OSTEOARTHRITIS

Summary

The Veteran, who served in the United States Air Force from October 1973 to June 1975, with subsequent duty in the Air Force Reserve and D.C. Air National Guard until June 1986, appeals the denial of service connection for a left ankle disability, a low back disability, a right knee disability, and a left knee disability. The Veteran claimed the left ankle disability, including osteochondritis dissecans, osteoarthritis, and status-post reconstruction, originated in service due to another service member repeatedly stepping on her ankle during marches. She also claimed the low back, right knee, and left knee disabilities were secondary to the left ankle condition. The Board denied service connection for all conditions. For the left ankle, the Board found the Veteran's lay testimony regarding an in-service injury not credible, citing inconsistencies with her service treatment records and later VA treatment records which indicated symptom onset decades after service. The Board found the Veteran's service treatment records negative for any left ankle injury or disability. While acknowledging the Veteran's statements about a culture discouraging reporting injuries, the Board noted she sought treatment for other issues during service. The Board found the VA examination from August 2021 probative, concluding the left ankle disability was less likely than not incurred in or caused by service, citing the lack of in-service medical records and the Veteran's reported post-service onset of symptoms. The Board also found the Veteran's lay testimony regarding the specific in-service incident not credible. As service connection for the left ankle was denied, the secondary claims for the low back, right knee, and left knee were also denied. No special benefits were claimed or granted.

Rationale

Service treatment records negative for left ankle injury/disability.; Veteran's lay testimony regarding in-service injury found not credible.; VA examination concluded less likely than not incurred in or caused by service.

Full Decision Text

Citation Nr: A25102857
Decision Date: 12/01/25	Archive Date: 12/01/25

DOCKET NO. 220124-212970
DATE: December 1, 2025

ORDER

Entitlement to service connection for a left ankle disability, to include osteochondritis dissecans, osteoarthritis, and status-post left ankle reconstruction is denied.

Entitlement to service connection for a low back disability is denied.

Entitlement to service connection for a right knee disability is denied.

Entitlement to service connection for a left knee disability is denied.

FINDINGS OF FACT

1. The Veteran's left ankle disability did not have its clinical onset in active service, did not manifest to a compensable degree within one year of separation from active service, and is not otherwise related to active service.

2. The Veteran's low back disability is not secondary to a service-connected disability.

3. The Veteran's right knee disability is not secondary to a service-connected disability.

4. The Veteran's left knee disability is not secondary to a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left ankle disability are not met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 

2. The criteria for service connection for a low back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from October 1973 to June 1975. She had additional duty with both the Air Force Reserve and District of Columbia Air National Guard.

The Veteran appeared at an August 2025 virtual hearing before the undersigned Veterans Law Judge (VLJ). The hearing transcript is of record.

In April 2015, the Agency of Original Jurisdiction (AOJ) determined that new and material evidence was received to reopen the claim of service connection for a left ankle disability, but denied the claim on the merits. In January 2020, the Veteran submitted a Decision Review Request: Supplemental Claim, VA Form 20-0995. On April 7, 2020, the AOJ determined that new and relevant evidence was received to readjudicate the claim of service connection for a left ankle disability, but denied the claim on the merits. On April 17, 2020, the Veteran submitted a Decision Review Request: Higher-Level Review, VA Form 20-0996. In September 2020, the AOJ denied service connection for a left ankle disability. In May 2021, the Veteran submitted a Decision Review Request: Supplemental Claim, VA Form 20-0995. In June 2021, the AOJ determined that new and relevant evidence was received to readjudicate the claim of service connection for a left ankle disability, but denied the claim on the merits. On July 21, 2021, the Veteran submitted a Decision Review Request: Higher-Level Review, VA Form 20-0996. On July 30, 2021, the AOJ identified a duty to assist error, and reverted the claim to the supplemental claim lane. In October 2021, the AOJ denied service connection for a left ankle disability.

In November 2020, the AOJ denied service connection for a low back disability. In May 2021, the Veteran submitted a Decision Review Request: Supplemental Claim, VA Form 20-0995. In June 2021, the AOJ determined that new and relevant evidence was received to readjudicate the claim of service connection for a low back disability, but denied the claim on the merits. On July 21, 2021, the Veteran submitted a Decision Review Request: Higher-Level Review, VA Form 20-0996. On July 30, 2021, the AOJ identified a duty to assist error, and reverted the claim to the supplemental claim lane. In October 2021, the AOJ denied service connection for a low back
J denied service connection for a low back disability. In May 2021, the Veteran submitted a Decision Review Request: Supplemental Claim, VA Form 20-0995. In June 2021, the AOJ determined that new and relevant evidence was received to readjudicate the claim of service connection for a low back disability, but denied the claim on the merits. On July 21, 2021, the Veteran submitted a Decision Review Request: Higher-Level Review, VA Form 20-0996. On July 30, 2021, the AOJ identified a duty to assist error, and reverted the claim to the supplemental claim lane. In October 2021, the AOJ denied service connection for a low back disability.

In June 2021, the AOJ denied service connection for both a right knee disability and a left knee disability. On July 21, 2021, the Veteran submitted a Decision Review Request: Higher-Level Review, VA Form 20-0996. On July 30, 2021, the AOJ identified a duty to assist error, and reverted the claims to the supplemental claim lane. In October 2021, the AOJ denied service connection for both a right knee disability and a left knee disability.

In January 2022, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, and elected the Hearing Review docket. Therefore, the Board may only consider the evidence of record at the time of the October 2021 AOJ supplemental rating decision as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the October 2021 decision, and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like the Department of Veterans Affairs (VA) to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify this evidence. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to service connection for a left ankle disability is denied.

The Veteran asserts that service connection for a left ankle disability, to include osteochondritis dissecans, osteoarthritis, and status-post left ankle reconstruction is warranted, as the claimed disability originated during active service as a result of another service-member consistently stepping on her left ankle during marches resulting in left ankle pain since both active service and separation from active service. See February 5, 2021 Affidavit; August 4, 2025 Board Hearing, pp. 2-6. For the reasons outlined below, the Board disagrees.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38?U.S.C. §§?1110, 1131;?38?C.F.R. §?3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the current disability and the claimed in-service disease or injury. Shedden v. Principi,?381 F.3d 1163?(Fed. Cir. 2004).

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

Service treatment records for the Veteran's active service period do not refer to either a left ankle injury or disability. In this regard, a June 1975 separation medical history report states that the Veteran answered "no" to the question of whether she then had, or once had foot trouble, bone, joint, or other deformity, and
 presumptive period) with continuity of symptomatology since service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Service treatment records for the Veteran's active service period do not refer to either a left ankle injury or disability. In this regard, a June 1975 separation medical history report states that the Veteran answered "no" to the question of whether she then had, or once had foot trouble, bone, joint, or other deformity, and any illness or injury other than those already noted (see December 21, 2014 STR - Medical, p. 107); and the report of a June 1975 separation physical examination states no lower extremity or foot abnormalities were identified. See December 21, 2014 STR - Medical, p. 109.

As noted, the Veteran had additional duty with both the Air Force Reserve and District of Columbia (D.C.) Air National Guard from June 1979 to June 1986. See December 21, 2014 Military Personnel Record, NGB Form 22, p. 4. Service treatment records for this period of service also do not refer to a left ankle disability. In this regard, medical history reports dated June 1979, September 1980, January 1981, January 1982, May 1983, and September 1983 all state that the Veteran answered "no" to the question of whether she then had, or once had foot trouble, bone, joint, or other deformity, and any illness or injury other than those already noted; the report of physical examinations dated June 1979, January 1981, and May 1983 all state that no lower extremity or foot abnormalities were identified; and medical certificates dated January 1984 and January 1985 both state that the Veteran certified "that to the best of my knowledge I have no medical defect, disease, or disability which would disqualify me for full military duty." See December 21, 2014 STR - Medical.

These medical records generated during the Veteran's active service and duty with both the Air Force Reserve and D.C. Air National Guard are highly probative both as to the Veteran's subjective reports and their resulting objective findings, as they were generated with a view towards ascertaining the Veteran's then-state of physical fitness and are akin to statements of diagnosis or treatment. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board's decision); see also LILLY'S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (many state jurisdictions, including the federal judiciary and Federal Rule 803(4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rationale that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care).

Notably, the Veteran stated that she declined to report any alleged left ankle injuries and/or symptoms during active service because "my generation of veterans, we didn't like to show any sign of weakness;" "that was what we w[ere] taught, and that's what was drilled into us;" and "we just didn't go to the doctor for every little thing." See August 2025 Board Hearing, p. 4. 

The Veteran is competent to report that another service-member consistently stepped on her left ankle during marching and the resulting left ankle symptoms, as the Veteran can observe and/or experience these alleged left ankle injuries and symptoms. 38 C.F.R. § 3.159(a)(2). However, the Veteran is not credible in her account that another service-member consistently stepped on the Veteran's left ankle during marching resulting in left ankle pain during active service. In this regard, despite the Veteran's allegation that there was a "culture there against complaining or going to the doctor" (see August 2025 Board Hearing, p. 4), her service treatment records show that she consulted medical treatment providers during active service for numerous reasons. Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact
). However, the Veteran is not credible in her account that another service-member consistently stepped on the Veteran's left ankle during marching resulting in left ankle pain during active service. In this regard, despite the Veteran's allegation that there was a "culture there against complaining or going to the doctor" (see August 2025 Board Hearing, p. 4), her service treatment records show that she consulted medical treatment providers during active service for numerous reasons. Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder). Additionally, the Veteran's motive for not reporting her claimed left ankle injury and/or symptoms during active service due to a "culture there against complaining or going to the doctor" would likely have disappeared in June 1975 because her discharge from active service was imminent. See Janssen v. Principi, 15 Vet. App. 370 (2001); Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (explaining that the Board's assessment of the credibility of lay statements involves considering factors such as facial implausibility, bias, self-interest, and consistency with other evidence of record). 

Furthermore, as noted, the Veteran consistently affirmatively denied any lower extremity injuries and symptoms during her active service and duty with both the Air Force Reserve and D.C. Air National Guard. Moreover, VA clinical records show the Veteran's report that her left ankle symptoms onset in the Year 2001 - approximately 26 years after active service separation. See Southall-Norman v. McDonald, 28 Vet. App. 346, 355 (2016) (when assessing the credibility of lay evidence, the Board may consider factors such as consistency with other evidence of record); Fed. R. Evid. 803(4) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth to receive proper care). In this regard, an April 7, 2005 VA clinical record states the Veteran's competent and credible report of left ankle weakness "since 2001." See April 7, 2020 CAPRI. The report of a June 2005 VA left ankle X-ray study showed "no abnormality of the bones except for minimal calcaneal spur" and "questionable soft tissue swelling." An assessment of left ankle pain was advanced. See April 7, 2020 CAPRI. The report of an October 20, 2005 VA orthopedic surgery consultation states that "the [Veteran] is ... experiencing left ankle giving way into varus about 3 or 4 spells per year over the last 4 or 5 years of unknown cause;" "there has been no injury;" and the VA treating medical doctor stated: "her left ankle is stable to varus valgus and drawer testing;" "there is no tenderness and it is not painful;" "she has strong peroneal muscles at this time;" and "X-ray: 19 September 2005 of her left ankle is normal." See April 7, 2020 CAPRI.

Plainly speaking, the Veteran is not truthful now as she seeks to obtain VA compensation. See Fountain v. McDonald, 27 Vet. App. 258, 272 (2015) (the Board must first establish a proper foundation for drawing inferences against a claimant from the absence of documentation); Horn v. Shinseki, 25 Vet. App. 231, 239 (2012) (recognizing that the absence of evidence cannot be substantive negative evidence without a proper foundation to demonstrate that such silence tends to prove or disprove a relevant fact).

In June 2007, the Veteran had VA left ankle surgery and assessed with a preoperative and postoperative diagnosis of "left talar bone osteochondral defect." See April 7, 2020 CAPRI. In an October 2007 statement, the VA D.P.M. (Doctor of Podiatric Medicine) who performed the June 2007 left ankle surgery stated: "[the Veteran] has been seen at the ... VAMC Podiatry Surgery Clinic for post-op follow-up of her left ankle surgery;" "this problem has become active since the mid-1990s most likely from over use during years in the service;" "she suffered from osteochondritis dissecans in her left ankle which after failed consecutive therapy, resorted to surgical intervention;" "her surgery has been successful so far and is currently doing physical therapy;" and "this problem is a slow progressing problem which often shows up years after original trauma or injury." See December 28
 an October 2007 statement, the VA D.P.M. (Doctor of Podiatric Medicine) who performed the June 2007 left ankle surgery stated: "[the Veteran] has been seen at the ... VAMC Podiatry Surgery Clinic for post-op follow-up of her left ankle surgery;" "this problem has become active since the mid-1990s most likely from over use during years in the service;" "she suffered from osteochondritis dissecans in her left ankle which after failed consecutive therapy, resorted to surgical intervention;" "her surgery has been successful so far and is currently doing physical therapy;" and "this problem is a slow progressing problem which often shows up years after original trauma or injury." See December 28, 2007 Third Party Correspondence. 

To the extent that the October 2007 VA opinion attempts to link the Veteran's left ankle disability to active service, it has no probative value, as it was based on the Veteran's non-credible report of a left ankle injury and/or experiencing left ankle symptoms during active service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (a medical opinion must be based on a full and accurate medical history); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based upon an inaccurate factual premise has no probative value); Swann v. Brown, 5 Vet. App. 229, 233 (1993) (the Board may reject a medical opinion because other facts present in the record contradict the facts provided by the veteran that formed the basis of the opinion). 

On November 21, 2014, the same VA D.P.M. who drafted the October 2007 VA opinion stated: "[the Veteran] has been seen at the ... VAMC Podiatry Surgery Clinic for chronic left ankle pain [on] May 7, 2006;" "she had seen the orthopedic department and was told she had early arthritis to her left foot/ankle;" "she was treated conservatively first which seemed to improve her condition for a while;" "she was seen back in June 2006 for persistent ankle pain and an MRI was ordered that revealed an osteochondral defect to her talus consistent with old trauma to the ankle;" "it is unclear when the trauma occurred but the lesion is representative to old ankle injuries;" "she underwent surgical intervention and was also treated concurrently with bracing and injection which seemed to help her ankle;" and "this is a progressive condition which will likely continue to become worse over time and cause her to alter her ambulation." See November 21, 2014 Third Party Correspondence. 

The November 21, 2014 VA opinion is inadequate because the opinion was inconclusive, as the VA D.P.M. indicated that the left ankle disability was "consistent with old trauma" but did not identify the occurrence of the trauma as it was noted "it is unclear when the trauma occurred." See Obert v. Brown, 5 Vet. App. 30, 33 (1993) (medical evidence that is speculative, general, or inconclusive in nature cannot support a claim); Miller v. Wilkie, 32 Vet. App. 249, 254 (2020) (a medical opinion is adequate when the medical expert discussed the relevant facts of a claimant's case, including any relevant lay statements about the disability picture, such that the opinion and rationale sufficiently inform the Board of the expert's judgment on the medical question).

The report of a November 26, 2014 VA ankle examination states the Veteran's report that "she does not remember a specific left ankle injury in-service;" "she reports pain started when she was in service;" "she now has constant pain in the left ankle;" "gives way;" "she had surgery in 2007, unsure what procedure;" and "still has pain." The examiner noted that imaging studies of the left ankle showed arthritis, but determined that "the Veteran does not have a current [left ankle] diagnosis." The examiner concluded that: "the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness" as "[the] Veteran had a talar dome osteochondral defect addressed surgically in 2007;" "she was discharged from service in 1975;" "STRs are not available in paper or on VBMS;" "however, she denies specific injury to the ankle in service;" and "it is therefore much more likely that her pathology was due to an interval event in the 30 years since discharge."

The November 26, 2014 VA opinion is inadequate, as both the examination and opinion were contradictory due to the examiner's finding that the Veteran
 concluded that: "the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness" as "[the] Veteran had a talar dome osteochondral defect addressed surgically in 2007;" "she was discharged from service in 1975;" "STRs are not available in paper or on VBMS;" "however, she denies specific injury to the ankle in service;" and "it is therefore much more likely that her pathology was due to an interval event in the 30 years since discharge."

The November 26, 2014 VA opinion is inadequate, as both the examination and opinion were contradictory due to the examiner's finding that the Veteran did not have a left ankle disability but concluded that the Veteran's left ankle disability was not incurred in or caused by service. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); Miller v. Wilkie, 32 Vet. App. 249, 254 (2020).

The report of an April 12, 2021 VA ankle disability benefits questionnaire (DBQ) from F.J.R., D.C. (Doctor of Chiropractic) states that the Veteran presented a history of "marching at boot camp, soldier next to her chronically stepped on her left foot and ankle." She was diagnosed with left ankle osteochondritis dissecans and osteoarthritis. Dr. R. concluded that: "it is more likely than not that the Veteran's left ankle conditions are a result of the Veteran's described mechanism of injury from her time in service" as "the Veteran has STR's identifying time of injury in service;" "she denies any additional injury or trauma to her left ankle post-discharge;" "the Veteran's memory correlates to the records I reviewed on her claims file and I have no reason to question her credibility or memory;" "the Veteran has a record from G.A.D., D.P.M., a podiatrist from the ... VAMC written on November 21, 2014;" "the letter confirms from a VA doctor that the Veteran's left ankle condition is a result of an old ankle injury;" and "I opine Dr. D's. opinion that the Veteran's left ankle condition is chronic in nature and had occurred during her time in service." See May 19, 2021 DBQ.

The April 12, 2021 non-VA opinion from Dr. R has no probative value, as it was based on the Veteran's non-credible report of a left ankle injury and/or experiencing left ankle symptoms during active service. Significantly, Dr. R.'s opinion was based on the Veteran's inaccurate medical history as Dr. R. erroneously noted "the Veteran has STR's identifying time of injury in service" despite STRs clearly showing no indication of a left ankle disability or injury. Additionally, Dr. R. did not discuss the April 7, 2005 VA clinical record where the Veteran reported left ankle weakness that onset in the Year 2001. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Swann v. Brown, 5 Vet. App. 229, 233 (1993).

An additional opinion titled "Chiropractic Injury Solutions" dated April 12, 2021 from Dr. R. concluded that: "the Veteran's left ankle diagnosis are, as likely as not, incurred or caused by the Veteran's time in service" as "the Veteran claims that she had no left ankle injury prior to enlisting in service and no left ankle injury from her time of discharge to the present date;" "the Veteran claims her left ankle pain started when the soldier next to her continuously stepped on her left ankle causing traumas and subsequent left ankle pains;" "I found no military STRs in the Veteran's claims file that could prove otherwise;" "if the military would provide the Veteran's STRs, I would review them, but the Veteran claims they were 'burnt up' and have not been made available to her;" "my sole reasoning that the Veteran's left ankle pain and injury are more likely than not the result of her time in service is that stepping on an ankle can cause an ankle injury from minor bruising/swelling to a ligament sprain, none of which are available to identify in the military STRs for confirmation." See May 19, 2021 Medical Treatment Record.

The additional April 12, 2021 non-VA opinion from Dr. R also has no probative value, as it was again based on the Veteran's non-credible report of a left ankle injury and/or experiencing left ankle symptoms during active service. Not
, but the Veteran claims they were 'burnt up' and have not been made available to her;" "my sole reasoning that the Veteran's left ankle pain and injury are more likely than not the result of her time in service is that stepping on an ankle can cause an ankle injury from minor bruising/swelling to a ligament sprain, none of which are available to identify in the military STRs for confirmation." See May 19, 2021 Medical Treatment Record.

The additional April 12, 2021 non-VA opinion from Dr. R also has no probative value, as it was again based on the Veteran's non-credible report of a left ankle injury and/or experiencing left ankle symptoms during active service. Notably, the Veteran for the first time, claimed that her service treatment records were "burnt up." The Board observes that this is factually untrue, as the claims file shows that VA obtained all of the Veteran's service treatment records and with the exception of this one notation in Dr. R's report, neither the Veteran nor her attorney has alleged missing service treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Swann v. Brown, 5 Vet. App. 229, 233 (1993). 

The report of an August 2021 VA ankle examination states that the Veteran presented a history of left ankle pain that "began in 1998" and "as a result of physical training." She was diagnosed with status-post left ankle reconstruction. The examiner concluded that: "the [left ankle disability] was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness" as "there are no medical records showing diagnosis, treatment for the ankle condition during active duty."

The Board finds that the August 2021 VA opinion is probative, as it is informed and responsive.   In this regard, the Board acknowledges the Court of Appeals for Veterans Claims' (Court's) decision in Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007), which found that the Board improperly relied on an inadequate medical examination in concluding that the "record contains a medical conclusion by which the idea of a nexus between the Veteran's current back disability and his military service is expressly rejected."  The Court noted that "the medical examiner impermissibly ignored the appellant's lay assertions that he had sustained a back injury during service." 

The present case is distinguishable from Dalton.  Here, the Veteran reported to the October 2021 VA examiner that her ankle symptoms first onset in 1998, nearly 23 years after separation from service, as a result of "physical training," and in no way indicated such training occurred during active service.  Other contemporaneous VA treatment records, which the examiner also reviewed, indicate an initial onset of symptoms in 2001, nearly 26 years after service. While the Board notes that the examiner relied on the absence of service treatment records as rationale, the Board infers the examiner's reasoning was also based on the Veteran's lay statements at the time of that examination, in which she reported an onset of left ankle symptoms years after service in 1998, and the contemporaneous VA records showing an onset in 2001 with no report of any injury.  Bastien v. Shinseki, 599 F.3d 1301, 1306 (Fed. Cir. 2010) ("The evaluation and weighing of evidence and the drawing of appropriate inferences from it are factual determinations committed to the discretion of the fact finder.")

As noted, the Veteran is not credible in her account that another service-member consistently stepped on the Veteran's left ankle during marching which resulted in left ankle pain during active service, and as such, service treatment records do not refer to a left ankle injury or disability. The examiner both considered the Veteran's accurate medical history and was informed of sufficient facts and data by referring to the lack of documented treatment for a left ankle disability and/or symptoms during active service in rendering an opinion. See Miller v. Wilkie, 32 Vet. App. 249, 254 (2020); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). Thus, it is probative.

There is no other competent and probative evidence in favor of nexus.  In this regard, the Board acknowledges that the Veteran is competent to report that another service-member consistently stepped on her left ankle during marching which resulted in left ankle pain, but the Veteran is not credible in her account that another service-member consistently stepped on the Veteran's left ankle during marching which resulted in left ankle
 of documented treatment for a left ankle disability and/or symptoms during active service in rendering an opinion. See Miller v. Wilkie, 32 Vet. App. 249, 254 (2020); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). Thus, it is probative.

There is no other competent and probative evidence in favor of nexus.  In this regard, the Board acknowledges that the Veteran is competent to report that another service-member consistently stepped on her left ankle during marching which resulted in left ankle pain, but the Veteran is not credible in her account that another service-member consistently stepped on the Veteran's left ankle during marching which resulted in left ankle pain during active service. Here, despite the Veteran's allegation that there was a "culture there against complaining or going to the doctor," her service treatment records show that she consulted medical treatment providers during active service for numerous reasons; the Veteran consistently affirmatively denied any lower extremity injuries and symptoms during her active service and duty with both the Air Force Reserve and D.C. Air National Guard; and more contemporaneous and probative VA clinical records show the Veteran's report that her left ankle symptoms onset in the Year 2001 - approximately 23 years after active service separation. As noted, the medical opinions dated October 2007; November 21, 2014; November 26, 2014; and April 12, 2021 have been found inadequate and/or lacking probative value. The August 2021 VA opinion, as the only adequate and probative opinion of record, concluded that: "the [left ankle disability] was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness." The Veteran does not have the expertise to opinion on the etiology of her ankle disability, and even if the Board were to find her competent to do so, she is not credible for reasons outlined above.  The Board has considered the doctrine of reasonable doubt but has determined that the competing evidence is not in approximate balance, or nearly equal, and is persuasively against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for a low back disability is denied.

3. Entitlement to service connection for a right knee disability is denied.

4. Entitlement to service connection for a left knee disability is denied.

The Veteran asserts that service connection for a low back disability, right knee disability, and left knee disability is warranted, as the claimed disabilities are secondary to a left ankle disability. See December 18, 2019 VA Form 21-526EZ; June 2, 2021 VA Form 21-526EZ; August 2025 Board Hearing. 

Service connection may be granted for a disability which is proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service-connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995).

As service connection for a left ankle disability is not warranted, secondary service connection for a low back disability, right knee disability, and left knee disability is not available. See 38 C.F.R. § 3.310(a). The Veteran does not assert, and the record does not otherwise raise the issue of entitlement to direct service connection, VA's duty to assist is not triggered, and service connection for a low back disability, right knee disability, and left knee disability is not warranted on a direct basis. 

Therefore, for reasons outlined above, the competing evidence is not in approximate balance, or nearly equal, the benefit-of-the-doubt rule is inapplicable, and service connection must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 

 

S. BUSH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Cohen

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.