ANKLE IMPAIRMENT OF

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26033063

MIXED

Summary

The Veteran, who served in the United States Marine Corps from October 1972 to September 1976, appeals the denial of service connection for several conditions, including left ankle, neck, and bilateral feet, shoulder, and hip disabilities, and the denial of TDIU. The Board granted service connection for a left ankle disability, to include left ankle pain, as secondary to his service-connected left knee disability. Service connection was also granted for bilateral foot disabilities, including foot pain with pes cavus deformity and Achilles tenderness, secondary to his service-connected left knee disability. The Board granted service connection for left and right shoulder disabilities, including osteoarthritis and bilateral impingement, on a direct basis, citing a private medical opinion and the Veteran's lay testimony about an in-service injury involving heavy lifting. Service connection for bilateral hip disabilities, including hip strain, was granted secondary to the service-connected left knee disability, based on a private medical opinion noting altered gait and mechanical stress. Service connection for a neck disability, including chronic neck pain and cervical degenerative disc disease with bilateral radiculopathy, was granted directly, supported by the Veteran's lay testimony of an in-service neck injury and a private medical opinion finding a nexus. The claim for TDIU was remanded for readjudication after the RO assigns ratings to the newly service-connected conditions.

Rationale

Current disability conceded by AOJ; Service-connected left knee disability established; Private medical opinion found favorable nexus

Service Branch

MARINE CORPS

Special Benefit

TDIU

Docket No.

210224-144329

Full Decision Text

Citation Nr: A26033063
Decision Date: 04/09/26 Archive Date: 04/09/26

DOCKET NO. 210224-144329
DATE: April 9, 2026

ORDER

Entitlement to service connection for a left ankle disability, to include left ankle pain, as secondary to service-connected left knee disability, is granted.

Entitlement to service connection for a left foot disability, to include foot pain with pes cavus deformity and Achilles tenderness, as secondary to service-connected left knee disability, is granted.

Entitlement to service connection for a right foot disability, to include foot pain with pes cavus deformity and Achilles tenderness, as secondary to service-connected left knee disability, is granted.

Entitlement to service connection for a left shoulder disability, to include left shoulder osteoarthritis and bilateral impingement, is granted.

Entitlement to service connection for a right shoulder disability, to include bilateral impingement, is granted.

Entitlement to service connection for a left hip disability, to include hip strain, as secondary to service-connected left knee disability, is granted.

Entitlement to service connection for a right hip disability, to include hip strain, as secondary to service-connected left knee disability, is granted.

Entitlement to service connection for a neck disability, to include chronic neck pain and cervical degenerative disc disease (DDD) with bilateral radiculopathy, is granted.

REMANDED

Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

FINDINGS OF FACT

1. The most probative evidence of record reflects that the Veteran's left ankle disability is caused by his service-connected left knee disability.

2. The most probative evidence of record reflects that the Veteran's left foot disability is caused by his service-connected left knee disability.

3. The most probative evidence of record reflects that the Veteran's right foot disability is caused by his service-connected left knee disability.

4. The most probative evidence of record reflects that the Veteran's left shoulder disability is related to service.

5. The most probative evidence of record reflects that the Veteran's right shoulder disability is related to service.

6. The most probative evidence of record reflects that the Veteran's left hip disability is caused by his service-connected left knee disability.

7. The most probative evidence of record reflects that the Veteran's right hip disability is caused by his service-connected left knee disability.

8. The most probative evidence of record reflects that the Veteran's chronic neck pain is related to service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a left ankle disability, as secondary to service-connected left knee disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for entitlement to service connection for a left foot disability, as secondary to service-connected left knee disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to service connection for a right foot disability, as secondary to service-connected left knee disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for entitlement to service connection for a left shoulder disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for a right shoulder disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to service connection for a left hip disability, as secondary to service-connected left knee disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

7. The criteria for entitlement to service connection for a right hip disability, as secondary to service-connected left knee disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

8. The criteria for entitlement to service connection for a neck disability have been met. 38 U.S.C. §§ 1110, 113
left hip disability, as secondary to service-connected left knee disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

8. The criteria for entitlement to service connection for a neck disability have been 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 in the United States Marine Corps from October 1972 to September 1976.

These matters come before the Board of Veterans' Appeals (Board) on appeal from the July 2020 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) which denied entitlement to TDIU and service connection for left ankle, neck, and bilateral feet, shoulder, and hip disabilities.

In the February 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on March 11, 2025, and a transcript is in the record. Therefore, the Board may only consider the evidence of record at the time of the July 2020 agency of original jurisdiction (AOJ) decision on appeal, and any evidence submitted by the Veteran or representative at the hearing or within 90 days following the Board hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the 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.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires: (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, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Further, lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, VA shall give the benefit of the doubt to the Veteran. Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).

1. Entitlement to service connection for a left ankle disability, as secondary to service-connected left knee disability.

The Veteran seeks entitlement to service connection for a left ankle disability. See June 2020 Claim Application.

Service connection may be established on a secondary basis when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show
regarding any issue material to the determination of the matter, VA shall give the benefit of the doubt to the Veteran. Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).

1. Entitlement to service connection for a left ankle disability, as secondary to service-connected left knee disability.

The Veteran seeks entitlement to service connection for a left ankle disability. See June 2020 Claim Application.

Service connection may be established on a secondary basis when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995).

Following a review of the evidence, the Board finds that the most probative and persuasive evidence of record is in favor of the Veteran's claim.

Regarding the first element of the Veteran's service connection claim (a current disability), the Board notes that the AOJ conceded a diagnosis of left ankle pain in the July 2020 rating decision on appeal. The first element is thereby met.

As for the second element of the Veteran's claim (a separate disability already subject to service connection), the Board notes that the Veteran is service connected for left knee strain. See October 2023 Rating Decision. The second element is thus satisfied.

Finally, the Board must determine whether the Veteran's current left ankle pain is proximately due to, the result of, or aggravated by his service-connected left knee disability.

In a May 2025 medical opinion, a private provider opined that the Veteran's left ankle pain is at least as likely as not related to his service-connected left knee disability. Specifically, the provider reviewed the Veteran's reports of chronic ankle pain since service and noted his altered gait due to left knee instability. From the foregoing, the provider concluded that the progression of the Veteran's symptoms supports a secondary service connection to his longstanding left knee disability.

2. Entitlement to service connection for a left foot disability, as secondary to service-connected left knee disability.

3. Entitlement to service connection for a right foot disability, as secondary to service-connected left knee disability.

The Veteran seeks entitlement to service connection for a bilateral foot disability. See June 2020 Claim Application.

Service connection may be established on a secondary basis when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995).

Following a review of the evidence, the Board finds that the most probative and persuasive evidence of record is in favor of the Veteran's claim.

Regarding the first element of the Veteran's service connection claim (a current disability), the Board notes that the AOJ conceded a diagnosis of left foot pain in the July 2020 rating decision on appeal. The record also documents a diagnosis of chronic bilateral foot pain with pes cavus deformity and Achilles tenderness. See May 2025 Private Medical Opinion. The first element is thereby met.

Finally, the Board must determine whether the Veteran's current foot pain is proximately due to, the result of, or aggravated by his service-connected left knee disability.

In a May 2025 medical opinion, a private provider opined that the Veteran's bilateral foot disability is at least as likely as not related to or aggravated by his left knee and back disabilities. Specifically, the provider reviewed the Veteran's reports of bilateral foot pain since service and noted findings of a retained metallic foreign body in his left foot. The provider opined that this foreign body is likely related to service trauma. Additionally, the provider noted findings of diabetic peripheral neuropathy, which he/she believes further complicate foot function. The provider then stated that the Veteran's "chronic antalgic gait stemming from his knee and lumbar pathology likely contributes to mechanical foot pain and strain." Thus, the provider found that secondary service connection is warranted.

As the only relevant nexus opinion of record is favorable, and in view of the other evidence of record, the Board finds that the most persuasive and probative evidence of record weighs in the Veteran's favor. Consequently, the Board finds that the final element for service connection is satisfied. See 38 U.S.C. § 5107 (b). Still, the Board notes that secondary service connection can only be granted between the Veteran's bilateral foot and left knee disabilities, as his back disability has yet to be service connected. Entitlement to service connection for a bilateral foot disability, to include foot pain with pes cavus deformity and Achilles tenderness, as secondary to service-connected left knee disability, is thus warranted.

4. Entitlement to service connection for a left shoulder disability, to include left shoulder osteoarthritis and bilateral impingement.

5. Entitlement to service connection for a right shoulder disability, to include bilateral impingement.

The Veteran seeks entitlement to service connection for a bilateral shoulder disability. See June 2020 Claim Application.

Following a review of the evidence, the Board finds that the most probative and persuasive evidence of record is in favor of the Veteran's claim.

Regarding the first element of the Veteran's service connection claim (a current disability), the Board notes that the record documents a diagnosis of left shoulder osteoarthritis with bilateral impingement. See May 2025 Private Medical Opinion. The first element is thereby met.

As for the second element of the Veteran's claim (an in-service injury or event), the Veteran has consistently attributed his shoulder pain to his military duties as a hydraulic and pneumatic systems administrator, which involved heavy lifting while being on the flight lines. See March 2025 Hearing Transcript, pg. 2. Specifically, the Veteran recounted an in-service incident, in which he injured his shoulders and neck while lifting a tire in 1973. Id. at pgs. 12-13. The May 2025 private provider also noted the same report during his/her review of the evidence. See May 2025 Private Medical Opinion, pg. 3.

Additionally, the Board notes that service treatment records (STRs) demonstrate treatment for a pulled muscle in the Veteran's left shoulder in March 1974. See August 2013 STR, pg. 41. The Veteran's DD 214 also confirms his reported MOS, which could reasonably involve heavy lifting. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). Here, the Veteran personally experienced readily observable events, such as experiencing acute shoulder and neck pain while lifting a heavy airplane tire during service. Resolving reasonable doubt in the Veteran's favor, the second element of service connection claim is thus met. Lynch, 21 F.4th at 781-82.

Finally, the Board must determine whether the Veteran's current shoulder disabilities are related to his military service.

In May 2025, the Veteran submitted a private medical opinion, in which the provider opined that the Veteran's bilateral shoulder disability is at least as likely as not due to his military service. Following a review of the Veteran's medical history and lay statements of onset, the provider noted that the Veteran's physically demanding MOS required repeated overhead lifting and loading tasks, which are known risk factors for shoulder tendinopathy and impingement. The provider then observed x-ray findings of osteoarthritis, a ruptured biceps tendon, calc
thus met. Lynch, 21 F.4th at 781-82.

Finally, the Board must determine whether the Veteran's current shoulder disabilities are related to his military service.

As the only direct nexus opinion of record is favorable, and in view of the other evidence of record, the Board finds that the most persuasive and probative evidence of record weighs in the Veteran's favor. Consequently, the Board finds that the final element for service connection is satisfied. See 38 U.S.C. § 5107 (b). Entitlement to service connection for a bilateral shoulder disability, to include bilateral impingement, is thus warranted on a direct basis.

6. Entitlement to service connection for a left hip disability, as secondary to service-connected left knee disability.

7. Entitlement to service connection for a right hip disability, as secondary to service-connected left knee disability.

The Veteran seeks entitlement to service connection for a bilateral hip disability. See June 2020 Claim Application.

Service connection may be established on a secondary basis when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995).

Following a review of the evidence, the Board finds that the most probative and persuasive evidence of record is in favor of the Veteran's claim.

Regarding the first element of the Veteran's service connection claim (a current disability), the Board notes that the record documents a diagnosis of bilateral hip strain. See May 2025 Private Medical Opinion. The first element is thereby met.

Finally, the Board must determine whether the Veteran's current hip strain is proximately due to, the result of, or aggravated by his service-connected left knee disability.

In a May 2025 medical opinion, a private provider opined that the Veteran's bilateral hip disability is at least as likely as not related to or aggravated by his left knee and back disabilities. Specifically, the provider reviewed the Veteran's reports of chronic hip pain since service and noted findings of reduced range of motion with pain. The provider also noted that the "biomechanical demands of the Veteran's altered gait and longstanding low back pathology exert cumulative stress on the hips." Thus, the provider stated that secondary service connection is "medically reasonable."

As the only relevant nexus opinion of record is favorable, and in view of the other evidence of record, the Board finds that the most persuasive and probative evidence of record weighs in the Veteran's favor. Consequently, the Board finds that the final element for service connection is satisfied. See 38 U.S.C. § 5107 (b). Still, the Board notes that secondary service connection can only be granted between the Veteran's bilateral hip and left knee disabilities, as his back disability has yet to be service connected. Entitlement to service connection for a bilateral hip disability, to include hip strain, as secondary to service-connected left knee disability, is thus warranted.

8. Entitlement to service connection for a neck disability, to include chronic neck pain and cervical degenerative disc disease (DDD) with bilateral radiculopathy.

The Veteran seeks entitlement to service connection for a neck disability. See June 2020 Claim Application.

Following a review of the evidence, the Board finds that the most probative and persuasive evidence of record is in favor of the Veteran's claim.

Regarding the first element of the Veteran's service connection claim (a current disability), the Board notes that the AOJ conceded a diagnosis of chronic neck pain in the July 202
connected. Entitlement to service connection for a bilateral hip disability, to include hip strain, as secondary to service-connected left knee disability, is thus warranted.

8. Entitlement to service connection for a neck disability, to include chronic neck pain and cervical degenerative disc disease (DDD) with bilateral radiculopathy.

The Veteran seeks entitlement to service connection for a neck disability. See June 2020 Claim Application.

Following a review of the evidence, the Board finds that the most probative and persuasive evidence of record is in favor of the Veteran's claim.

Regarding the first element of the Veteran's service connection claim (a current disability), the Board notes that the AOJ conceded a diagnosis of chronic neck pain in the July 2020 rating decision on appeal. The record also documents a diagnosis of multilevel cervical degenerative disc disease (DDD) with bilateral radiculopathy. See January 2020 CAPRI, pg. 119; see also May 2025 Private Medical Opinion. The first element is thereby met.

As for the second element of the Veteran's claim (an in-service injury or event), the Veteran has consistently attributed his neck pain to his military duties as a hydraulic and pneumatic systems administrator, which involved heavy lifting while being on the flight lines. See March 2025 Hearing Transcript, pg. 2. Specifically, the Veteran recounted an in-service incident, in which he injured his shoulders and neck while lifting a tire in 1973. Id. at pgs. 12-13. The May 2025 private provider also noted the same report during his/her review of the evidence. See May 2025 Private Medical Opinion, pg. 3.

While the Board notes that service treatment records (STRs) do not reveal evidence of neck pain, the Board must consider that the Veteran's DD 214 confirms his reported MOS. This MOS could reasonably involve heavy lifting. Additionally, the Board notes that lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). Here, the Veteran personally experienced readily observable events, such as experiencing acute shoulder and neck pain while lifting a heavy airplane tire. Thus, resolving reasonable doubt in the Veteran's favor, the second element of service connection claim is met. Lynch, 21 F.4th at 781-82.

Finally, the Board must determine whether the Veteran's current neck disability is related to his military service.

In May 2025, the Veteran submitted a private medical opinion, in which the provider opined that the Veteran's neck disability is at least as likely as not due to his military service. Based on a review of the Veteran's medical history and lay statements of onset, the provider noted post-service x-ray results that confirm multilevel DDD, bilateral foraminal narrowing, and bilateral radiculopathy. Hence, considering the presence and progression of the Veteran's symptoms during and post service, the examiner concluded that a nexus could be established.

As the only direct nexus opinion of record is favorable, and in view of the other evidence of record, the Board finds that the most persuasive and probative evidence of record weighs in the Veteran's favor. Consequently, the Board finds that the final element for service connection is satisfied. See 38 U.S.C. § 5107 (b). Entitlement to service connection for the Veteran's neck disability, to include chronic neck pain and cervical DDD with bilateral radiculopathy, is thus warranted on a direct basis.

REASONS FOR REMAND

1. Entitlement to a total disability rating based on individual unemployability (TDIU).

In the February 2021 VA Form 10182, the Veteran asserts that he is entitled to a TDIU claim. Accordingly, the issue of entitlement to TDIU has been clearly raised by the record.

However, upon review of the record, the Board finds that the TDIU claim is not ripe for adjudication. Specifically, it is premature to adjudicate the Veteran's TDIU claim given the Board's current decision to grant service connection for the disabilities noted above. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a significant impact upon another, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined).

Therefore, the matter of entitlement to a TDIU must be remanded to the RO to assign ratings for the Veteran's now service-connected disabilities and readjudicate the claim of entitlement to a TDIU in
not ripe for adjudication. Specifically, it is premature to adjudicate the Veteran's TDIU claim given the Board's current decision to grant service connection for the disabilities noted above. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a significant impact upon another, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined).

The matter is REMANDED for the following action:

1. Assign the ratings pursuant to the Veteran's now service-connected left ankle, neck, and bilateral foot, shoulder, and hip disabilities.

2. Conduct any additional development determined to be warranted for consideration of the issue of entitlement to a TDIU and then readjudicate the claim.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Alexander, Lasheyna T.

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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