Citation Nr: 18142472 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-24 108 DATE: October 15, 2018 ORDER Entitlement to service connection for left-knee disorder, as secondary to service-connected left-ankle disorder is denied. FINDING OF FACT The objective medical evidence does not provide competent and credible evidence establishing a current left-knee disability at any point during the period on appeal. CONCLUSION OF LAW The criteria for service connection for left-knee disorder, secondary to service-connected left-ankle disorder, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Marine Corps from October 1981 to October 1985. Entitlement to service connection for left-knee disorder, as secondary to service-connected left-ankle disorder. Service Connection Generally, service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) The existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). See also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Additionally, establishing service connection on a secondary basis due to a service-connected disability requires evidence sufficient to show (1) that a current disability exists, and (2) that the current disability was either (a) caused, or (b) aggravated by the service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). See also Wallin v. West, 11 Vet. App. 509, 512 (1998). Evidence The Veteran’s service treatment records (STRs) show that, in his May 1981 enlistment examination, the Veteran denied any knee problems and relevant categories were checked off as normal. Sometime in 1981, the Veteran was treated for a contusion to his left knee after he had fallen while walking down a hill. Although the in-service examiner found mild swelling, he further found the Veteran maintained a full range of motion and was able to bear weight on the knee. The Veteran himself reported that he had not “hit it very hard.” He was directed to return to full duty. In or near June 1984, the Veteran fractured his left ankle (distal tibia/fibula, above the ankle). Between July and September 1984, in-service treatment examiners variously found early healing, eventual non-tenderness, good alignment, and a “stable fracture.” In the September 1985 separation examination, the category of “lower extremities” was checked off as normal. The Veteran also denied having a current or past “trick” or locked knee. In April 2011, the Veteran’s private primary care physician, Dr. L.W., assessed him with hip and leg pain. The hip pain was also noted as a symptom of degenerative arthritis. In September 2011, Dr. L.W. noted the Veteran was “having arthritic symptomatology to his back and knees and ankles.” In May 2012, the Veteran underwent a VA examination for knee and lower leg, which included only a diagnosis for his distal tibia/fibula fracture above the ankle. The May 2012 VA examiner recorded findings pertaining to the left knee, which included some decreased left-knee range of motion, as well as pain on motion, and normal muscle strength and stability. Imaging studies had not documented arthritis. The May 2012 VA examiner characterized the diagnosed fracture as the same injury as that to the left ankle and opined positively as to service connection. However, he did not address a left-knee disorder or the issue of secondary service connection due to the service-connected left-ankle disorder. In a May 2013 VA primary care initial evaluation note, the treatment provider noted the Veteran’s reports of experiencing problems with his left-lower extremity, including knee, hip and left-lower spine, with pain having been progressing. However, in her assessment and plan section, after again noting the Veteran’s left-lower extremity pain, she stated “[w]e discussed [the] natural history of osteoarthritis.” In July 2013, the Veteran underwent a VA examination for knee conditions, in which, after stating the Veteran’s first diagnosis for left ankle fracture, the July 2013 VA examiner stated “[t]here are no objective findings to render a diagnosis of the left knee at this time.” She found pain on motion and some decreased left-knee range of motion and muscle strength, as well as loss of function due to less movement, pain on movement and instability of station. However, stability test results were normal. Imaging studies showed an “[u]nremarkable radio graph of right and left knees” and had not documented arthritis. The July 2013 VA examiner opined that the Veteran’s left-knee disorder is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected left-ankle disorder. She explained: There are no objective findings to give diagnosis of the knee joint. There has not been any specific evaluation of a knee condition. There has been evaluation as noted above [regarding hips] [] related to the spine with radiation down the hip to the lower leg related to the spine. Most likely the pain to the knee is related to the lumbar spine condition as described above with left lower extremity pain radiation from back condition. In an April 2014 VA primary care follow-up visit, the treatment provider noted crepitus in the left knee. A June 2014 VA outpatient therapy note commented: On exam there was no gross ligamentous laxity; McMurray’s unremarkable; Q-angle not grossly positive; he reports some tightness of lateral patella area; [tender to palpation] to parapatellar area more to lateral aspect. No gross crepitus palpated and no effusion or warmth. He was initially fitted [with] a patella stabilization left knee brace which he did not find to be that comfortable (“puts pressure where my pain is located”). We next tried a standard knee sleeve [with] patellar opening window and medial/lateral flexible stays and straps. He indicated that the second sleeve was more comfortable, and he will wear it progressively. Reviewed precautions for brace use [with] understanding. In the period of October 2015 through February 2017, primary care physician notes state the Veteran’s chief pain complaint to be “pain –present all the time.” However, a March 2016 x-ray of the left knee revealed no “fracture, subluxation or dislocation. The soft tissues are unremarkable. Normal mineralization. No significant compartment narrowing. No significant osteophyte formation. Impression: Unremarkable radiograph of the left knee.” In March 2016, a VA primary care follow-up note stated: “Left-sided hip pain and knee pain, pain seems to get worse during the past weeks, but no recent history of injury, most likely related to osteoarthritis, meloxicam already provided good relief, continue current therapy….” August 2017 VA x-rays revealed the Veteran’s left-knee “was viewed by the radiologist as normal.” As stated earlier in this decision, to establish service connection, whether direct or secondary, requires first the existence of a current disability. The foregoing summary of treatment of the treatment record shows that the Veteran’s STRs mention only 1981 treatment for a contusion of the left knee, which pre-dated the left-ankle injury by approximately three years. Other than that, there are no complaints, treatment or diagnoses in service related to the left knee. Moreover, the May 2012 VA examiner stated no diagnosis other than the left-ankle fracture and the July 2013 VA examination stated unequivocally that there were no objective findings on which to render a diagnosis of the left knee. She further concluded that, similar to her findings pertaining to the hip, the Veteran’s left-knee pain is most likely related to his lumbar disorder. As the record stands, all the Veteran’s treatment providers duly noted his reports of left-knee pain and his assertion that it is due to his left-ankle disorder, but none made a diagnosis to that effect. From this, the Board can only conclude there is no current disability of a left-knee disorder. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (current disability requirement is satisfied when one exists when claim is filed or during pendency of appeal). See also Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Conclusion The Board has reviewed and carefully considered the Veteran’s March 2011 and June 2013 Statements in Support of Claim; the statements accompanying his May 2014 Notice of Disagreement and May 2016 VA Appeals Form 9; and his November 2016 Statement in Support of Claim, as well as his reports to treatment providers, as they appear throughout the record. All these have helped the Board in understanding better the nature and development of the Veteran’s disorder and how it has affected him. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Board must emphasize that he is not competent to diagnose an orthopedic disorder or interpret accurately clinical findings pertaining to it, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Moreover, the Board cannot render its own independent medical judgments; it does not have the expertise. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board must look to the medical evidence when there are contradictory findings or statements inconsistent with the record and it must rely on clinical findings and opinions to determine the level of severity of current disabilities or establish their connection to service-related events, injuries or illnesses. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Based on the preponderance of objective medical evidence, the Board finds there is no competent and credible evidence establishing a current left-knee disability at any point during the period on appeal. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Franke, Associate Counsel