Citation Nr: 1319518 Decision Date: 06/17/13 Archive Date: 06/27/13 DOCKET NO. 06-38 908 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to service connection for a left knee disorder, to include as secondary to a service-connected disability. REPRESENTATION Appellant represented by: Georgia Department of Veterans Services ATTORNEY FOR THE BOARD T. M. Gillett, Counsel INTRODUCTION The Veteran served on active duty from May 1965 to November 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In a March 2012 Decision and Remand, the Board granted an initial 10 percent rating for residuals of a left thigh wound, and dismissed an increased rating claim for PTSD, per the Veteran's request. In the same document, the Board also remanded the Veteran's respective claims for service connection for left knee, left ankle, and left shoulder disorders to the Appeals Management Center (AMC) for further development. Subsequently, in a January 2013 Decision and Remand, the Board denied the respective claims for service connection for left ankle and left shoulder disorders. In the same document, the Board remanded the claim for service connection for a left knee disorder to the AMC for further development. As will be explained following, the Board finds that the AMC complied with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting the Board's duty to "insure [the RO's] compliance" with the terms of its remand orders). Therefore, the Board will proceed with adjudication of the Veteran's claim. FINDINGS OF FACT 1. The Veteran did not experience chronic left knee disorder symptomatology during service. 2. The Veteran did not experience continuous left knee disorder symptomatology since discharge from service. 3. The Veteran did not experience left knee arthritis symptomatology manifested to a compensable degree within one year of his discharge from service. 4. The Veteran's diagnosed left knee disorder, specifically osteoarthritis or degenerative joint disease of the left knee, is not related to service or to any incident of service. 5. The Veteran's diagnosed left knee disorder was not caused or aggravated by any service-connected disability. CONCLUSION OF LAW Service connection a left knee disorder, to include as secondary to a service-connected disability, is not warranted. 38 U.S.C.A. §§ 1101, 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). VA has a duty to notify a veteran of any information and evidence needed to substantiate and complete a claim. 38 U.S.C.A. §§ 5102, 5103. In order to meet the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), VCAA notice must (1) inform the veteran about the information and evidence necessary to substantiate the claim; (2) inform the veteran about the information and evidence that VA will seek to provide; and (3) inform the veteran about the information and evidence the veteran is expected to provide. VCAA notice should be provided to a veteran before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). The United States Court of Appeals for Veterans Claims (Court) held in Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include (1) the veteran's status; (2) the existence of a disability; (3) a connection between the veteran's service and the disability; (4) the degree of disability; and (5) the effective date of the disability. The Court held that, upon receipt of an application for a service connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim, and to provide the veteran with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Id. at 486. This notice must also inform the veteran that a disability rating and an effective date for the award of benefits will be assigned if service connection is granted. Id. In this instance, a March 2013 VCAA notice letter satisfied the provisions of 38 U.S.C.A. § 5103(a). In this letter, VA informed the Veteran about the information and evidence not of record that was necessary to substantiate the claim; the information and evidence that VA would seek to provide; the information and evidence the Veteran was expected to provide; the information regarding the type of evidence necessary to establish a disability rating or effective date for the disability on appeal required by Dingess; and information regarding the substantiation of a claim for service connection secondary to a service-connected disability. The March 2013 VCAA notice was issued after the issuance of the September 2005 rating decision from which the Veteran's claim arises. In Pelegrini, 18 Vet. App. at 112 (Pelegrini II), the Court held, in part, that a VCAA notice, as required by 38 U.S.C. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. This was not done in this case; however, subsequent to the issuance of the aforementioned notice letter, the AMC re-adjudicated the Veteran's claim, as demonstrated by the April 2013 Supplemental Statement of the Case (SSOC). See Prickett v. Nicholson, 20 Vet. App. 370, 376-78 (2006) (validating the remedial measures of issuing a fully compliant VCAA notification and re-adjudicating the claim in the form of a statement of the case to cure timing of notification defect); Mayfield v. Nicholson, 20 Vet. App. 537, 541-42 (2006) (Mayfield III) (holding that a statement of the case that complies with all applicable due process and notification requirements constitutes a re-adjudication decision). As the April 2013 SSOC complied with the applicable due process and notification requirements for a decision, it constitutes a re-adjudication decision. Accordingly, the provision of adequate notice followed by a re-adjudication "cures" any timing problem associated with notice or the lack of notice prior to an initial adjudication. Mayfield III, 20 Vet. App. at 541-42, citing Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006) (Mayfield II). The Board finds that all necessary assistance has been provided to the Veteran. VA has acquired the Veteran's service, private, and VA treatment records, and Social Security Administration (SSA) records to assist the Veteran with the claim. In a March 2012 Decision and Remand, the Board remanded the Veteran's respective claims for service connection for a left knee disorder to the AMC for further development. Specifically, in the March 2012 Remand, the Board requested that the AMC attempt to procure the entirety of the Veteran's VA treatment records from the Augusta, Georgia VA Medical Center (VAMC), dating back to May 1985. The Board also requested that the AMC provide the Veteran with a VA medical examination to determine the nature and etiology of his claimed left knee disorder. In a January 2013 Decision and Remand, the Board noted that the AMC had partially complied with the Board's March 2012 Remand requests. Specifically, the Board indicated that the AMC had been unable to procure the VA treatment records, dating from May 1985 to February 25, 2004, from the Augusta, Georgia VAMC. The Board noted that the AMC had exhausted all avenues available in attempting to procure the records. After being unable to procure the records, in July 2012, the AMC issued in a Formal Finding of Unavailability of the treatment records, noting the steps they had taken in attempting procurement. In light of the AMC's actions, to include the Formal Finding of Unavailability, the Board finds that an additional remand to seek to obtain the VA treatment records from the Augusta, Georgia VAMC would serve no useful purpose and would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). In the January 2013 Decision and Remand, the Board noted that the Veteran had not been provided with a VA notice letter regarding the substantiation of a claim for service connection, secondary to an already service-connected disability. The Board also noted that the AMC had provided the Veteran with an April 2012 VA medical examination in attempted compliance with the Board's March 2012 Remand requests. The Board noted that, in April 2012 VA medical examination report, the April 2012 VA examiner concluded that the Veteran's degenerative arthritis of the left knee was less likely than not related to service. In support of that opinion, the VA examiner indicated that there were no significant knee problems in the service treatment records. In the January 2013 Decision and Remand, the Board noted that, in a February 1968 service treatment record, a service examiner reported finding no abnormality of the left knee after the Veteran reported experiencing pain in the medial aspect of the knee. The Board found that, in writing the opinion regarding the etiology of the Veteran's left knee disorder, the April 2012 VA examiner did not address the Veteran's in-service treatment for left knee pain. Therefore, the Board remanded the Veteran's claim for the issuance of an appropriate VCAA notice letter and the provision of an additional VA medical examination to determine the nature and etiology of the Veteran's claimed left knee disorder. Subsequently, in March 2013, the AMC issued the VCAA notice letter regarding secondary service connection, in compliance with the Board's January 2013 Remand requests. In addition, in March 2013, the AMC provided the Veteran with a VA medical examination to determine the nature and etiology of the claimed left knee disorder. In the March 2013 VA medical examination report, the VA examiner noted reviewing the claims file, interviewing the Veteran, and providing a thorough examination. Having done so, the March 2013 VA examiner provided an etiology opinion, based on all evidence of record and his medical experience as an orthopedic surgeon. Therefore, the Board finds that the AMC complied with the Board's March 2012 and January 2013 Remand requests. See Stegall, 11 Vet. App. at 271. As the March 2013 VA examiner's opinion is adequate for VA purposes, there is no duty to provide an additional medical examination or opinion. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). In view of the foregoing, the Board finds that VA has fulfilled its duties to notify and assist the Veteran in the claim under consideration. Adjudication of the claim at this juncture, without directing or accomplishing any additional notification and/or development action, poses no risk of prejudice to the Veteran. Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Service Connection Laws and Regulations Service connection may be granted if it is shown a veteran suffers from a disability resulting from an injury sustained or disease contracted in the line of duty, or for aggravation during service of a pre-existing condition beyond its natural progression. 38 U.S.C.A. §§ 1110; 38 C.F.R. §§ 3.303, 3.306 (2012). To establish service connection, generally, there must be (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd 78 F.3d 604 (Fed. Cir. 1996). Disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). For disorders noted by VA to be "chronic," such as arthritis, a disorder also may be service connected if the evidence of record indicates that the disorder was chronic in service or, if not chronic, that was seen in service with continuity of symptomatology demonstrated thereafter. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may be granted for certain diseases noted in VA regulations to be "chronic," such as arthritis, when they are manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.307, 3.309. Also, pursuant to 38 C.F.R. § 3.310(a), a "disability which is proximately due to or the result of a service-connected disease or injury shall be service connected." See Evans v. West, 12 Vet. App. 22, 29 (1998) (noting requirements for establishing service connection on a secondary basis). Thus, in order to establish a secondary service connection claim, a veteran must show (1) the existence of a current (secondary) disability; (2) the existence of a service-connected disability; and (3) evidence that the service-connected disability proximately caused the secondary disability. A veteran may also establish secondary service connection by demonstrating that his current (secondary) disability became aggravated or chronically worsened by the already service-connected disease. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (holding that "when aggravation of a veteran's non-service-connected [secondary] condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation"); see Libertine v. Brown, 9 Vet. App. 521, 522 (1996) (finding that an "additional disability resulting from the aggravation of a non-service-connected [secondary] condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a)"). The provisions of 38 C.F.R. § 3.310 also require that service connection not be awarded on an aggravation basis without establishing a pre-aggravation baseline level of disability and comparing it to current level of disability. The purpose of the regulatory change was to implement the requirements of Allen, 7 Vet. App. 439. In the comments to the new regulation, the changes were intended to place a burden on the claimant to establish a pre-aggravation baseline level of disability for the non-service-connected disability before an award of service connection based on aggravation may be made. If a veteran succeeds in establishing service connection for a secondary condition, "the secondary condition shall be considered a part of the original condition." 38 C.F.R. § 3.310(a). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the veteran. By reasonable doubt is meant one that exists because of an approximate balance of positive and negative evidence that does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. The Board has reviewed all of the lay and medical evidence in the Veteran's claims folder. The Board finds that the Veteran is competent to report the symptoms and impairments associated with his left knee disorder. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (holding that lay statements may serve to support a claim by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability that are susceptible of lay observation). The Board has not discounted lay evidence regarding the Veteran's left knee disorder because it is lay evidence or because it was reported by the Veteran. See Kowalski v. Nicholson, 19 Vet. App. 171 (2005) (holding that a history given by a veteran that has not been found by the Board to be inaccurate is not a basis for discounting an opinion based on that history). That being said, the Board has an obligation to determine the credibility of all evidence, lay and medical. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the duty to assess the credibility and weight to be given to the evidence); Ashley v. Derwinski, 2 Vet. App. 307, 308-09 (1992). The Board has considered all evidence of record as it bears on the question of service connection. See 38 U.S.C.A. § 7104(a) (West 2002 & Supp. 2012) ("Decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C.A. § 5107(b) ("Secretary shall consider all information and lay and medical evidence of record in a case"). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran's appeal. Service Connection for a Left Knee Disorder The Veteran essentially contends that he developed a left knee disorder during service. Specifically, in an August 2004 statement, the Veteran reported that he injured his left knee while serving in Vietnam when he stepped into a pit while on patrol, releasing a "punji stick" which penetrated the Veteran's left leg and knee. The Veteran has reported experiencing pain in his knee since the injury. The Board notes that the Veteran currently is service connected for posttraumatic stress disorder (PTSD), bilateral tinnitus, residuals of a left thigh wound (manifested by scars), and tinea pedis. Having reviewed the record of evidence, the Board finds that the preponderance of the evidence weighs against the Veteran's claim for service connection for a left knee disorder. Briefly reviewing the evidence of record, in January 1966 and February 1966 service treatment records, service examiners indicated treating the Veteran for a puncture wound to the left leg by suturing the wound. The service examiners did not report treating any puncture wound symptomatology related to the left knee. In a February 1968 service treatment record, the Veteran reported experiencing pain in the medial aspect of the left knee. In a February 1968 X-ray report, a service examiner noted finding no abnormalities of the Veteran's left knee. In a September 1970 service discharge medical examination report, a service examiner noted that the Veteran's lower extremities were normal. The post-service treatment records do not contain any notations indicating treatment or diagnosis for a left knee disorder until May 2004. In a May 2004 VA treatment record, the Veteran reported experiencing pain in the knees since 1971. The Veteran reported having no history of an injury to the knees. Upon examination, the VA examiner noted full range of flexion of the left knee, but also indicated feeling very mild crepitation. The VA examiner diagnosed osteoarthritis of the left knee. In a May 2004 VA X-ray report, a VA examiner noted that the Veteran's left knee was normal. In a March 2005 VA medical examination report, the Veteran reported experiencing a 1966 in-service left leg punji stick injury. The Veteran reported experiencing constant knee pain since the incident. The Veteran also reported having a limp and weakness related to the left knee disorder. The Veteran stated that his left knee disorder caused him to miss work three times during the previous month. Upon examination, the March 2005 VA examiner noted that the knee's general appearance was normal. Moreover, the VA examiner reported that drawer and McMurray's tests were normal. The VA examiner noted finding crepitus and medial joint line tenderness. The VA examiner indicated that range of motion, neurological, and motor function tests were normal. The VA examiner indicated that a left knee X-ray was within normal limits. The VA examiner diagnosed a chronic left knee strain with subjective pain and objective crepitus and decreased range of motion with pain. Subsequent treatment records indicate treatment for left knee pain, noted as osteoarthritis of the left knee. In an April 2012 VA medical examination report, the Veteran reported injuring his knee in the fall into the punji pit on January 8, 1966. The Veteran also reported twisting his left knee when his fellow service members pulled him out of the pit on the same date. The Veteran stated that he had a scar in the left thigh area above the knee related to the in-service punji pit injury. The Veteran indicated that he had pain in the anterolateral joint line area of the left knee with intermittent pain which he rated as a six on a scale of 10, occasionally flaring up to an eight on a scale of 10 after walking. The Veteran stated that he also noticed a rubbing sensation under the kneecap area. The Veteran indicated that he did not undergo surgery on the left knee either before or after service. Upon examination, the April 2012 VA examiner noted finding no significant swelling or effusion in the left knee or in the popliteal area. After a full knee examination, the VA examiner diagnosed mild degenerative arthritis of the left knee. After a review of the claims file, the April 2012 VA examiner opined that the Veteran's left knee disorder was less likely than not related to service or any incident of service. In support of this opinion, the VA examiner noted that service examiners noted treating the Veteran for a January 1966 punji stick injury to the left thigh in the service treatment records. The VA examiner further noted that there was no indication in the subsequent service and post-service treatment records of any significant problems with the Veteran's left knee until 2004 or 2005. In a March 2013 VA medical examination report, the Veteran reported experiencing knee pain, measuring eight on a scale of 10, almost all of the time. Upon examination, the March 2013 VA examiner noted that the Veteran demonstrated inconsistent giveaway muscle weakness at the left knee and, when the Veteran was distracted during the examination, the Veteran demonstrated no muscle weakness of the left quads or hamstrings. The VA examiner noted that reflexes in all extremities were normal. Moreover, the VA examiner noted that the Veteran had no tenderness or pain in the left knee joint during range of motion testing, even upon repeat examination. After reviewing the claims file, the March 2013 VA examiner opined that the Veteran's left knee disorder, diagnosed as left knee arthritis, was less likely than not related to service or any incident of service, to include the punji pit incident. The VA examiner noted that the Veteran had a left thigh laceration which he incurred during service in Vietnam in 1966. The VA examiner also noted that the Veteran underwent an X-ray for reported left medial knee region pain in February 1968. Yet, the VA examiner noted that there was no in-service documentation indicating that the Veteran experienced any left knee injury during service or that he experienced a left knee joint disorder during service. In addition, the VA examiner noted that, upon examination that day, the Veteran had no tenderness or pain in the left knee joint, even upon repeat examination. The VA examiner indicated that left and right knee X-rays demonstrated only mild narrowing of the medial joint spaces in both knees, consistent with mild degenerative arthritis as one would expect to find in a person of the Veteran's age. The VA examiner reported being surprised to find that the Veteran's X-rays were almost normal, considering the Veteran's age and experiences during service. The VA examiner, in reporting his own credentials, indicated that he had many years of experience as a board-certified orthopedic surgeon. The VA examiner wrote that, in his professional experience, he had rarely seen an individual of the Veteran's age and service experience with such mild degeneration in the knees. The March 2013 VA examiner also found that the Veteran's left knee disorder was less likely than not caused by or permanently worsened in severity by the Veteran's service-connected disability, to include the service-connected left thigh disability. The VA examiner wrote, in his opinion as an orthopedic surgeon, the Veteran's knees, as seen on X-ray, were in better condition than not only those of the vast majority of people the Veteran's age, but also those of many current service members in their twenties. After a review of the evidence, both lay and medical, the Board finds that the preponderance of the evidence weighs against a grant of service connection for a left knee disorder. First, the evidence indicates that the Veteran did not experience chronic left knee disorder symptomatology during service. As noted above, the Veteran reported experiencing a left knee injury in January 1966 when he fell into a punji stick trap during service. The Veteran has indicated that he injured his knee twice on that day. The Veteran claims that he was injured when he fell into the trap and the stick penetrated his leg, and that he was injured again when his fellow service members pulled him out of the trap, twisting his knee in the process. The Veteran stated that he experienced left knee pain ever since that incident. The Board finds that the Veteran's claims of chronic left knee pain in service following the January 1966 punji trap incident lack credibility. The record indicates January 1966 and February 1966 service examiners treated a puncture wound, claimed by the Veteran as resulting from the punji trap, solely through the use of sutures. Yet, the Board notes that the January 1966 and February 1966 service examiners did not indicate treating any specific left knee injury or, indeed, any structural damage caused by what was noted to be a "puncture wound," requiring only the aforementioned sutures. Although the January 1966 and February 1966 service examiners did not specify the location of the wound, which they referred to only as the being in the "left leg," the Board notes that the Veteran is service-connected for scars of the left thigh which, the Veteran admits, are residuals of the punji trap incident. Although the records contain no notations indicating treatment after the January 1966 punji trap incident, the service treatment records contain no notation indicating that the Veteran was treated for any injury to the left knee at the time, to include puncture damage, damage from a fall, or a twist injury. The Veteran's reports of left knee damage incurred in the punji trap incident are, therefore, inconsistent with the accounts of the January 1966 and February 1966 service examiners included in the service treatment records. The service treatment records contain no notation indicating treatment or diagnosis for any left knee disorder symptomatology until February 1968, more than two years after the documented trap incident. In the February 1968 service treatment record, the Veteran reported experiencing pain in the medial aspect of the left knee. A February 1968 service examiner, having taken X-rays, noted finding no abnormalities of the Veteran's left knee. The record contains no notation indicating treatment or diagnosis for left knee disorder symptomatology during the Veteran's remaining two years of service. In the September 1970 service discharge medical examination report, the September 1970 service examiner noted that the Veteran's left extremities were normal. Therefore, the service treatment records contain only a single record, dated two years after the punji trap incident, indicating treatment for left knee disorder symptomatology. The record contains no subsequent service treatment records indicating treatment for left knee disorder symptomatology during the remaining two years of the Veteran's service. At the time of the Veteran's November 1970 discharge, the Veteran's lower extremities, to include the knees, were deemed to be normal upon examination. The first post-service treatment record indicating treatment for a left knee disorder was written in May 2004, over three decades after the Veteran's discharge from service and approximately three months prior to the filing of this claim for service connection. In the May 2004 VA treatment record, the Veteran reported experiencing left knee disorder symptomatology, specifically pain, since 1971, after his discharge from service. Although the Veteran claims to have experienced left knee pain since a day in January 1966 when he injured his left knee twice, in the May 2004 VA treatment record, the Veteran reported experiencing specifically denied experiencing any specific left knee injury. As the Veteran's reports of chronic in-service left knee disorder symptomatology are inconsistent with the other evidence of record, to include the Veteran's own statements, the Board finds that the Veteran's reports of chronic in-service left knee disorder symptomatology lack credibility. See Caluza v. Brown, 7 Vet. App. 498 (1995) (holding that, in weighing credibility of lay evidence, VA may consider such elements as interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness). Therefore, the evidence indicates that the Veteran did not experience chronic left knee disorder symptomatology during service. The evidence also indicates that the Veteran did not experience continuous left knee disorder symptomatology since discharge from service. As noted above, the Veteran claims to have experienced continuous left knee disorder symptomatology since January 1966. Yet, the service treatment records note only one instance of treatment for left knee disorder symptomatology, specifically pain in the medial aspect of the left knee, in February 1968. The next treatment record on file containing any notation indicating treatment or diagnosis for left knee disorder symptomatology a VA treatment record dated May 2004, more than 33 years after the Veteran's discharge from service. As noted above, in the May 2004 VA treatment record, the Veteran reported experiencing pain since 1971, after his discharge from service and specifically denied experiencing any left knee injury. As the Veteran's reports of continuous left knee disorder symptomatology are inconsistent with both the medical evidence of record and the Veteran's own statements, the Board finds that they lack credibility. See id. The Board also finds that the Veteran did not experience arthritis disorder symptomatology manifested to a compensable degree within a year of his November 1970 discharge from service. As will be explained below, the Veteran is diagnosed currently as having an arthritic disorder of the left knee. Degenerative arthritis is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2012). Diagnostic Code 5003 states that degenerative arthritis, established by X-ray findings, will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion is noncompensable under the appropriate diagnostic codes, a minimum rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. Id. Under C.F.R. § 4.71a, Diagnostic Code 5260 (2012), the diagnostic code utilized in evaluating limitation of flexion of the leg, a compensable 10 percent rating is assigned for symptomatology more nearly approximating flexion of the leg limited to 45 degrees. Under C.F.R. § 4.71a, Diagnostic Code 5261 (2012), the diagnostic code utilized in evaluating limitation of extension of the leg, a minimum compensable 10 percent rating is assigned for symptomatology more nearly approximating extension of the leg limited to 10 degrees. The record indicates that the Veteran was first diagnosed with osteoarthritis of the left knee in May 2004, more than 33 years after the Veteran's discharge from service. Moreover, the treatment records, including the recent VA medical examination reports, contain no notation indicating either limitation of flexion of the leg to 45 degrees or limitation of extension of the leg to 10 degrees. Therefore, the evidence indicates that the Veteran did not experience left knee arthritis disorder symptomatology manifested to a compensable degree within a year of his November 1970 discharge from service. Finally, the Board finds that the Veteran's current left knee disorder is not related to service or any incident of service. Moreover, the Board finds that the Veteran's current left knee disorder was not caused by or permanently worsened in severity by any service-connected disability. It is the responsibility of the Board to weigh the evidence, including the medical evidence, and determine where to give credit and where to withhold the same. Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995); see also Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006) (noting that the Board, as part of its duties, is to weigh the evidence of record and determine credibility). As noted above, in May 2004, a VA examiner diagnosed the Veteran as having osteoarthritis. Subsequently, various examiners, including both the April 2012 and March 2013 VA examiners, confirmed the arthritis diagnosis. Yet, in a March 2005 VA medical examination report, based on his review of an X-ray report, a VA examiner diagnosed the Veteran as having a chronic left knee strain and not an arthritic disorder. However, the Board notes that the March 2005 VA examiner, unlike the April 2012 and March 2013 VA examiners, did not review the claims file prior to writing the March 2005 VA medical examination report. Therefore, the March 2005 VA examiner did not have access to the other diagnoses already of record. Moreover, the Board notes that the other examiners of record, despite thorough reviews of the Veteran's left knee, consistently diagnosed an arthritic condition and did not note finding any muscle strain. Considering this evidence, the Board finds that the preponderance of the evidence indicates that the Veteran's left knee disorder during the pendency of this appeal has been an arthritic disorder rather than a strain. See id. As noted above, in the April 2012 and March 2013 VA medical examination reports, the respective VA examiners diagnosed degenerative arthritis of the left knee. Moreover, in the March 2013 VA medical examination report, after providing a thorough examination and reviewing all evidence of record, the March 2013 VA examiner opined that the Veteran's left knee disorder, diagnosed as left knee arthritis, was less likely than not related to service or any incident of service, to include the punji trap incident. The VA examiner noted that the Veteran had a left thigh laceration which he incurred during service in Vietnam in 1966. The VA examiner also noted that the Veteran underwent an X-ray for reported left medial knee region pain in February 1968. Yet, the VA examiner noted that there was no in-service documentation indicating that the Veteran experienced any left knee injury or left knee disorder during service, outside of the single report of left knee pain. In addition, the VA examiner noted that, upon examination, the Veteran had no tenderness or pain in the left knee joint even upon repeat examination. The VA examiner indicated that left and right knee X-rays demonstrated only mild narrowing of the medial joint spaces in both knees, consistent with mild degenerative arthritis as one would expect to find in a person of the Veteran's age. The VA examiner reported being surprised to find that the Veteran's X-rays were almost normal, considering the Veteran's age and experiences during service. The VA examiner indicated that he had many years of experienced as a board-certified orthopedic surgeon and he rarely had seen an individual of the Veteran's age and service experience with such mild degeneration in the knees. The March 2013 VA examiner also found that the Veteran's left knee disorder was less likely than not caused by or permanently worsened in severity by the Veteran's service-connected disability, to include the service-connected residuals of a left thigh disability. The VA examiner wrote, in his opinion as an orthopedic surgeon, the Veteran's knees, as seen on X-ray, were better than not only those of the vast majority of people the Veteran's age, but also those of many current service members in their twenties. As the March 2013 VA examiner reviewed the claims file, interviewed the Veteran, performed a proper examination, diagnosed the Veteran, and offered opinions backed by both evidence and the VA examiner's own medical knowledge, the Board finds that the March 2013 VA examiner's opinions have great probative value in this matter. See Prejean v. West, 13 Vet. App. 444, 448 (2000) (indicating that the Board may determine the probative value of medical opinions based on their detail, the persuasiveness of their opinions, and the physicians' access to a veteran's medical records). For these reasons, the Board finds that the preponderance of evidence weighs against the claim for service connection and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for a left knee disorder, to include as secondary to a service-connected left leg disability, is denied. ____________________________________________ KELLI A. KORDICH Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs