 presumptive period, but is later diagnosed, such disability may still be service connected based on continuity of symptomatology. In this regard, evidence of a chronic disease shown either in service (or within an applicable presumptive period under 38 C.F.R. § 3.307, usually one year) and with chronic and continuous manifestations either beginning in service or since discharge from service, may permit service connection on the basis of continuity of symptomatology, unless otherwise attributable to an intercurrent cause. See 38 C.F.R. § 3.303(b). The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology, however, can be applied only in cases involving those conditions explicitly enumerated under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

The Veteran contends that service connection for bilateral ankle and foot strains is warranted, to include as secondary to her other service-connected disabilities. 

In 1984, the Veteran fell from a telephone pole and sustained a spinal fracture. Service treatment records from the time of injury also document reports of pain 4 inches proximal to the distal end of the left tibia. 

Since the time of the filing of her original claim for service connection in 2015, the Veteran has consistently reported that this initial injury caused pain in her back, hips, knees, and ankles. She also reported that running, marching, and other rigors of military service created more stress on her injuries. See, e.g. December 2015 Statement in Support of Claim. 

A July 2016 VA medical examination noted bilateral ankle instability. The Veteran reported that prolonged standing and walking increased her ankle pain. The examiner noted that this was a functional impact of her ankle disorders. A contemporaneous medical opinion stated that the Veteran's bilateral ankle disorders were not secondary to her service-connected spine disorder. 

A January 2022 Board decision found that this decision was inadequate and further found that the Veteran's reports of functional impairment in her bilateral ankles was sufficient to be considered as a compensable disability pursuant to Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (The term "disability" in 38 U.S.C. § 1110 refers to the functional impairment of earning capacity, not the underlying cause of said disability, and in the context of a veteran's disability claim, pain may be considered a disability if it diminishes the body's ability to function, whether that pain is diagnosed as connected to a current underlying condition or not.).

A June 2022 VA examination diagnosed the Veteran with bilateral ankle and foot strains. During that examination, the Veteran reported that she had a hard time walking due to ankle and foot pain. Range of motion testing was normal in both ankles. The examiner noted pain on motion in both her ankles and her feet. There was noted pain during the use of both feet. The examiner also noted a history of medial tibial stress syndrome during active duty. 

June 2022 and August 2022 medical opinions provided negative nexus opinions. Based on those opinions, a January 2023 Board decision denied service connection for bilateral ankle and foot disorders. In November 2023, the Court of Appeals for Veterans Claims (CAVC) granted a joint motion for partial remand and vacated the January 2023 Board decision, including the portion of that decision which denied service connection for bilateral ankle and foot disorders. In the Joint Motion for Partial Remand, the parties agreed that the January 2023 decision did not ensure substantial compliance with the Board's January 2022 remand directives and relied on inadequate VA medical opinions. An April 2024 Board decision remanded the issues of service connection for bilateral ankle and foot disorders for further development. 

?

During a November 2024 VA examination, the Veteran reported that she experienced pain in both feet that began after a fall during a period of active duty. The Veteran further reported that this pain was initially mild, but increased over the years to a constant aching pain in the arches of both feet that she rated 8 out of 10. As there was no objective pain, the examiner determined that the Veteran did not have a current diagnosis of a foot disorder. 

March 2025 VA opinions opined that the Veteran had not been diagnosed with ankle or foot disorders "due to lack of objective findings to support a diagnosis."

In April 2025 the Board determined that the November 2024 VA opinions were inadequate as they did not consider whether the Veteran's bilateral ankle and foot disorders manifested as functional impairment of earning capacity under Saunders and did not consider any disabilities that may have resolved during the period on appeal. 

A May 2025 VA medical opinion noted the June 2022 diagnosis of bilateral
 pain in the arches of both feet that she rated 8 out of 10. As there was no objective pain, the examiner determined that the Veteran did not have a current diagnosis of a foot disorder. 

March 2025 VA opinions opined that the Veteran had not been diagnosed with ankle or foot disorders "due to lack of objective findings to support a diagnosis."

In April 2025 the Board determined that the November 2024 VA opinions were inadequate as they did not consider whether the Veteran's bilateral ankle and foot disorders manifested as functional impairment of earning capacity under Saunders and did not consider any disabilities that may have resolved during the period on appeal. 

A May 2025 VA medical opinion noted the June 2022 diagnosis of bilateral ankle strains, but stated "However, the condition appears resolved" as latter VA examinations did not show objective signs of ankle disorders. This opinion then provided a negative nexus opinion based on the absence of diagnosed bilateral ankle disorders.  

When addressing the Veteran's bilateral foot pain, a May 2025 VA medical opinion provided a negative nexus, stating 

Veteran has claimed right foot disorder as being directly related to military service. Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of bilateral feet sprain and military service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. Veteran served in the Army 1984-1989 and Air Force intermittently between 2003-2006. Her claim of left foot disorder was diagnosed as Bilateral Foot Sprain on the 03/31/2025 and 2022 FOOT CONDITIONS DBQ. Veteran recalls a June 1984 fall onto her back is the nexus of her current complaint of foot pain. However there is no evidence of this in C-file, which is silent for complaint, diagnosis or treatment plan for a foot injury related to that event, likely because landed on her back and not her feet. There is no report of a foot injury or condition during Army service through 1989. Separation Report of Medical Exam 04/25/1989 is silent for complaint, diagnosis or treatment plan for a foot condition during Army service. Review of recent post-service medical records (PCP records 04/04/2024 and 02/10/2025) note generalized musculoskeletal complaints of nonspecific foot pain. However, foot pain is not addressed in assessment on either encounter, and records are silent for a medically diagnosed foot condition. C-file is silent for podiatry records. (See references below.)

The August 2025 Board decision found these opinions inadequate and remanded the issues of service connection for bilateral ankle and foot disorders for further development. In part, the examiner was instructed to:

consider the Veteran's description of her in-service injury and symptoms as well as her post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?

January 2026 VA medical opinions addressed secondary service connection and service connection based on aggravation. 

A February 2026 exam addendum addressed service connection on a direct basis. Therein, the examiner stated:

The entirety of the claims file has been reviewed including the remand, lay statements, treatment notes, outside provider medical opinions and associated literature. On active duty, there is no evidence of an acute or chronic orthopedic ankle condition. No treatment note evidence nor Exit exam shows chronicity of care, continuity of symptoms or pathology for an orthopedic ankle condition. In the available claims file, unable to define the line of duty for an ankle condition. Based on Veteran's specific evidence, no diagnosis for an orthopedic ankle condition exists. Lay statements of chronicity are noted however they are not supported by available evidence. V.ii.1.A.2.g. The absence of evidence on a particular question cannot be construed as substantive negative evidence against a claimant unless there is a foundation in the record that demonstrates that such silence has a tendency to prove or disprove a relevant fact. This is not an absence of evidence but is instead evidence to support an absence of a chronic condition. The most probative evidence of record are the service treatment records and postservice medical records which are negative for complaints, diagnosis, or treatment for the claimed disorder until after the Veteran's last period of service and well after 1 year from release of active duty. These records are more probative than the Appellant lay claims to the contrary. See,
 not supported by available evidence. V.ii.1.A.2.g. The absence of evidence on a particular question cannot be construed as substantive negative evidence against a claimant unless there is a foundation in the record that demonstrates that such silence has a tendency to prove or disprove a relevant fact. This is not an absence of evidence but is instead evidence to support an absence of a chronic condition. The most probative evidence of record are the service treatment records and postservice medical records which are negative for complaints, diagnosis, or treatment for the claimed disorder until after the Veteran's last period of service and well after 1 year from release of active duty. These records are more probative than the Appellant lay claims to the contrary. See, Owens, supra. Outside provider lay statements, opinions and literature have been reviewed however, they are not supported by veteran specific evidence. All veteran is competent to report their suspicions, he is not qualified to render a nexus. No nexus for the claimed right ankle condition to active duty exists. 

Notably, the examiner expressed legal, rather than medical, reasons to discount the Veteran's statements about the onset of her bilateral ankle and foot disorders. As such, the Board finds that these opinions are inadequate. 

Given the significant history of inadequate or insufficient VA medical opinions, the Board finds that attempts to obtain an adequate opinion would be futile.

The Board has previously found that the Veteran's bilateral ankle strains can be considered as disabilities for VA purposes. See January 2022 opinion. The Board now finds that the Veteran's reports that her bilateral foot pain causes constant, aching pain in her feet and VA examinations noting limitations in walking, show that her bilateral foot strains can be considered as disabilities for VA purposes. See Saunders, supra.  Furthermore, the Veteran has also reported that the 1984 fall caused her initial injuries, which were exacerbated by the rigors of military service (i.e., running, marching, etc.).   The Board reflects that the "rigors" noted above are consistent with the Veteran's types, places and circumstances of service.  See 38 U.S.C. § 1154(a).  Likewise, VA has already conceded a 1984 fall resulted in several of her now-service-connected disabilities.  As such, the first two elements of service connection are satisfied; the remaining question for the Board is whether there is a nexus between the Veteran's disorders and her military service. 

As noted above, there are no probative medical opinions of record. As a layperson, the Veteran is competent to report matters within her own personal knowledge. A lay person is competent to report on the onset and reoccurrence of current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board must determine on a case-by-case basis whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). 

The Board finds that the Veteran is competent to report that her bilateral ankle and foot pain began during service and that her pain has continued and worsened since her discharge. However, the Veteran is not competent to provide opinions as to etiology, specifically that her bilateral ankle or foot disorders were incurred in or caused by service. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Accordingly, the Board finds the lay statements credible as to the onset and persistence of symptoms of bilateral ankle and foot pain during and since service, therefore making the lay statements probative.

As there are only negative but inadequate VA opinions and the Veteran's competent statements of an onset during and continuation of bilateral ankle and foot pain since service, benefit of the doubt is given to the Veteran.  In this regard, the competent and credible evidence demonstrates incurrence in service with continuity since discharge from service.  Accordingly, the Board concludes that the Veteran's bilateral ankle and bilateral foot strains were incurred in active service; thus, the criteria for direct service connection are met. See 38 C.F.R. § 3.303. In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021
 pain since service, benefit of the doubt is given to the Veteran.  In this regard, the competent and credible evidence demonstrates incurrence in service with continuity since discharge from service.  Accordingly, the Board concludes that the Veteran's bilateral ankle and bilateral foot strains were incurred in active service; thus, the criteria for direct service connection are met. See 38 C.F.R. § 3.303. In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

MARTIN B. PETERS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Stricker, Katherine 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.