Citation Nr: 18145722 Decision Date: 10/30/18 Archive Date: 10/29/18 DOCKET NO. 13-08 228 DATE: October 30, 2018 ORDER Entitlement to service connection for degenerative joint disease of the left knee is granted. Entitlement to service connection for diabetes mellitus, type II, is denied. REMANDED Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s degenerative joint disease of the left knee is as likely as not related to his miliary service. 2. The Veteran’s diabetes mellitus did not manifest during his military service or within the first post service year; 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 degenerative joint disease of the left knee are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1970 to February 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from March 2010 and October 2016 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 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 chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir. 2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b) (2018). 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). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). 1. Entitlement to service connection for a left knee disability. The Veteran contends that his current left knee disability is related to service. The Board concludes that the Veteran has a current diagnosis of degenerative joint disease of the left knee that is related to his military 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). An October 2016 VA examination of the knees revealed a current diagnosis of degenerative joint disease of the left knee. The VA examiner reviewed the Veteran’s claims file and conducted a physical examination of the Veteran’s left knee. The VA examiner opined that the Veteran’s current left knee disability was at least as likely as not incurred in or caused by his military service. In support of this opinion, the VA examiner noted the Veteran’s inservice treatment for a twisting left knee injury in January 1971, along with the Veteran’s complaints of ongoing pain in the Veteran’s left knee since that time. In contrast is a February 2018 addendum to this examination which was prepared by another VA examiner based solely upon a review of the evidence of record. This examiner opined that it was less likely than not that the Veteran’s current left knee disability had its onset during his military service or is otherwise etiologically related to such service. In support of this opinion, the VA examiner noted the lack of any subsequent treatment for a left knee disability following the Veteran’s January 1971 left knee injury until 2009. The Veteran, as a lay person, is competent to report his having ongoing symptoms in his left knee following his January 1971 left knee injury. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Based upon a longitudinal review of the record, the Board finds the evidence of record is in relative equipoise. Accordingly, resolving all reasonable doubt in the Veteran’s favor, the Board finds that a nexus exists between the current left knee disability and his miliary service, and service connection for degenerative joint disease of the left knee is warranted. 2. Entitlement to service connection for diabetes mellitus, type II. The Veteran filed his present claim seeking service connection for diabetes mellitus in October 2016. A review of his post service treatment records reveals that he has been diagnosed with diabetes mellitus, type II. Accordingly, the remaining portion of the Board’s decision herein shall focus on whether this condition is related to his military service. The Veteran served on active duty from February 1970 to February 1977. His service personnel records do not show him to have been in an area where exposure to herbicide agents is presumed, and no inservice exposure has been established. A review of his service treatment records revealed no complaints, treatment for or diagnosis of high glucose levels or diabetes mellitus during his military service. On his November 1976 separation examination, urinalysis was negative for sugar. The first post service treatment of diabetes mellitus shown in the record was in August 2016, over 38 years after his separation from military service. To the extent the Veteran believes he suffered from diabetes in service or within the year following discharge from service, as a lay person he has not been shown to possess specialized training sufficient to render such an opinion. In this regard, the diagnosis of diabetes requires medical testing and training to determine. Accordingly, his opinion as to the diagnosis of diabetes is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In summary, there is no competent and credible evidence of diabetes mellitus in service, and no competent evidence suggesting his diabetes is related to service. Accordingly, the preponderance of the evidence is against the Veteran’s claim for service connection for diabetes mellitus. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to TDIU is remanded. The Board’s decision above has granted service connection for a left knee disability. The grant of service connection impacts the Veteran’s claim for a TDIU as the RO will have to assign an evaluation for the left knee disability in the first instance. Moreover, the Veteran has not submitted a completed VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, despite being asked to provide one in August 2016. The Veteran is advised that failure to provide this requested evidence could result in denial of the claim. The matter is REMANDED for the following action: 1. Ask the Veteran to fully complete a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. 2. After the above has been completed and the grant of service connection for the left knee disorder has been implemented, readjudicate the claim for entitlement to TDIU. If the claim remains denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W. Yates, Counsel