Citation Nr: 18146728 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 15-16 635 DATE: November 1, 2018 ORDER Entitlement to service connection for bilateral knee arthritis is granted. Entitlement to service connection for bilateral hip arthritis is granted. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran’s bilateral knee arthritis is related to service. 2. The evidence is at least evenly balanced as to whether the Veteran’s bilateral hip arthritis is related to service. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bilateral knee arthritis have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 1131, 1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309(a) (2017). 2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bilateral hip arthritis have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1980 to October 1981 and on active duty for training (ACDUTRA) in April 1982. These matters come before the Board of Veterans’ Appeals (Board) from an August 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan, which denied the Veteran’s claims for service connection for bilateral knee and hip disabilities, both with arthritis. In October 2018, the Veteran testified during a Board video-conference hearing before the undersigned Veterans Law Judge. The RO denied service connection for PTSD on August 2017. The Veteran filed a Notice of Disagreement (NOD) in July 2018. However, as it appears the RO is developing the claim, the Board will take no action at this time with regard to this claim. Service Connection The Veteran contends that her current bilateral knee and hip disabilities were due to a 1980 injury sustained in service. Service connection will be granted if the evidence demonstrates that current disability resulted from a disease or injury incurred in active military, naval, or air service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Active military, naval, or air service includes active duty, any period of active duty training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred in the line of duty. See 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a). Thus, service connection may also be granted for disability resulting from disease or injury incurred in, or aggravated, while performing ACDUTRA. Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disability first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the injury was incurred in service. 38 C.F.R. § 3.303(d). 1. Bilateral Knee Arthritis A March 2002 private medical record diagnosed the Veteran with a degenerative narrowing of the medial joint space in the right knee per January 2002 x-rays. Moreover, an October 2010 VA examination revealed that both the left and right knee were in degenerative condition per July 2010 x-rays. Thus, the Veteran has bilateral knee arthritis and has met the current disability requirement. The evidence reflects the Veteran’s bilateral knee injury took place in service. Per her October 2010 VA examination, the Veteran reported that during her basic in-service training she dropped to her knees and her right knee hit a pole. Both knees became swollen, and the Veteran experienced pain and developed shin splints. An October 1980 service treatment record indicates that the Veteran reported joint pain and the physician observed the Veteran had shin splits, thereby, corroborating the Veteran’s report of in-service injury. For the following reasons, the evidence supports a causal relationship between the current bilateral knee arthritis and the in-service bilateral knee injury. On the October 2010 VA examination, the examiner reviewed all medical records, test results, and medical history, and opined that the Veteran’s bilateral knee disability is at least as likely as not related to her military service. Similarly, a September 2018 private treatment record contains an opinion from a physician who has treated the Veteran since August 2008 and opined that “it is more likely than not the arthritis of the knee and hip is due to injury stained at basic training in 1980.” Although the October 2010 VA examiner’s and September 2018 private physician’s reasons were not extensive, this does not render their opinions inadequate. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner “did not explicitly lay out the examiner’s journey from the facts to a conclusion,” did not render the examination inadequate); see also Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). These positive medical opinions are more probative than the negative opinions of record. In a July 2011 examination report, the VA examiner concluded the Veteran’s current bilateral knee condition is less than likely as not related to her in-service injury. The examiner’s reasoning is lacking, as he merely stated there is no evidence of the fall during training and private medical records do not show treatment until years after service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). This medical examination ignores the Veteran’s credible lay statements that she fell on her knees during service training. Buchanan v. Nicholson, 451 F.3d 1331, 1336 n. 1 (Fed. Cir. 2006) (noting that VA’s examiner’s opinion, which relied on the absence of contemporaneous medical evidence, “failed to consider whether the lay statements presented sufficient evidence of the etiology of [the veteran’s] disability such that his claim for service connection could be proven without contemporaneous medical evidence”). In June 2014, a VA examiner reviewed available records, without an in-person examination of the Veteran, and opined that the right knee condition is more than likely as not related to an injury from the Veteran’s post service fall in March 1995. The Board finds that the June 2014 VA negative opinion as to whether the Veteran’s bilateral knee injury is related to her military service is of no probative value, as the VA medical professional did not consider the Veteran’s reported complaints of knee pain since service. Prior to her March 1995 fall, the Veteran had reported knee pain on at least two prior occasions, in 1980 and 1982, the former which occurred during service. The June 2014 VA medical professional’s negative rationale was primarily based on the finding that the Veteran’s injury was not diagnosed until decades later. Moreover, the Veteran had already previously reported her knee pain as seen through a June 1986 service treatment record. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise is not probative). Lastly, the Veteran is competent to report continuous bilateral knee symptoms in the years since service. See Jandreau v. Nicholson, 492 F.3d 1372,1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Throughout the years the Veteran described to doctors her symptoms and limitations including – her difficulty working; limitation on squatting; inability to lift and push anything beyond 10 pounds; and inability to stand for 15 minutes, to include in her August 2010 Social Security Benefits Application Form. Thus, the Board finds that the reports of continuous bilateral knee symptoms in the years since service are credible. Based on the foregoing, the Board finds that the evidence is at least evenly balanced as to whether the Veteran’s bilateral knee arthritis is related to service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for bilateral knee arthritis is therefore warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. Bilateral Hip Arthritis The Veteran currently has hip arthritis. On October 2008, a private center diagnosed the Veteran with bilateral hip socket degeneration. X-rays from July 2010 show moderate to severe degenerative changes in her pelvis and bilateral hips. A July 2011 VA examination states that there is objective evidence of pain following repetitive hip range motion. The Veteran underwent hip replacement surgery in July and August 2011. She has thus met the current disability requirement. In addition, the Veteran has met the in-service disease or injury requirement. On November 1980, the Veteran sought in-service treatment for hip pain. During that doctor visit, she reported having hip pain for several weeks and that the pain predominated in the cervical region. This report of hip pain follows the Veteran’s October 1980 in-service medical treatment report in which she complained of having fallen during training on her knees. In addition, according to a March 1982 service medical examination, the Veteran fell and injured her left hip. The 1982 service medical paperwork states that the Veteran was on active duty for training when the injury occurred, ACDUTRA. The 1980 and 1982 incidents occurred while she was on duty and during a period of ACDUTRA, thus, the requirement for in-service injury is met. Thus, the remaining issue is whether there is a causal relationship between the current bilateral hip arthritis and the Veteran’s service time. On this question, there are conflicting medical opinions. In October 2010, an examiner conducted a VA examination. After reviewing all medical records, test results, and medical history, the VA examiner opined that the Veteran’s bilateral hip condition is at least as likely as not related to her military service. Moreover, the Veteran’s private treating physician who has treated the Veteran since August 2008 opined in July 2010, July 2015, and September 2018 that “it is more likely than not that arthritis of the knee and hip is due to injury sustained at basic training in 1980.” This private treating physician has treated the Veteran for 10 years for various diseases including her hip and knee arthritis. The Veteran has continually reported her bilateral hip pain to this physician and is competent to testify regarding continuous symptoms since service. Conversely, the July 2011 and August 2017 VA negative opinions as to whether the Veteran’s hip arthritis is related to her military service are of limited value, as the VA medical professionals did not consider the Veteran’s statements reported in her in-service medical treatments. The 2011 VA examination reasons that there is no objective evidence of a fall during basic training, nor any complaint. However, as described previously, the Veteran reported and sought in-service medical treatment for both the November 1980 and March 1982 incidents. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise is not probative). The August 2014 negative VA opinion is conclusory and without much reasoning places great emphasis on a 1995 fall that the examiner himself states led to unremarkable exam results. Given the lack of reasoning, the Board discounts this negative medical opinion. See Nieves-Rodriguez, 22 Vet. App. at 304 (most of the probative value of a medical opinion comes from its reasoning). For the foregoing reasons, the Board finds that the evidence is at least evenly balanced as to whether the current bilateral knee and hip arthritis had their onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for bilateral hip arthritis is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lopez, Law Clerk