ANKLE IMPAIRMENT OF

JONATHAN B. KRAMER · 2026 · Case ID: A26040035

GRANTED

Summary

The Veteran, an Army Veteran who served from September 1998 to December 2003, appealed the denial of service connection for a bilateral ankle disability. The Veteran claimed this condition was secondary to his already service-connected bilateral knee and low back disabilities. The Board reviewed the evidence, including the Veteran's service treatment records (STRs), which showed no ankle complaints during service. However, a January 2024 private chiropractic examination and opinion from Dr. S.G. diagnosed bilateral ankle myofascial syndrome and opined that it was at least as likely as not aggravated by the service-connected knee and back strains, citing biomechanical relationships and overcompensation. A June 2024 VA examination also diagnosed bilateral ankle myofascial syndrome and opined that it was at least as likely as not due to or the result of the service-connected knee and back strains, explaining how increased wear and tear on joints can occur from overcompensation. Both the private and VA opinions provided similar rationales regarding the kinematic chain and aggravation of ankle conditions due to back and knee issues. The Board found both opinions persuasive and aligned, noting no conflicting evidence. Applying the benefit of the doubt, the Board found the criteria for secondary service connection met. Therefore, service connection for the bilateral ankle disability was granted as secondary to the service-connected bilateral knee and low back disabilities.

Rationale

Service-connected bilateral knee and low back disabilities established.; Private and VA opinions found bilateral ankle disability aggravated by service-connected knee/back conditions.; Opinions cited biomechanical relationship and overcompensation.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260128-634508

Full Decision Text

Citation Nr: A26040035
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 260128-634508
DATE: April 29, 2026

ORDER

Entitlement to service connection for a bilateral ankle disability is granted.

FINDINGS OF FACT

The Veteran's bilateral ankle disability is at least as likely as not caused or aggravated by his service-connected bilateral knee and low back disabilities.

CONCLUSIONS OF LAW

The criteria for service connection for a bilateral ankle disability as secondary to service-connected left knee and low back disabilities are 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 Army from September 1998 to December 2003.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2024 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In March 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the claim for service connection for a bilateral ankle disability, most recently addressed in a July 2021 rating decision. In August 2024, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.

In October 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the August 2024 decision. In January 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior August 2024 decision.

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the August 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like 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. 38 C.F.R. § 3.2501. 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. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to service connection for a bilateral ankle disability

The Veteran seeks entitlement to service connection for a bilateral ankle disability. Specifically, he contends that his bilateral ankle disability is secondary to his service-connected bilateral knee and low back disabilities.

Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained in the line of duty during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a).

Service connection on a direct basis generally requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability which is due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires (1) evidence of a current nonservice-connected disability; (2) evidence of a service-connected disability; and (3) evidence establishing that the service-connected disability either (a) caused, or (b) aggravated, the nonservice-connected disability. 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (
1163, 1166-67 (Fed. Cir. 2004).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. This standard does not require the evidence to be exactly equal; rather, it includes "scenarios where the evidence is not in equipoise but nevertheless is in approximate balance. Put differently, if the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt." Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

In the August 2024 rating decision on appeal, the AOJ found that the Veteran has a currently diagnosed disability. The Board is bound by favorable findings of the AOJ unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. See 38 C.F.R. § 3.104(c), 20.801(a). In this case, the favorable finding is supported by the medical evidence of record, discussed in further detail below, which indicates a diagnosis of bilateral ankle myofascial syndrome. Accordingly, the Board adopts the favorable finding of the AOJ and finds that the first element of secondary service connection is satisfied. The AOJ denied the Veteran's claim, in part, because of a failure to show for an examination. However, as is described below, there was an adequate examination of the ankles already of record, so there was no need for the Veteran to attend another one.

Additionally, the Veteran has been service connected for the claimed primary conditions of lumbosacral strain and bilateral knee strain, since June 1, 2021. Accordingly, the Board finds that the second element of secondary service connection is satisfied.

Therefore, with regard to secondary service connection, the remaining question before the Board is whether the Veteran's bilateral ankle myofascial syndrome is caused or aggravated by his service-connected lumbosacral strain and/or bilateral knee strain.

Turning to the evidence of record, the Veteran's service treatment records (STRs) contain a June 1997 enlistment examination. The Veteran denied any history of painful joints, and his lower extremities were evaluated as normal. At a July 2003 post-deployment examination, the Veteran denied painful joints. The STRs are silent for any treatment or complaints of ankle pain, swelling, or other symptoms.

The claims file contains a January 2024 private medical examination and opinion from a private chiropractic provider, Dr. S.G., D.C. The Veteran reported that following separation from service, he began experiencing bilateral ankle pain with stiffness and "clicking and popping" upon exertion. He reported difficulty standing and walking for long periods, climbing stairs, hills, and inclines, and bending or squatting. On physical examination, all ranges of motion were limited and painful for both ankles. A diagnosis of bilateral myofascial syndrome with pain was noted. Dr. S.G. opined that the Veteran's bilateral ankle condition was at least as likely as not aggravated by his bilateral knee strain and lumbosacral strain. The following rationale was provided:

Consistent with the peer-reviewed orthopedic and physical therapy literature, it is common for individuals with ankle disorders (when either unilateral or bilateral) to be significantly affected by comorbid back and lower extremity disorders, as each of the these play a crucial role in the biomechanics of posture, station and gait. This biomechanical relationship, known as the kinematic chain, depends on quality input from each joint of both lower extremities to maintain equal loading while an individual is standing. Furthermore, this facilitates symmetric load distribution which helps an individual achieve an effortless, flowing gait and maintains biomechanical efficiency for other more complex and strenuous movements. When the kinematic chain is disrupted by pathology in one or more joints, this includes the back, the resulting overcompensation leads to alterations in biomechanics and aggravation, dysfunction and pain in other joints and that may have developed disabling comorbid conditions. [...] It is without question that his SC left knee strain, SC right knee strain and sc lumbosacral strain alters the kinematic chain including his back and lower extremities and, therefore, the biomechanics of his posture, station and gait, which, in turn, aggravates his bilateral ankle myofascial syndrome.

The Veteran underwent a VA examination in June 2024. The Veteran was examined in-person, and a review of the VA e-folder was noted. A diagnosis of bilateral ankle myofascial syndrome was noted, with symptoms of loss of power, weakness, lowered threshold of fatigue, fatigue and/or pain, and uncertainty of movement. Reduced muscle strength on ankle plantar flexion and ankle dorsiflexion was noted. The examiner opined that the Veteran's bilateral ankle condition was at least as likely as not due to or the result of both the service-connected bilateral knee strain and the service-connected lumbosacral strain. The following rationale was provided:

Lower joints such as the hips, knees and ankles will suffer the most from overcompensation. The mechanics of the body are carefully balanced when a joint is forced to endure greater forces and weight. It can lead to deterioration of the bones or injuries to ligaments and tendons if you're putting more weight on an uninjured joint, there is the potential for developing bone related conditions. This is typically due to increased wear and tear.

Having considered the above, the Board finds that the Veteran's bilateral ankle disability is at least as likely as not caused or aggravated by the service-connected bilateral knee strain and lumbosacral strain.

The Board notes that both the January 2024 private opinion and the June 2024 VA opinion endorse a nexus between the claimed ankle disability and the service-connected knee and back disabilities. Additionally, the opinions appear to be aligned as to the specific biomechanical relationship between the Veteran's back, knee, and ankle injuries. Both opinions provide adequate rationales to explain how injuries in one joint can cause overcompensation, leading to wear and tear on other joints. Notably, the claims file contains no conflicting opinions of record.

Accordingly, the Board finds that the criteria for service connection for a bilateral ankle disability as secondary to service-connected bilateral knee and low back disabilities are met, and the claim is granted.

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Utter, Margaret 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.

Analyze in VA Law Explorer