Citation Nr: 18146028 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-39 003 DATE: October 30, 2018 ORDER Entitlement to service connection for a left knee condition is denied. Entitlement to service connection for a right knee condition is denied. FINDINGS OF FACT 1. The Veteran’s left knee condition 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. 2. The Veteran’s right knee condition 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 a left knee condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 2. The criteria for service connection for a right knee condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1984 to April 1988. This matter is on appeal from a January 2016 rating decision, which denied entitlement to service connection for both a left knee condition and a right knee condition. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). 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); 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). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for a left knee condition 2. Entitlement to service connection for a right knee condition The Veteran contends that he has a left knee condition and a right knee condition that are related to an in-service injury, event, or disease. The question for the Board is whether the Veteran has current disabilities that 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 bilateral knee osteoarthritis, 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. The Veteran served on active duty from June 1984 to April 1988. The Veteran’s March 1988 report of medical history documented the Veteran’s negative responses to whether he had ever had arthritis or a joint deformity. A March 1988 report of medical examination reported that the Veteran’s lower extremities were normal and that the Veteran was in good health. A September 1991 report of medical history for enlistment into the Air Force National Guard documented the Veteran’s negative responses to whether he had ever had arthritis or a joint deformity. A September 1991 report of medical examination reported that the Veteran’s lower extremities were. The Veteran’s military personnel records indicate that he was honorably discharged from the Air Force Reserve in September 1994. In August 2015, the Veteran submitted a VA primary care message reporting that he had been experiencing knee pain. According to the Veteran, his knee problems started just before he was discharged in 1988 but he did not complain, as he stated “[t]he mantra at the time was never to say you were sick, so I said very little.” However, he reported that his knee problems seemed to be getting worse as he ages. He stated that “jumping from planes, vehicles, road marches, etc., seem to have taken a toll.” An August 2015 private orthopedic record reported that the Veteran complained of constant aching and sharp pain in both knees that occurs constantly. The Veteran reported that the onset of the pain was “gradual without injury about one year ago.” Radiographic imaging did not show arthritis in either knee. The reported impression was bilateral knee pain, bilateral chondromalacia patellae, and a medial meniscus tear in the right knee. In January 2016, the Veteran was afforded a VA examination of his left knee condition and right knee condition. The Veteran reported that he had more than thirty parachute jumps during his service. At the examination, the Veteran complained of constant pain of 5/10 on both knees. Upon examination, the Veteran exhibited full range of motion without pain in both knees. The Veteran did not report any functional loss or flare ups associated with his knees, and he reported that he could walk up to two miles. The examiner reported that diagnostic testing did not document degenerative or traumatic arthritis. As to the Veteran’s claimed condition of bilateral knee conditions, the examiner found that the Veteran does not have a diagnosis associated with the claimed conditions. Furthermore, the examiner opined that “[w]ithout any objective finding it is less likely as not that veteran has any permanent disability of his bilateral knees. It is also less likely as not his symptoms caused or aggravated by his service or any service connected conditions and more likely as not his symptoms caused or aggravated by other non-service connected conditions.” In August 2016, the Veteran’s representative submitted a Knee and Lower Leg Disability Benefits Questionnaire (DBQ) addressing the Veteran’s left and right knees. Within the medical history section of the DBQ, the examiner wrote “see notes from 8/24/2015 [and] 8/17/2016.” However, no treatment notes were provided with the DBQ. The Board notes that an August 2015 examination report written by the examiner who completed the DBQs documented the Veteran’s report that the onset of the pain was “gradual without injury about one year ago.” The examiner diagnosed both knees with patellofemoral pain syndrome and opined that it is as likely as not that the Veteran’s knee condition was caused by his military service. No rationale was provided by the examiner for his medical opinion. In October 2016, the Veteran was informed that the August 2016 knee DBQs were incomplete as the examiner who completed the August 2016 knee DBQs did not include the notes from August 24, 2015 and August 17, 2016 that he referred to in the DBQ responses. In December 2017 and July 2018, records were received from the examiner who completed the August 2016 DBQs; however, the records received did not include notes from August 24, 2015 and August 17, 2016 that were referenced by the examiner in the DBQs. In November 2017, the Veteran submitted a statement from R.M., who stated he served with the Veteran at Schofield Barracks, Hawaii. The individual reported that the Veteran frequently complained about knee pain resulting from road marches, unit runs, field exercises, and garrison duties. According to R.M., the Veteran was placed on a profile due to his constant knee pain. He also reported that the Veteran routinely iced his knees during the duty day and after duty hours. A December 2017 private treatment note documented the Veteran’s report that his knees ache all the time and that they were getting worse. According to the Veteran, his military duties included parachuting from airplanes carrying heavy loads, road marches in boots carrying heavy loads, jumping from vehicles, and performing physical training in boots rather than athletic footwear. The examiner reported that the Veteran, who weighed 209 pounds during the examination, had lost forty pounds since the examiner had last seen him, but his knee still hurts quite a bit. Radiographic imaging showed that both knees exhibited “mild medial compartment osteoarthritis.” The examiner reported that he told the Veteran that “based on the new information provided that the osteoarthritis is likely caused by or substantially worsened by his military activities/service.” However, the examiner provided no rationale as to why the knee osteoarthritis was likely caused by or substantially worsened by the Veteran’s military service As previously described, the Veteran’s service treatment records show no evidence of treatment for any knee conditions. The Veteran failed to report any problems with his knees at a military examination one month before he was discharged in April 1988. He also failed to report any problems with his knees at a military examination conducted in September 1991, more than three years after he was discharged from active duty. The earliest evidence of either a knee condition was the Veteran’s report of bilateral knee pain in August 2015, more than twenty-seven years after the Veteran’s discharge from service. While not dispositive, the passage of so many years between discharge from active service and the objective documentation of a disability is a factor that weighs against a claim for service connection. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Although the Veteran stated in his August 2015 primary care message that his knee problems began in 1988, during his August 2015 treatment, he reported that the onset of the pain was “gradual without injury about one year ago.” Furthermore, the Veteran did not provide any competent medical evidence indicating a link between the Veteran’s knee conditions and service. Although the examiner who completed the August 2016 DBQs and examined the Veteran in December 2017 indicated there was a link between the Veteran’s knee conditions and his military service, the examiner failed to provide any rationale to support such a link. A medical opinion must “support its conclusions with an analysis that the Board can consider and weigh against contrary opinion.” Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Therefore, the Board provides no probative value to the nexus opinions provided in the August 2016 DBQs and the December 2017 treatment record. Thus, the Board finds that neither the Veteran’s left knee condition nor his right knee condition had its onset in active service or for many years thereafter. A lay person is competent to address etiology in some limited circumstances in which nexus is obvious merely through lay observation, such as a fall leading to a broken leg. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this case, however, the record dates the onset of symptoms of knee conditions to many years after separation from active service and the question of causation extends beyond an immediately observable cause-and-effect relationship. As such, the Veteran is not competent to address the etiology of his disability. Additionally, the lay statement received from R.M. in November 2017 reported that the Veteran suffered only knee pain, rather than a knee injury. The record reflects that, if the Veteran did endure knee pain during service, the knee pain likely resolved, as the Veteran reported at his separation examination in March 1988 that he was in good health and he did not have any physical abnormalities. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for a left knee condition and right knee condition. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the claims for a left knee condition and a right knee condition must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Moore, Associate Counsel