Citation Nr: 18141998 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 13-08 489 DATE: October 12, 2018 ORDER Service connection for a left knee traumatic arthritis is granted. Service connection for residuals of right total knee replacement is granted. FINDINGS OF FACT 1. Traumatic joint disease of the left knee is due to the Veteran’s in-service combat knee injury. 2. Residuals of right total knee replacement are due to the Veteran’s in-service combat knee injury. CONCLUSIONS OF LAW 1. Traumatic joint disease of the left knee was incurred in wartime service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. Residuals of right total knee replacement were incurred in wartime service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1966 to March 1969, to include service in the Republic of Vietnam from November 1967 to May 1968. In December 2014, he withdrew his prior request for a hearing, in writing. These matters had been remanded for further development in December 2015 and in November 2016. Here, substantial compliance with the remand orders is demonstrated. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection is awarded for disability that is the result of a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Certain chronic diseases—including arthritis—may be presumed to have been incurred or aggravated during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. 1. Left Knee Disability 2. Residuals of Right Total Knee Replacement The Veteran contends that service connection for a left knee disability and for residuals of right total knee replacement is warranted on the basis that he injured both knees in active service by “hitting the ground” when mortar rounds struck in his vicinity in Vietnam. His personnel records show a combat history of participation in Operation Danang from November 1967 to May 1968. Here, VA already has conceded that the Veteran saw combat in Vietnam. The Board finds the Veteran’s statements to be credible and consistent with the circumstances, conditions, and hardships of wartime service. 38 C.F.R. § 3.303. Clinical evaluation of the Veteran’s lower extremities at the time of entry in active service in April 1966 and at separation in March 1969 shows normal lower extremities. The Board finds that there is no showing of arthritis of either knee in active service or within the first post-service year. To the extent that the Veteran reports that he suffered knee injuries during service, he is entitled to the considerations afforded under 38 U.S.C. § 1154(b); and his lay statements regarding the circumstances of his in-service knee injuries are accepted as credible and persuasive for purposes of establishing an incident in service. X-rays taken in January 2014 reveal severe arthritis in the left knee. VA records, dated in January 2016, show complaints of right knee pain; and indicate that the Veteran has had arthritis “for some time.” Records show that the Veteran had tried shots, physical therapy, and stem cell injection without success; conservative therapy had failed, and knee replacement was recommended. The Veteran underwent a right total knee replacement in April 2017. A June 2017 VA examination report reveals diagnoses of degenerative joint disease of the left knee, and residuals of right total knee replacement. The Veteran reported injuring both knees by “hitting the ground” during mortar rounds in Vietnam, and reported that his bilateral knee condition had worsened over the years. The examiner noted that service treatment records were silent for any knee complaints, and there was no objective evidence of treatment until many years after service. Based on this evidence, the examiner opined that the Veteran’s current degenerative joint disease of the left knee and residuals of right total knee replacement were not caused by an in-service event. In support of the opinion, the examiner noted that the Veteran had many risk factors for development of arthritis consistent with his age cohort. Here, the Board finds that the June 2017 opinion is afforded minimal probative value because the examiner had not considered the Veteran’s credible statements of in-service combat knee injuries—notwithstanding the fact that there is no official record of treatment or complaints during active service. In this regard, the Federal Circuit has held that, in the case of a combat Veteran, not only is the combat injury accepted, but so, too, is the disability due to the in-service combat injury. Reeves v. Shinseki, 682 F.3d 988, 998-99 (Fed. Cir. 2012). Likewise, the Veteran has reported recurring symptoms of bilateral knee pain that gradually worsened over the years and restricted his mobility, following his discharge from active service. Where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). The Board finds the Veteran’s descriptions of knee pain and reduced mobility after service, as credible and persuasive. In this case, the Board finds that the evidence is in favor of finding that traumatic joint disease of the left knee and residuals of right total knee replacement are related to the in-service combat injuries. The Board acknowledges the June 2017 VA opinion, in which the examiner reasoned that the Veteran had many risk factors for developing arthritis. The Board finds this opinion to be less persuasive than the Veteran’s lay statements of ongoing symptomatology. In contrast to the VA opinion, there are the Veteran’s contentions, which have been consistent throughout the appeal. Particularly, the Veteran stated that crawling on his knees during active service had taken on “toll” in later years. His statements are consistent with the circumstances of his service, and are not expressly contradicted by the record. When considering the competent and credible lay statements, and the post-service medical evidence substantiating the Veteran’s claims; and resolving all reasonable doubt in his favor, the Board finds that traumatic joint disease of the left knee and residuals of right total knee replacement are each related to the in-service combat knee injuries. See 38 C.F.R. § 3.102. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mary C. Suffoletta