Citation Nr: 1324063 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 10-13 536 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUE Entitlement to service connection for a bilateral knee disorder. REPRESENTATION Appellant represented by: Vietnam Veterans of America WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Mary E. Rude, Associate Counsel INTRODUCTION The Veteran served on active duty from June 1956 to June 1960. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. In June 2011 and July 2012, the Board remanded the claim for addition development, including the holding of a Board hearing. A Board hearing via videoconference was held before the undersigned Veterans Law Judge in February 2013, and all additional requested development has been completed. See Stegall v. West, 11 Vet. App. 268 (1998). In April 2013, the Veteran's claim was referred for a medical opinion by an expert from the Veterans Health Administration (VHA). 38 U.S.C.A. § 7109 (West 2002); 38 C.F.R. § 20.901 (2012). In April 2013, an opinion letter was received and was later referred to the Veteran and his representative for review and the submission of any additional evidence or argument. 38 C.F.R. §§ 20.903, 20.1304(c) (2012). A copy of the VHA opinion letter has been associated with the claims file. In July 2013, the Veteran submitted additional evidence and argument in support of his claims on appeal. This evidence was accompanied by a waiver of review by the agency of original jurisdiction. As such, there is no prejudice in the Board reviewing this evidence in the first instance. See 38 C.F.R. § 20.1304 (2012). In addition to the paper claims file, there is an electronic claims file associated with the claim. A review of the documents in such file reveals that they are duplicative of the evidence in the paper claims file or irrelevant to the issue on appeal. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The evidence is in equipoise as to whether the Veteran's current bilateral knee disorder is causally related to his military service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, a bilateral knee disorder was incurred during active duty service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Veterans Claims Assistance Act The requirements of the Veterans Claims Assistance Act of 2000 (VCAA) have been met. In light of the fact that the Board allows the benefit sought, discussion of the notice and assistance requirements of the VCAA and a detailed explanation of how VA complied with the Act is unnecessary. Relevant Laws and Regulations Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Analysis The Veteran seeks entitlement to service connection for a bilateral knee disorder. He has described in written statements, and at his February 2013 Board hearing, that he first started having problems with his knees while serving in the Air Force, where he spent a great deal of time kneeling on concrete floors to repair aircraft. The Veteran has stated that he was treated for knee pain in service and was told at that time that he had arthritis, but he did not have any X-rays during service. The Veteran's May 1960 separation examination notes, "History of arthritis of knees-this condition approximately one year ago-none since, no (complications), no (sequelae)." The Veteran has provided records from his August 2006 left knee arthroplasty due to osteoarthritis, and a May 2013 VA X-ray report showing degenerative changes in the right knee. In September 2008 and October 2009, the Veteran was provided VA examinations by the same VA physician. At both examinations, the examiner discussed the Veteran's symptoms of knee pain, stiffness, and weakness; and noted that he had a limping gait. He diagnosed left knee degenerative joint disease, status post prosthesis; and right knee degenerative joint disease. The examiner opined that it was not caused by or related to the arthritis noted on his May 1960 separation examination, but was more likely caused by wear and tear due to age. The examiner also provided a follow-up opinion in June 2011, in which he stated that after reviewing carefully the claims file and medical history, he again found that the Veteran's bilateral knee arthritis was separate from any knee problems in service and was more likely due to age-related degenerative changes. The record also includes a July 2010 opinion from a nurse practitioner who reviewed the case file and concluded that the Veteran's bilateral knee degenerative changes were most likely related to his occupational history and age. Because the prior VA examinations had relied solely on the lack of medical evidence of a chronic knee disability at separation for their conclusions, and failed to adequately address the Veteran's competent lay assertions regarding wear and tear to the knees in-service and continuing knee pain since, the Board requested a VHA opinion letter from an appropriate expert. In April 2013, VA received a VHA opinion letter from an orthopedic surgeon who reviewed the claims file and concluded that while it is impossible to know when or to what extent the knee strain incurred in service affected the arthritis in his knees, it "is at least as likely as not that there was some contribution to the overall wear and tear on the joint related to his active duty, including the kneeling and crouching while performing the duties of aircraft mechanic." Considering the pertinent evidence above, and resolving reasonable doubt in the Veteran's favor, the Board finds that entitlement to service connection for a bilateral knee disability is warranted. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board may not, however, reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993). In this case, the Veteran's private medical records and his VA examinations establish that he has a current bilateral knee disorder, degenerative joint disease. There is also the Veteran's lay statements indicating events in service which placed strain on his knees, Significantly there is his May 1960 separation examination suggests he had been treated for arthritis of the bilateral knees in service. Finally, there is persuasive medical evidence including an April 2013 VHA medical opinion which found that it was at least as likely as not that the Veteran's current bilateral knee disorder is related, at least partially, by in-service stress on his knees. The April 2013 opinion is afforded high probative value. It was made after a review of all relevant evidence, including past examination reports of the Veteran, it was written by an orthopedic specialist, and it contains an adequate rationale for the conclusion reached. The opinion provides competent evidence favoring the existence of a medical nexus between the Veteran's currently diagnosed bilateral knee disability and events which occurred in service. As such, the medical evidence regarding the relationship of the Veteran's current disability and service is at least in equipoise, and entitlement to service connection is warranted. See 38 U.S.C.A. § 5107(b). ORDER Entitlement to service connection for a bilateral knee disorder is granted. ____________________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs