Citation Nr: 18148842 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-37 764 DATE: November 8, 2018 ORDER Service connection for a left knee condition is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his left knee patellofemoral pain syndrome is at least as likely as not related to his military service. CONCLUSION OF LAW The criteria for service connection for a left knee condition are met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2008 to September 2015. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. 1. Entitlement to service connection for a left knee condition 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 service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The Veteran contends that his left knee diagnosis of patellofemoral pain syndrome (PFPS) was caused by trauma to the knees due to several airborne jumps during service. The Board notes that military personnel records show the Veteran received a Parachutist Badge during service. Resolving reasonable doubt in the Veteran’s favor, the Board concludes that the Veteran has a current diagnosis of PFPS that is etiologically 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). A review of service treatment records shows that the Veteran’s medical history reports and medical examinations from June 2008 through April 2013 were silent regarding a knee condition. However, in December 2013, the Veteran reported having leg and joint pain. The Veteran was afforded a VA examination in November 2015, one month after service discharge. The VA examiner noted the Veteran’s file was not reviewed. The Veteran reported his bilateral knee pain began in 2010, which he attributed to wear and tear from rucksack (backpack) marches and completing 35 airborne jumps with hard landings. He stated his knee pain has worsened over the years, and he has flare-ups that are aggravated by kneeling or squatting. Upon examination, the Veteran was noted to have pain on extension, and mild tenderness on the medial side of the knee. An X-ray of the left knee was unremarkable and showed no evidence for acute osseous abnormality. The examiner diagnosed bilateral PFPS. Because the November 2015 VA examiner did not review the Veteran’s file or provide an opinion regarding the etiology of the Veteran’s left knee condition, an addendum medical opinion was requested in March 2016. The March 2016 VA examiner confirmed the claims file was reviewed, and opined that the Veteran’s claimed condition was less likely than not incurred in or caused by his military service. The examiner explained that the Veteran’s service treatment records do not contain complaints of or treatment for a knee condition, and there is no evidence that the Veteran had a chronic knee condition during his active service. The RO requested a clarifying VA medical opinion, specifically instructing the VA examiner to address the Veteran’s in-service airborne jumps. In June 2016, the VA examiner stated that the Veteran’s left knee PFPS could have multiple causes or etiologies. The examiner determined that because the Veteran did not report any knee symptoms or seek medical care for his left knee during service, a nexus between his post-service diagnosis and in-service activities, including airborne jumps, cannot be reasonably established. The Board resolves reasonable doubt in the Veteran’s favor and finds that a nexus between currently diagnosed left knee PFPS and service has been shown. Probative weight is assigned to the Veteran’s lay statements regarding in-service airborne jumps and trauma to the knees. Service treatment records show he reported having leg and joint pain in December 2013, and he was diagnosed with bilateral PFPS one month after service discharge at the November 2015 VA examination. The Board acknowledges that a negative opinion was provided from a VA examiner in March 2016 and June 2016 based on the lack of records indicating a left knee injury during service. However, when specifically asked to opine as to whether the Veteran’s left knee condition is related to his in-service airborne jumps, the examiner indicated the condition could have several etiologies. The examiner did not explicitly rule out airborne jumps as the cause of PFPS, but instead found a nexus could not be established due to a lack of documentation of treatment for a knee injury during service. (Continued on the next page)   Given that the evidence is in equipoise, the Board must resolve reasonable doubt in the Veteran’s favor to find that a nexus exists between the current disability and the in-service injury. Therefore, entitlement to service connection for left knee patellofemoral pain syndrome is granted. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Miller, Associate Counsel