Citation Nr: 18143674 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 18-17 940 DATE: October 19, 2018 ORDER Entitlement to service connection for degenerative arthritis of the left knee is granted. FINDING OF FACT The Veteran’s degenerative arthritis of the left knee is related to an in-service injury. CONCLUSION OF LAW The criteria for service connection for degenerative arthritis of the left knee have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from January 1980 to January 1984. In his March 2018 VA Form 9, the Veteran indicated that he wanted a travel board hearing. No such hearing has been scheduled. However, the evidence of record allows the Board to grant the Veteran’s claim without additional evidentiary testimony and the Veteran will not prejudiced by a favorable decision on the merits. For these reasons, the Board will proceed with adjudication without instruction to the RO to schedule a hearing. 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 military service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for degenerative arthritis of the left knee The Board will provide a brief medical history regarding the Veteran’s left knee before explaining why he is entitled to service connection for his current disorder of degenerative arthritis of the left knee. The Veteran first sought to join the United States Marine Corps in August 1979. A report of medical history from that time (received 7/25/17, page 14 of 105) indicates “bone chip [left] leg near left knee” and “some pain on occasion.” The Veteran was told that he could not join the military unless this bone chip was removed. See November 2017 notice of disagreement. Undeterred, the Veteran had surgery for excision of an osteochondroma in the left lower thigh. See October 1979 medical record (received 11/20/17, page 2 of 2). A December 1979 letter from a private doctor (received 7/25/17, page 19 of 105) states that the Veteran “had a outer chondroma removed from his knee area” but that “neither the surgery or the lesion should in any way interfere with his ability to perform in the service.” The Veteran entered service in January 1980. A service treatment record from his first month of service (received 7/25/17, page 57 of 105) indicates “severe pain in area where operated on for bone tumor.” An April 1980 service treatment record (received 4/25/17, page 55 of 105) indicates “pain to medial aspect of [left] knee.” A July 1980 service treatment record (received 7/25/17, page 56 of 105) indicates “continued [left] knee pain.” Despite these early instances of knee pain, the Veteran continued to serve in the United States Marine Corps until January 1984. A September 2017 VA knee indicates degenerative arthritis of the left knee with pain. The three elements of service connection are satisfied. Regarding the first element, a September 2017 VA examination indicates a current diagnosis of degenerative arthritis of the left knee. The second element is also satisfied, based on service treatment records indicating in-service knee pain. The nexus element is also established. A September 2017 VA medical opinion states that the Veteran “had no issues related to the claimed [disorder] prior to military service.” Rather, “[o]nset of the condition was during service,” as documented in his service treatment records. Furthermore, after service “[t]here is evidence of current, chronic and continuous treatment and care.” For these reasons, the examiner concludes that the Veteran’s degenerative arthritis of the left knee is at least as likely as not related to service. This medical opinion is probative because it is based on a review of the record and contains clear conclusions with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301–02 (2008). The Board notes that an October 2017 VA addendum opinion states that the Veteran’s degenerative arthritis of the left knee clearly and unmistakably existed prior to service but was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The rationale, in its entirety, reads as follows: “Veteran had clear and unmistakable evidence of the preexisting medical [disorder]. There is evidence to indicate the Veteran continued to suffer from the disorder during service, which is typical of the [disorder]. However, the progression is not beyond normal progression for this disorder. No evidence of permanent aggravation beyond normal progression identified.” The RO denied entitlement to service connection on the basis of the addendum opinion. The addendum opinion is entitled to less weight than the September 2017 opinion. To the extent that the addendum opinion is referring to the Veteran’s degenerative arthritis, the opinion is incorrect, in that there is no indication of left knee arthritis in the Veteran’s service treatment records. To the extent that the addendum opinion is referring to the Veteran’s excision of an osteochondroma, this tumor was undisputedly removed prior to service, and was therefore not present upon entry. Also, a surgery does not by itself constitute a pre-existing condition. Aside from the osteochondroma, the only pre-service entry regarding the left knee is “some pain on occasion,” a description that does not constitute clear and unmistakable evidence that arthritis preexisted service. Finally, the examiner’s statement that there is no clear and unmistakable evidence of aggravation does not consider the medical evidence that the Veteran’s left knee pain was occasional in August 1979, but “severe” after entering service in January 1980. For these reasons, the addendum opinion is entitled to less evidentiary weight than the September 2017 opinion, which supports entitlement to service connection on a direct basis. Since the evidence supports the existence of a nexus between a current disorder and service, the claim must be granted. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Cannon, Associate Counsel