ANKLE IMPAIRMENT OF

Summary

The veteran, who served in the U.S. Navy from November 1995 to September 2000, appeals the denial of service connection for left ankle residuals of an eversion injury. The veteran sustained an in-service left ankle inversion injury during physical training in March 1998, which was treated with a walking cast. Although the separation examination did not note ankle disability, the veteran reported continued pain and tightness, and sought treatment for chronic left ankle pain in 2008 and again in 2021. The Board found that the in-service injury, despite a concurrent fifth metatarsal fracture diagnosis, led to long-term ankle instability. This instability was supported by the veteran's consistent reports of pain, the need for bracing, and subsequent medical treatment, including a fracture and surgery in 2021. The Board afforded the veteran the benefit of the doubt, finding a nexus between the in-service injury and current residuals. A private medical opinion was deemed adequate and probative, linking the in-service injury to the current instability and subsequent fracture. Conversely, a VA medical opinion was found inadequate as it did not address the veteran's lay statements or the full scope of the in-service injury and subsequent symptoms. Service connection for left ankle disability residuals is therefore granted.

Rationale

Current disability with residuals; In-service inversion injury sustained during PT; Adequate private medical opinion linking in-service injury to current instability and residuals; VA opinion found inadequate for failing to address lay statements and full scope of injury; Benefit of the doubt afforded to veteran

Full Decision Text

Citation Nr: A26040291
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210818-180888
DATE: April 29, 2026

ORDER

Entitlement to service connection for left ankle disability residuals is granted.

FINDING OF FACT

The evidence of record supports a finding that the appellant's current left ankle disability residuals is due to is otherwise related to an in-service left ankle inversion injury. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for left ankle disability residuals are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The appellant served on active duty in the United States Navy from November 1995 to September 2000.  

Procedural History

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2021 rating decision issued by the Department of Veterans Affairs (VA) Veterans Benefits Administration, the agency of original jurisdiction (AOJ), which denied service connection for left ankle residuals of eversion injury. VA timely received the appellant's August 2021 notice of disagreement (NOD), via VA Form 10182. The appellant selected the Board's Hearing docket. A Board Hearing was held before the undersigned Veterans Law Judge (VLJ) in May 2025. A transcript of the proceeding is of record.

Applicable Evidentiary Windows

The Board may only consider the evidence of record before the AOJ at the time of its decision on the issue on appeal, evidence submitted by the appellant or his or her representative at the Board hearing, to include testimony provided at the hearing; and evidence submitted within 90 days following the Board hearing. 38 C.F.R. § 20.300(a), 302(a). If additional evidence was submitted between the dates of the AOJ decision and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following each of these actions. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. See also Cook v. McDonough, 36 Vet. App. 175 (2023).

Entitlement to service connection for left ankle disability residuals is granted.

The appellant seeks service connection for the residuals of an in-service left ankle injury. See NOD, August 18, 2021.

Legal Criteria

Establishing service connection generally requires (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

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. 38 C.F.R. § 3.310(a)-(b). The United States Court of Appeals for the Federal Circuit clarified the standard for secondary service connection in Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023), finding that secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Id. Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364.

Legal Analysis

A March 1998 service treatment record (STR) shows the appellant presented for medical care after twisting his left ankle rolling over onto his foot. After an x-ray, the appellant was found to have a small fracture of his fifth proximate metatarsal. See STR, March 3, 1998. He was referred for an orthopedic consultation for his left ankle eversion injury with findings of fracture of the fifth proximal metatarsal. Id. An acute orthopedic care note states the
 in a causal chain. Id. Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364.

Legal Analysis

A March 1998 service treatment record (STR) shows the appellant presented for medical care after twisting his left ankle rolling over onto his foot. After an x-ray, the appellant was found to have a small fracture of his fifth proximate metatarsal. See STR, March 3, 1998. He was referred for an orthopedic consultation for his left ankle eversion injury with findings of fracture of the fifth proximal metatarsal. Id. An acute orthopedic care note states the appellant was status post inversion injury to left ankle while playing basketball. See STR, March 6, 1998. He was placed in a walking cast. Id. The appellant's report of medical examination (RME) for separation did not note any ankle or foot disability. See STR, July 6, 2000.

The appellant's March 2008 informal claim asserts frequent pain in left ankle which was broken in March 1998 in-service during physical training (PT). He complained of pain after extensive walking, weather, or other use. 

At an August 2008 VA Joint examination, the appellant reported an in-service left ankle fracture, treated in a walking cast for two months, and which was ok upon case removal. He was able to keep using his ankle but started to feel tight and would ache with weather or prolonged standing. See VA examination, August 4, 2008. A physical examination and x-ray revealed a normal left ankle that ached with heavy use due to an old injury. Id.

The appellant next sought left ankle treatment in February 2021 VA Treatment records, where he reported left ankle pain and was given a wrap. He sought treatment again in March 2021, for his chronic left ankle pain, which occurred on and off and was worse with activity. See VA treatment record, March 17, 2021. When he was seeking treatment, the appellant reported his left ankle pain started after he fractured his ankle a long time ago in service, that it was treated with a cast, and, ever since the injury, he has had ankle pain which had progressively worsened of the past year. Id. He also said he purchased an over-the-counter ankle sleeve and wears tennis shoes for support. Id. At that time, he did not have an acute fracture or dislocation and was diagnosed with left ankle pain. Id. His May 2017 VA treatment records show more complaints of ankle pain, and June 2021 VA treatment records show an ankle fracture based on an x-ray of a mildly displaced fibular fracture, which required surgery. A June 2025 private treatment record shows the appellant continues to have persistent pain and stiffness and uses ankle braces for stabilization of his left ankle. The appellant's private treatment provider also filled out an ankle conditions Disability Benefits Questionnaire (DBQ) providing current diagnoses of left lateral collateral ligament sprain and tendonitis with appellant reporting frequent pain and limitation of weight bearing activities requiring physical therapy, bracing, and supportive gear. See private ankle DBQ, June 10, 2025.

In August 2021, the appellant attended a VA examination where he asserted his left ankle disability onset in 2021 but stated he fractured his left ankle in service when he rolled his ankle in PT and was treated with a soft cast and light duty. The appellant reported continued left ankle pain, wearing a VA provided brace, and in May 2021, he shifted his weight and fractured his ankle resulting in surgery. See VA Ankle Conditions DBQ, August 4, 2021. The DBQ shows the appellant had left ankle functional impairment described as difficulty with weightbearing. Id. 

An accompanying August 2021 VA medical opinion provides a direct service connection opinion that the appellant's current left ankle disability residuals are not likely due to service; however, the rationalization provided addresses why the appellant's in-service fifth metatarsal foot fracture would not have resulted in the appellant's ankle instability and led to his current disability.  

The appellant provided a June 2025 private medical opinion that his current left ankle disability residuals are likely due to his military service. Specifically, the opinion, based on a review of the medical records, determined the appellant had both a fifth metatarsal fracture and an ankle inversion injury in service, which led to long term ankle instability that was not corrected, and his May 2021 ankle fracture and resulting residuals are due to his ankle instability. See private treatment record, June 20, 2025. 

The appellant also testified at a May 2025 Board Hearing that he rolled his foot from the outside during PT. He first thought it was an ankle injury but was identified as
 appellant's ankle instability and led to his current disability.  

The appellant provided a June 2025 private medical opinion that his current left ankle disability residuals are likely due to his military service. Specifically, the opinion, based on a review of the medical records, determined the appellant had both a fifth metatarsal fracture and an ankle inversion injury in service, which led to long term ankle instability that was not corrected, and his May 2021 ankle fracture and resulting residuals are due to his ankle instability. See private treatment record, June 20, 2025. 

The appellant also testified at a May 2025 Board Hearing that he rolled his foot from the outside during PT. He first thought it was an ankle injury but was identified as a fifth metatarsal fracture and treated in a boot cast until the fracture healed. See Board Hearing, May 2, 2025. He reported additional left ankle treatment at VA, including bandages and sleeves for additional support. Id. During the Hearing, the appellant specified his assertion that the initially rolling of his foot in-service caused instability, which led to the need for bracing, and ultimately led to his current left ankle disability residuals. Id.

The August 2021 rating decision on appeal favorably found the appellant has been diagnosed with a left ankle eversion injury and was treated for a left ankle injury in service. In the absence of clear and unmistakable evidence to the contrary, the Board is bound by these favorable findings. See 38 C.F.R. §§ 3.104(c), 20.801(a). Elements (1), current disability, and (2) in-service disease or injury, have been met.  See Shedden, supra.

As to Shedden element (3), nexus, affording the appellant the benefit of the doubt, the evidence of record supports a finding that the appellant's in-service left ankle inversion injury, led to instability in his left ankle, resulting in an ankle fracture and his current left ankle disability residuals. 

First, the evidence of record shows the appellant complained of ankle pain in-service and was found to have a left ankle inversion injury due to rolling his ankle in PT. Although the appellant was also diagnosed with a fifth metatarsal fracture, such a diagnosis does not exclude him from also injuring his left ankle in-service. Further, although he seemed ok after removing his walking cast and his RME for separation did not note any ankle disability, the additional evidence of record indicates his left ankle continued to have symptoms as he reported left ankle pain and discomfort in a March 2008 Statement and tightness and pain at an August 2008 examination. The appellant's VA treatment records also indicate long term symptoms regarding his left ankle as he described his left ankle pain as chronic, on and off, and worse with activity. He also reported left ankle pain since his in-service injury, which had continued to progress to the need for a sleeve and supportive shoes. Finally, his VA treatment records show an increase in medical complaints regarding his left ankle the year before his left ankle fracture, indicating an association between his chronic left ankle pain complaints and his ankle fracture. Thus, his medical treatment records indicate a continuation of left ankle pains since his in-service PT injury.

Additionally, the adequate medical opinion of record opines the appellant's current left ankle disability residuals are due to his military service, specifically his in-service left ankle inversion injury. A medical opinion is adequate when the medical expert discusses 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. Miller v. Wilkie, 32 Vet. App. 249, 254 (2020). It is a medical examiner's responsibility to provide a well-supported opinion so that the Board may carry out its duty to weigh the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (concluding that a medical opinion is not entitled to any weight "if it contains only data and conclusions").

Here, the June 2026 private medical opinion, addressing direct service connection, is adequate as it is based upon consideration of the appellant's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the claimed disability is a fully informed one. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (an adequate medical examination must provide a rationale and explanation for its conclusions). Specifically, the opinion documents treating the appellant and reviewing his medical records and rationalized the appellants in-service ankle inversion injury led to long term ankle instability, and a left ankle fracture due to that ankle instability. This opinion is also supported by
 direct service connection, is adequate as it is based upon consideration of the appellant's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the claimed disability is a fully informed one. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (an adequate medical examination must provide a rationale and explanation for its conclusions). Specifically, the opinion documents treating the appellant and reviewing his medical records and rationalized the appellants in-service ankle inversion injury led to long term ankle instability, and a left ankle fracture due to that ankle instability. This opinion is also supported by the additional evidence of record, including medical treatment records and lay statements, confirming the appellant's report of an ankle injury in-service, continued symptoms of pain, discomfort, and tightness, followed by medical treatment, including bracing. Moreover, the August 2008 VA examination notes the appellant's left ankle ached with heavy use due to an old injury, indicating a connection between the appellant's in-service left ankle injury and his continued symptoms of pain. As the June 2026 medical opinion is adequate and supported by the consistent evidence of record, it is afforded significant probative weight. 

Contrarily, the August 2021 VA negative medical opinion does not adequately address the appellant's claim of direct service connection. While the opinion states the appellant's current left ankle disability residuals are not likely due to service, the rationale provided addresses why the appellant's in-service fifth metatarsal foot fracture would not have resulted in the appellant's ankle instability and led to his current disability, a secondary service connection opinion. The opinion does not address the appellant's lay statement as to rolling his ankle in PT, the STR showing a left ankle inversion injury, and continuous complaints and treatment for left ankle pain. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinion based on inaccurate factual premise may properly be rejected as non-probative); Miller v. Wilkie, 32 Vet. App. 249, 260 (2020) (holding an "examiner must address the veteran's lay statements to provide the Board with an adequate medical opinion"); Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007) (holding that an examination was inadequate where the examiner did not comment on the Veteran's report of in-service injury and instead relied entirely on the absence of evidence in the service treatment records to provide a negative opinion). Therefore, the August 2021 medical opinion is afforded no significant weight.

In sum and affording the appellant the benefit of the doubt, the appellant has a current left ankle disability with residuals, an in-service left ankle inversion injury, and medical evidence establishing a nexus between the appellant's current disability and in-service injury. The appellant's claim for service connection is granted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).

 

 

K.A. KENNERLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Wayne, Associate Counsel

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.