Citation Nr: 18141676 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 15-40 732 DATE: October 11, 2018 ORDER Entitlement to service connection for bilateral knee patellofemoral pain syndrome is granted. Entitlement to service connection for degenerative disc disease of the lumbar spine is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his bilateral knee patellofemoral pain syndrome began during active service. 2. The Veteran’s degenerative disc disease of the lumbar spine did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral patellofemoral pain syndrome are met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for degenerative disc disease of the lumbar spine are not met. 38 U.S.C. §§ 1112, 1113, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 2000 to June 2005. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Entitlement to service connection for bilateral knee patellofemoral pain syndrome. The Veteran contends that his patellofemoral pain syndrome stems from his duties performed during service, and in turn, should be service connected. The Board concludes that the Veteran has a current diagnosis of patellofemoral pain syndrome that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). VA treatment records show the Veteran has a current diagnosis of patellofemoral pain syndrome (PFPS), and an October 2014 VA examiner opined that the Veteran’s PFPS at least as likely as not began during active service, as competently and credibly reported by the Veteran. The rationale was PFPS is often caused by increased pressure on the patellofemoral joint. This increased pressure can be caused by increased levels of activity such as prolonged running and jumping, activities that are consistent with the Veteran’s service. Service personnel records show the Veteran has combat status, and the Board finds his lay testimony regarding what happened during combat consistent with the circumstances of his combat service in motor transport. 38 U.S.C. § 1154(b). Having established the Veteran’s combat status, the Board must consider all places, types, and circumstances of the Veteran’s service. 38 U.S.C. § 1154(a). The Veteran, having worked in motor transport during service, was required to repeatedly run, jump, and lift heavy objects. The Board finds these aspects of the Veteran’s service consistent with the Veteran’s diagnosed condition. As stated above, the October 2014 VA examiner stated that the Veteran’s PFPS was at least as likely as not caused by events in service. The rationale being that PFPS is strongly linked to the types of activities the Veteran performed during service. However, a November 2014 VA examiner opined that the Veteran’s PFPS was less likely than not caused by an in-service event because the Veteran did not seek treatment during service or within one year after leaving service. The Veteran has stated numerous times in lay statements that he did not seek treatment because of his leadership position during active duty. In an attempt to not appear weak to his fellow service members, the Veteran states that he avoided seeking medical help when possible. The Board finds that both VA examinations provide competent and credible evidence, as both provide sufficient medical analysis regarding the Veteran’s conditions and medical history. However, the Board gives more probative weight to the October 2014 VA examination. In that examination, more analysis was given linking the condition to the duties performed by the Veteran during service. The later exam instead appears to rely more on the fact that the Veteran’s service treatment records do not reflect a knee condition. Again, this fact is not determinative. Therefore the Board affords more probative weight to the October 2014 VA examination. The Veteran is competent to report any reasoning for why he did not seek treatment during his time on active duty. With the Veteran’s statements remaining consistent with personnel and treatment records, and across lay statements, the Board finds the Veteran’s statements credible. With the evidence in relative equipoise, the Board resolves reasonable doubt in favor of the Veteran. In turn, the Veteran’s patellofemoral pain syndrome is service connected. Entitlement to service connection for degenerative disc disease of the lumbar spine. The Veteran contends that his degenerative disc disease of the lumbar (DDD) should be service connected. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The question for the Board is whether the Veteran’s DDD manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has DDD, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service, or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. VA treatment records show the Veteran was not diagnosed with DDD until November 2014, over a decade after his separation from service and years outside of the applicable presumptive period. Service connection for DDD may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s DDD and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The November 2014 VA examiner opined that the Veteran’s DDD is not at least as likely as not related to an in-service injury, event, or disease. The rationale was that there was no documentation of chronicity of the back pain. Further, the examiner stated that it would be mere speculation that the Veteran’s DDD is attributable to a report of back pain from 2003. While the Veteran believes his DDD is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.   As a result, the Veteran’s claim for entitlement to service connection for degenerative disc disease of the lumbar spine is denied. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Hebert, Law Clerk