Citation Nr: 1318356 Decision Date: 06/05/13 Archive Date: 06/11/13 DOCKET NO. 08-04 244 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Manchester, New Hampshire THE ISSUE Entitlement to service connection for a right knee disability. REPRESENTATION Appellant represented by: Kenneth S. Beskin, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Zenzano, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1968 to July 1972. This appeal to the Board of Veterans' Appeals (Board) arises from an August 2007 rating decision in which the RO denied service connection for a back disability and a right knee disability. In August 2007, the Veteran filed a notice of disagreement (NOD). A statement of the case (SOC) was issued in January 2008, and the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) in February 2008. In May 2009, the Veteran testified during a Board hearing before a Veterans Law Judge at the RO; a transcript of that hearing is of record. In an October 2009 decision, the Board, inter alia, denied service connection for a back disability and a right knee disability. The Veteran, in turn, appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In a May 2010 Order, the Court granted a Joint Motion (filed by representatives of both parties) to partially vacate and remand that portion of the October 2009 decision in which the Board denied service connection for a back disability and a right knee disability, and returned these matters to the Board for further proceedings consistent with the Joint Motion. The Board notes that, at the time of the October 2009 Board decision, the Veteran was represented by the Military Order of the Purple Heart (as reflected in a March 2007 VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative). In August 2010, the Veteran filed a VA Form 21-22a, appointing private attorney Kenneth S. Beskin as his representative. The Board has recognized the change in representation. The Board further notes that the Veterans Law Judge who conducted the May 2009 hearing is no longer employed by the Board. The judge chairing such a hearing must decide the veteran's appeal, unless that right is waived by the veteran. See 38 U.S.C.A. § 7107(c) (West 2002). In October 2010, the Board notified the Veteran that he could request a hearing before another Veterans Law Judge who would participate in the final decision. The Veteran's attorney subsequently requested a hearing before a Veterans Law Judge at the RO. Accordingly, in November 2010, the Board remanded the claims for service connection for a back disability and a right knee disability to afford the Veteran the requested hearing. In June 2011, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge at the RO in Hartford, Connecticut; a transcript of that hearing is of record. In September 2011, the Board remanded the matters on appeal to the RO, for further action, to include additional development of the evidence. After completing the requested development, the RO granted the claim for service connection for a back disability in an August 2012 rating decision; hence, that matter is now longer before the Board. However, the RO continued to deny the claim for service connection right knee disability, (as reflected in a July 2012 supplemental SOC (SSOC)), and returned this matter to the Board for further consideration. In May 2012, jurisdiction of the Veteran's claim was transferred to the Manchester, New Hampshire, RO, due to the Veteran's change in residence. As a final preliminary matter, the Board notes that, in addition to the paper claims file, there is a paperless, electronic (Virtual VA) claims file associated with the appellant's claim. The Veteran's Virtual VA electronic claims folder was reviewed in connection with this claim. FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate the claim on appeal have been accomplished. 2. Although the Veteran suffered, and was treated for, a right knee injury during service, there is no credible evidence of continuity of right knee symptoms since service, no right knee disability was shown during service or for many years thereafter, and the most persuasive evidence on the question of whether there exists a medical relationship between the degenerative joint disease diagnosed many years later and service weighs against the claim. CONCLUSION OF LAW The criteria for service connection for a right knee disability are not met. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1131, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Due Process Considerations The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim(s), as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim(s); (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim(s), in accordance with 38 C.F.R. § 3.159(b)(1). The Board notes that, effective May 30, 2008, 38 C.F.R. § 3.159 has been revised, in part. See 73 Fed. Reg. 23,353 -23,356 (April 30, 2008). Notably, the final rule removes the third sentence of 38 C.F.R. § 3.159(b)(1), which had stated that VA will request that a claimant provide any pertinent evidence in his or her possession. VA's notice requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the Ro, to include the AMC). Id.; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In this appeal, in an April 2007 pre-rating letter, the RO provided notice to the Veteran explaining what information and evidence was needed to substantiate a service connection claim, as well as what information and evidence must be submitted by the Veteran, and what information and evidence would be obtained by VA. The April 2007 letter also provided the Veteran with general information pertaining to VA's assignment of disability ratings and effective dates, as well as the type of evidence that impacts those determinations, consistent with Dingess/Hartman. The August 2007 RO rating decision reflects the initial adjudication of the claim after issuance of the April 2007 letter. Hence, the April 2007 letter meets the content of notice requirements of Pelegrini and Dingess/Hartman, as well as the VCAA's timing of notice requirement. The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matter on appeal. Pertinent medical evidence associated with the claims file consists of service and post-service VA and private treatment records. Also of record and considered in connection with the appeal is the July 2012 examination report, the transcripts of the Veteran's May 2009 and June 2011 Board hearings, and various written statements provided by the Veteran. The Board finds that no further action on this claim, prior to appellate consideration, is required. Specifically as regards the Board hearings, the Board points out that the Veteran appeared, along with his then authorized representative, and provided testimony on the matter(s) then before the Board. The transcript of each hearing reflects that the Veteran was afforded the opportunity to present hearing testimony, argument and evidence. The transcripts also reflect appropriate exchanges between the Veteran, his then representative, and the undersigned Veterans Law Judge, in accordance with Stuckey v. West, 13 Vet. App. 163 (1999) and Constantino v. West, 12 Vet. App. 517 (1999). The transcripts further reflect that the Veterans Law Judge identified and explained the material issue(s) then before the Board, and suggested or discussed with the appellant and his then representative the submission of evidence that would support the claim(s). See 38 C.F.R. § 3.103(c)(2) (2012); Bryant v. Shinseki, 23 Vet. App. 488 (2010). The Board hearings are, thus, legally sufficient. As for compliance with the Board's September 2011 remand, as directed, the RO sought to obtain records regarding the Veteran's Rhode Island state disability benefits; however said records were found to be unavailable and the Veteran was notified of this fact. The RO also sent a letter to the Veteran requesting information concerning any additional information and evidence with respect to his claim, including his consent to obtain records from Dr. S.G. A consent form to obtain these records was not returned by the Veteran. Here, the Board notes that the duty to assist is a two-way street. If the Veteran wishes help in developing his claim, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the relevant evidence. Wood v. Derwinski, 1 Vet. App 190, 193 (1991). Also in connection with the remand, the RO obtained updated VA treatment records, which have been associated with the Veteran's Virtual VA electronic file, and the Veteran was afforded another VA examination in July 2012, pursuant to which an appropriate medical opinion was obtained; the examination is deemed adequate for appellate review. Accordingly, the Board finds that the RO has substantially complied with the Board's remand directives, to the extent possible, and that no additional RO action in this regard is required. See Dyment v. West¸ 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall, 11 Vet. App. 268 where Board's remand instructions were substantially complied with); see also D'Aries v. Peake, 22 Vet. App. 97, 105-106 (2008) (finding that substantial compliance, rather than strict compliance, with the terms of a Board engagement letter requesting a medical opinion is required). In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices, the Veteran has been notified and made aware of the evidence needed to substantiate this claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with this claim. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the Veteran or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matter herein decided, at this juncture. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006) (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analysis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish entitlement to direct service connection, there must be: (1) competent and credible evidence confirming the Veteran has the claimed disability or, at the very least, showing he has at some point since the filing of his claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or an injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). See also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The determination as to whether elements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Certain chronic diseases, such as arthritis, shall be presumed to have been incurred in service if manifested to a compensable degree within a prescribed period post service (one year for arthritis) even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributed to intercurrent causes. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is questioned. When the fact of chronicity in service is not adequately supported, then the showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The United States Court of Appeals for the Federal Circuit recently clarified that the provisions of 38 C.F.R. § 3.303(b) pertaining to the award of service connection on the basis of continuity of symptomatology (in lieu of a medical opinion) is limited to chronic diseases as defined in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Considering the evidence in light of the governing legal authority, the Board finds that the claim for service connection for a right knee disability must be denied. That the Veteran has a current disability and suffered an in-service injury are not in contention. In this regard, he has a current diagnosis of osteoarthritis of the right knee. Service treatment records (STRs) reflect that he was involved in a bicycle accident in September 1970. He had an abrasion on his left elbow and pain in his right leg and over his lateral right knee. Examination of his right knee revealed crepitus over his patella, but his ligaments and cartilage were "O.K." He had no effusion, and an X-ray was negative. He was diagnosed as having a contusion, and he was prescribed no duty and told to stay off his knee. (A contusion is defined as a bruise or an injury of a part without a break in the skin. See Dorland's Illustrated Medical Dictionary 410 (32nd ed. 2012)). The Veteran's May 1972 separation examination was normal, including a normal clinical evaluation of his lower extremities. However, the record fails to persuasively establish that the Veteran's current right knee disability is medically-related to service, to include injury therein. Post service, the earliest documented evidence pertaining to the right knee is reflected in VA treatment records, dated in October 2006; these records document a history of an injury and subsequent surgery of his right knee. March 2007 VA treatment records note that the Veteran gave a medical history of hitting his right knee on a tailpipe that required surgery in 1975 (post-service), and a few years later falling onto ice at work and subsequent surgery again in 1977. In February 2009, the Veteran underwent a VA examination. The examiner noted that the Veteran had knee trauma 40 years ago, but also noted a current normal examination with no apparent functional impairment. The physician commented that, although the record reflected that the Veteran sustained an injury to his right knee 40 years earlier, there was substantial insufficient data to warrant any opinion as to whether service had caused his current claimed problem. He concluded by stating that to entertain an opinion with the insufficient data would be to entertain speculation. In the May 2010 Joint Motion, the parties found that the February 2009 VA examiner's opinion was inadequate, as the examiner did not specify the precise data that would allow him to render an opinion as regards a connection between the Veteran's present complaints regarding his back and right knee and his in-service injuries, nor did he indicate whether further testing could be of potential benefit to his medical examination. See Joint Motion, at p. 2-3, citing Jones v. Shinseki, 23 Vet. App.382, 391-93 (2010). In a September 2010 VA treatment note addendum, the VA physician who had been providing care for the Veteran's knee and back disabilities offered the following: [The Veteran] is requesting notation via a letter from his attorney as to my medical opinion as to the service connection of his problems with back and leg pain - I am not a comp and pen evaluator and cannot specifically comment other than to state that the patient has always stated to me in detail that all of his musculoskeletal complaints were initially related to service related injuries -if one takes this as a report then it is certainly as likely as not that his current problems with chronic pain are related to his time in the service. In August 2012, the Veteran was awarded service connection for a back disability and radiculopathy of the right lower extremity. Pursuant to the Board's September 2011 remand, the Veteran underwent VA examination in July 2012. The examination report documents that the examiner reviewed the Veteran's claims file and VA electronic treatment records. The Veteran's medical history was recounted, to include a recitation of the facts noted in his STRs of his in-service knee injury, his assertions that his separation examination was invalid, that he sought VA care for his knee after service but was denied such, and that he has had knee surgeries in 1975, 1977 and 1997. After taking a thorough medical history and conducting a comprehensive examination of the Veteran, the examiner opined that the Veteran's right knee disability was less likely than not related to service. He commented on the Veteran's in-service injury, and reasoned that, had the injury been more significant, he would have expected additional notes and follow up (to have been documented in the STRs). He further noted the Veteran's post-service history of two work-related injuries requiring surgical intervention. The examiner then stated: It is noted that he had been working on a highway road maintenance crew at the time, a job that involved a considerable amount of standing and jumping down off of trucks per the Veteran's description of the work. It seems unlikely that he would have been able to perform this work had he a significant knee problem at the time. The fact that the Veteran has degenerative osteoarthritis only in the right injured knee would indicate that this is the result of trauma and not just part of the natural aging process. I believe that the Veteran's current knee disability is most likely due to his post service worker's comp injuries and less likely as not due to his in service right knee injury. There is no convincing evidence of record that the Veteran had any significant residual right knee disability at the time of his work injury in 1975 and any subsequent knee disability is more likely the result of the injuries and surgeries in 1975 and 1977. In analyzing the evidence of record, it is entirely within the Board's province to give more probative weight to certain pieces of evidence than others. See Schoolman v. West, 12 Vet. App. 307, 310-311 (1999); Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Federal Circuit Court has recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). As regards evidence submitted in support of the claim, the Board turns to the September 2010 VA physician's note reflecting a comment that it is as likely as not that his current problems with chronic pain are related to his time in the service. A reasonable, yet liberal, reading of the September 2010 VA physician's note indicates that the examiner comments encompasses the Veteran's right knee disability; the Board adopts this view, as it is most favorable to the Veteran. Even if so, however, the September 2010 opinion is of limited probative value. There is no indication that the physician had reviewed the Veteran's service treatment records or was aware of the details of the Veteran's in-service injury, other than what the Veteran had reported to him. The physician also did not address the significance of the Veteran's post-service injuries and surgeries, including those in 1975, 1977 and 1997. Indeed, the examiner provided no rationale for his opinion whatsoever. A bare conclusion, even one reached by a medical professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Moreover, the Court has held that the value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). By contrast, the Board accords the July 2012 VA examiner's opinion significant probative weight. The examiner provided detailed clinical findings and conclusions, which were based upon physical examination, testing results and medical principles. The examiner recounted the Veteran's pertinent medical history, to include specifically addressing the details of the Veteran's in-service injury, as described in his STRs. The Veteran also denied that he told the July 2012 VA examiner that his post-service highway maintenance job involved picking up trash and not jumping in and out of trucks. See August 2012 statement. In this regard, the Board notes that a Veteran's contemporaneous statements to physician or other medical professional, made in connection with treatment, are more credible than those made in furtherance of a claim for benefits. See White v. Illinois, 502 U.S. 346, 355-56 (1991) (noting that statements made for the purpose of medical diagnosis or treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive a proper diagnosis or treatment). Accordingly, the Board finds that the Veteran's more recent assertions that he did not jump up and down from trucks while working highway maintenance are simply inconsistent with the documented evidence of record, and are not credible. Moreover, to the extent the Veteran has alleged continuity of symptomatology of right knee problems since service, the Board observes that the Veteran, as a layperson, is competent to report on matters observed or within his personal knowledge, and thus is competent to report his symptoms. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994), and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Here, while the Board finds the Veteran's reported history of continued symptomatology since active service competent, it is nonetheless not credible. Significantly, the Veteran's reported history of continued symptoms since active service is inconsistent with the other evidence of record, as illustrated in the summary of facts above. See Caluza v. Brown, 7 Vet. App. 498 (1995) (in determining whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of a veteran). Here, the Board notes that the Veteran has asserted in various statements of record that his separation examination does not reflect the true nature of his condition and is therefore invalid, that he sought VA care in the 1970s, 80s and 90s, but was repeatedly refused because his disability was not service connected, and that he waited to file his claim because of his belief that he would just be denied anyway. See generally, June 2011 Board Hearing Transcript. The Board places far greater probative value on the pertinently negative contemporaneous service department records than it does on the more recent statements of the Veteran. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the veteran); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (noting that it was proper to consider the veteran's entire medical history, including the lengthy period of absence of complaint with respect to the condition he now raised). Such records are more reliable, in the Board's view, than the Veteran's unsupported assertion of events over forty years ago. See also Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom, Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (noting that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact). Although the lack of contemporaneous medical evidence does not, in and of itself, render the lay testimony incredible, the absence of such evidence may go to the credibility and weight of the Veteran's lay testimony. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Here, the Veteran's statements are self-serving and are unsupported by his service records. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (stating that VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence). Furthermore, the Board notes that there are no objective documentations of right knee symptoms until October 2006-more than 34 years after service separation. The Board notes that the passage of so many years between discharge from active service and the objective documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Additionally, as there was no evidence of arthritis within one year of discharge, the in-service incurrence of arthritis may not be presumed. Additionally, despite the Veteran's assertions that he did not bother to file a claim soon after service separation because he believed he would be denied, he filed a dental claim in March 1985. Such an inconsistency undermines the Veteran's credibility and militates against his claim. If the Veteran had been experiencing right knee pain since service, it is reasonable to believe he would have also filed a claim at that time for his right knee. This, combined with the fact that the Veteran did not file a claim for his right knee until decades after service tends to refute the Veteran's contentions that he had been having chronic right knee pain since service. The Board also observes that VA treatment notes, dated May 2010, note that the Veteran is a "poor historian," providing additional cause to question the Veteran's credibility. Accordingly, the Board finds the Veteran's statements assertions as continuity of right knee symptoms during and since service to be lacking in credibility and probative value. Finally, as for any direct assertions by the Veteran and/or his former representative or current attorney that there exists a medical relationship between the Veteran's current right knee disability and his service, the Board notes that the matter of the medical etiology of the right knee disability under consideration is a complex medical matter, and one within the province of trained professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As one of the identified individuals is shown to be other than a layperson without appropriate training and expertise, none is competent to render a probative (i.e., persuasive) opinion on the medical matter upon which this claim turns. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998); see also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Hence, lay assertions of medical nexus between the Veteran's right knee disability and military service are not considered competent or probative evidence favorable to his claim. In view of all the foregoing, the Board finds that the claim for service connection for a right knee disability must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim. that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Service connection for a right knee disability is denied. ____________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs