Citation Nr: 18149636 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16-23 373 DATE: November 13, 2018 ORDER Entitlement to an earlier effective date earlier than December 27, 2011, for service connection of posttraumatic stress disorder (PTSD) is denied. Entitlement to an earlier effective date earlier than December 27, 2011, for a total rating based on individual unemployability (TDIU) due to service-connected disability is denied. Entitlement to a disability rating greater than 70 percent for service-connected post-traumatic stress disorder (PTSD) is denied. Entitlement to service connection for right knee status post arthroscopy with arthritis and chondromalacia of the patella (right knee disability) is granted. FINDINGS OF FACT 1. No communication was received from the Veteran prior to December 27, 2011, that may be construed as a formal or informal claim for entitlement to service connection for posttraumatic stress disorder (PTSD). 2.No communication was received from the Veteran prior to December 27, 2011, that may be construed as a formal or informal claim for entitlement to a total rating based on individual unemployability (TDIU) due to service-connected disability. 2. The Veteran’s PTSD is manifested by occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment. 3. The evidence is at least in equipoise as to whether the Veteran has a right knee disability related to his military service. CONCLUSIONS OF LAW 1. The criteria for entitlement to an effective date earlier than December 27, 2011, for the grant of entitlement to service connection for posttraumatic stress disorder have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.155, 3.160 (2014); 38 C.F.R. §§ 3.102, 3.159, 3.400 (2018). 2. The criteria for entitlement to an effective date earlier than December 27, 2011, for the grant of entitlement to a TDIU have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.155, 3.160 (2014); 38 C.F.R. §§ 3.102, 3.159, 3.400 (2018). 3. The criteria for a disability rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Codes 9411 (2018). 4. The criteria for service connection for right knee status post arthroscopy with arthritis and chondromalacia of the patella (right knee disability) have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty July 1974 to July 1975. This matter is before the Board of Veterans’ Appeals (Board) on appeal from March 2016 rating decisions issued in March 2016 and August 2013 by the Department of Veteran Affairs (VA) Regional Office (RO). 1. Entitlement to an earlier effective date earlier than December 27, 2011, for service connection of posttraumatic stress disorder (PTSD). The Veteran seeks entitlement to an effective date prior to December 27, 2011, for the grant of service connection for PTSD. The Veteran and his attorney contend that the effective date for the grant of service connection for PTSD should be earlier than December 27, 2011, due to the alleged failure of the VA to submit a PIES request for the Veteran’s entire personnel record until March 2013 pursuant to 38 C.F.R. § 3.156(c). Generally, the assignment of effective dates is governed by 38 U.S.C. § 5110 (2012) and 38 C.F.R. § 3.400 (2018). If a claim is received within one year of a veteran’s separation from service, the effective date will be the date of separation from active duty or the date that entitlement arose. Otherwise, the effective date for an award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase, will be the date of receipt of the claim or the date that entitlement arose, whichever is later. See 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2018). In this case, the Veteran filed a claim for service connection for drug and alcohol abuse September 1, 2006. The June 2007 rating decision denied the claim due to the RO finding that the drug and alcohol abuse was the result of the Veteran’s own willful misconduct. The Board also notes that the Veteran’s service treatment records were considered in the decision. The March 2008 Statement of the Case acknowledged that the Veteran’s service treatment records documented drug abuse during service, to include hashish and amphetamines. The Veteran received counseling and treatment for drug abuse during service. The Veteran did not appeal the March 2008 SOC and it became final. The Veteran claims that he submitted a claim to reopen his claim in January 2009, however there is no indication of any formal or informal request to reopen the claim for service connection for drug and alcohol abuse and/or service connection for PTSD. Moreover, the Veteran’s March 2009 congressional correspondence made no mention of a 2009 attempt to file for service connection for PTSD, the letter predominantly focused on the June 2007 denial of service connection for drug and alcohol abuse. The Veteran submitted a claim for service connection for PTSD on December 22, 2011. The medical records indicated that the Veteran received a diagnosis of PTSD around 2011. The August 2013 rating decision denied service connection for PTSD because there was no documentation that his condition occurred during service or was linked to a confirmed verified stressor. The rating decision noted once again that the Veteran’s service treatment and personnel records were considered in the decision. Following the August 2013 rating decision, the Veteran was afforded a VA examination in March 2016 that provided a positive medical opinion regarding his PTSD and military service. The examiner cited the Veteran’s lack of psychiatric history prior to military service and noted that the Veteran began drinking and using drugs after the incident to try to cope with his anxiety and memory of the potential life-threatening incident. The March 2016 rating decision granted service connection for PTSD effective December 27, 2011. The rating decision cited the Veteran’s service treatment records, buddy statements, and the March 2016 positive nexus opinion as the support for the grant of service connection. The Veteran and his attorney contends that the Veteran’s claim for drug and alcohol abuse should be the equivalent of a claim for service connection for PTSD for which the Veteran was granted in March 2016. However, at the earliest the Veteran was diagnosed with PTSD in 2011 and did not filed a claim for service connection for PTSD in December 2011. Moreover, the Veteran contends that the Veteran’s service treatment records and personnel files were not retrieved until March 2013, thus the previous denial in June 2007 should not be considered a final decision. However, the Board points out that the RO noted the consideration of the Veteran’s service treatment and personnel records in the June 2007 denial and the March 2008 SOC noted the Veteran’s treatment for drug and alcohol abuse during military service. To the extent that the Veteran asserts that he is entitled to an earlier effective date based on his earlier claim for entitlement to service connection for drug and alcohol abuse, the Board reiterates that a June 2007 rating decision denied service connection for drug and alcohol abuse. The Veteran filed a Notice of Disagreement in November 2007, and a March 2008 SOC was issued, but the Veteran did not complete an appeal as to any aspect of that SOC, and there has been no adjudicatory finding of clear and unmistakable evidence (CUE) of the June 2007 rating decision. As noted above, the Veteran did not file a claim for PTSD until December 2011 and the claim was granted after a positive nexus opinion in March 2016. Moreover, the Board notes that neither the March 2016 positive medical opinion nor the Veteran’s diagnosis existed at the time of the June 2007 denial of service connection for drug and alcohol abuse. The March 2016 VA examiner’s medical determination that the Veteran’s in-service drug use was indictive of PTSD was the pivotal factor in the Veteran being awarded service connection PTSD because the record well established that the Veteran suffered from drug-use during service at the time of the June 2007 rating decision. As such, the Veteran did not file his claim for service connection within one year of service discharge. As the date of the claim is the later date between the date of receipt of the claim and the date that entitlement arose, an earlier effective date is not warranted. The Board must deny an effective date prior to December 27, 2011, for the award service connection for the Veteran’s PTSD. The effective date corresponds to the date on which his claim of service connection was received by VA and is the earliest possible assignable effective date in this case. See 38 C.F.R. §§ 3.102, 3.400 (2018). In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b) (2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 2. Entitlement to an effective date earlier than December 27, 2011, for the award of service connection for a TDIU. The Veteran contends that an effective date prior to December 27, 2011, for grant of a TDIU is warranted. Here, review of the record indicates that the Veteran first alleged a claim for entitlement to service connection for TDIU in June 2016. The Veteran filed a June 2016 notice of disagreement to the March 2016 assignment to the disability rating related to PTSD and include the claim of TDIU as well. Currently, the Veteran is assigned an effective date of December 27, 2011, for the award of service connection for TDIU. This effective date corresponds to the date of receipt for the initial claim of service connection for PTSD, which was opened via VA Form 21-526b after the Veteran contacted his local RO regarding his request for benefits. This claim was received well after one year following the Veteran's discharge from service. The Board has reviewed the file and there is no indication of any claim for service connection for TDIU received prior to June 2016 or December 27, 2011. Neither the Veteran nor his representative has presented any argument regarding entitlement to an effective date prior to that date; specifically, neither the Veteran nor his representative has argued that the Veteran submitted a TDIU claim prior to December 27, 2011. However, he did not file his claim for service connection within one year of service discharge. As the date of the claim is the later date between the date of receipt of the claim and the date that entitlement arose, an earlier effective date is not warranted. The Board must deny an effective date prior to December 27, 2011, for the award service connection for the Veteran's TDIU. The effective date corresponds to the date on which his claim of service connection was received by VA and is the earliest possible assignable effective date in this case. See 38 C.F.R. §§ 3.102, 3.400 (2018). In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b) (2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 3. Entitlement to a disability rating greater than 70 percent for service-connected post-traumatic stress disorder (PTSD). The Veteran seeks higher initial ratings for PTSD. The disability is currently rated as 70 percent disabling from December 27, 2011, the date of receipt of her claim for service connection for the disability. The applicable rating period is from December 27, 2011, the effective date for the award of service connection for PTSD with major depressive disorder, through the present. See 38 C.F.R. § 3.400. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). The Veteran’s service-connected psychiatric disability is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411, and the General Rating Formula for Mental Disorders. Relevant to the issue on appeal, under the General Rating Formula for Mental Disorders, a 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A maximum 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. The VA General Rating Formula for Mental Disorders is meant to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms. Vasquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Symptomatology should be the fact finder’s primary focus when deciding entitlement to a given disability rating, and a veteran may only qualify for a given disability rating under 38 C.F.R. § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Id. The psychiatric symptoms listed in the above rating criteria are not exhaustive. Rather, they are examples of typical symptoms for the listed percentage ratings. Mauerhan, 16 Vet. App. 436. Accordingly, consideration will be given to all symptoms of the Veteran’s service-connected psychiatric disabilities that affect her level of occupational and social Turning to the relevant evidence of record, the Veteran’s medical treatment records do not indicate that the Veteran’s PTSD causes a total impairment of his social and occupational functioning. The Veteran was afforded a VA examination in June 2013 to determine the current severity of service-connected PTSD. The examiner assigned a level of occupational and social impairment with reduced reliability and productivity for the Veteran’s service-connected PTSD. The Veteran reported being married for 39 years with two adult sons. He also reported employment with Home Depot part-time, after working for the post office. The Veteran stated that the fear of possible terrorist activities through the mail triggered his PTSD symptoms and reported decreased attention and concentration due to his PTSD. The examiner noted that the Veteran reported suffering a depressed mood, anxiety, panic attacks, panic attacks, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, impaired impulse control, difficulty adapting to stressful circumstances, and intermittent inability to perform activities of daily living. The report of a March 2016 VA examination to determine the severity of his service-connected PTSD shows that the examiner assigned a level of occupational and social impairment with reduced reliability and productivity for the Veteran’s service-connected PTSD. The Veteran reported being married for more than forty (40) years, but stated that his marriage is rough due to irritability. He also described having a good relationship with his sons and grandchildren. The Veteran also stated that he maintains contact with his siblings. He stated that family gatherings cause him stress and he prefers peace and quiet. The Veteran worked for the Post Office from 1976 until 2009 when he retired. The Veteran reported that he got along with supervisors and coworkers. The examiner noted that the veteran reported suffering a depressed mood, anxiety, panic attacks, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, flattened affect, difficulty establishing and maintaining effective work and social relationships, impaired impulse control, difficulty adapting to stressful circumstances, and intermittent inability to perform activities of daily living. The examiner observed the Veteran to be casually dressed, but unkempt, solemn, and depressed. The Veteran submitted a November 2016 affidavit describing his symptoms related to his PTSD. The Veteran reported that he took his early retirement with the Post Office because he could no longer handle the work and had difficulty being around customers and other employees. He also reported flashbacks and panic attacks while working and stated that his attendance was affected by his lack of sleep. The Veteran also stated that he also deals with anxiety, irritability, and panic attacks working for Home Depot. The Veteran described being angry and irritable 70 percent to 80 percent of the time with violent thoughts. The Veteran reported yelling at people, chasing people in stores due to anger, considering physically attacking people, and throwing things when he is angry. The Veteran reported issues with his concentration. The Veteran stated that he relies on his wife for everything and she reminds him to take showers and put on clean clothes. The Veteran reported that he sees people and animals that are not there and hears voices. The Veteran also stated that he attempted suicide in 1989 and the presences of suicidal thoughts quite often, but do not act upon them. After considering all the evidence, the Board finds that, throughout the relevant rating period, the Veteran’s service-connected psychiatric disability does not meet the criteria for a 100 percent rating. During that period the Veteran’s service-connected psychiatric disability manifested in symptoms such as depressed mood, anxiety, panic attacks, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, flattened affect, difficulty establishing and maintaining effective work and social relationships, impaired impulse control, difficulty adapting to stressful circumstances, and intermittent inability to perform activities of daily living. Turning to occupational impairment, the Veteran reported working for Home Depot part-time, after a 30-year plus career with the Post Office. In the June 2013 and March 2016 VA examinations, the Veteran did not report any complications with co-workers due to his service-connected PTSD. He did report panic attacks and anxious due concerns of potential terrorism through the US mail system. In the March 2016 VA examination, the Veteran reported that he got along with his coworkers and supervisors. The Board does note that the Veteran reported complications getting along with customers and coworker in his November 2016, however the Board does not find that those reported complications are to the level of total occupational impairment. In terms of social impairment, the Veteran reported marriage of over 40 years that produced two sons. The Veteran reported a strong relationship with his sons and his grandchildren. He also stated that he keeps in contact with his siblings. The Board does acknowledge that the Veteran has reported anxiety, anger, and irritability affect his relationship with his wife and other family members, but there is no indication that the Veteran’s social functioning is totally impaired. The Board finds the Veteran’s reported symptomology coupled with his levels of social and occupational impairment are consistent with the criteria for a 70 percent rating under Diagnostic Code 9411. The Board further finds that, at no time during the relevant rating period, did the Veteran’s service-connected psychiatric disability more closely approximate the criteria for a 100 percent rating in terms of severity, frequency, and duration. Specifically, during that period, the Veteran had deficiencies in family relationships, and mood, but he did not have total occupational and social impairment due to her service-connected psychiatric disability. Furthermore, he did not demonstrate symptoms consistent with many of those specifically listed under the 100 percent ratings in terms of severity, frequency, and duration such that the criteria for a 100 percent rating was more closely approximated. He did not exhibit gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. The Board acknowledges the Veteran’s symptomology as reported in his November 2016 affidavit. The Veteran endorsed persistent delusions, hallucinations, and suicidal thoughts with a suicidal attempt in 1989. The Veteran also reported extreme accounts of anger, concentration, and memory complications. While the Board acknowledges the contents of the Veteran’s November 2016 affidavit, the Board limits the probative value due inconsistency with the objective medical evidence. The Veteran’s medical treatment records and VA examinations are negative for complaints related to delusions, hallucinations, suicidal thoughts, or a suicidal attempt in 1989. The Veteran has denied any history related to suicide several times in his medical treatment record. Moreover, the Veteran has expressed issues with anger, concentration, and memory before the November 2016 affidavit, however not to that degree. The Veteran failed to report a similar symptomology in his June 2013 and March 2016 VA examinations, and his VA medical treatment records. The Veteran has an interest in providing accurate information to his health providers to ensure he receives the proper care, thus the Board is not persuaded that the Veteran underreported his symptoms to VA doctors and examiners on numerous occasions. Moreover, the Board notes that the assignment of a disability rating under Diagnostic Code 9411 is not merely a checklist of symptoms, but an assessment of the social and occupational impairment imposed by the reported symptomology. Thus, the Board finds the Veteran’s reported symptomology coupled with his levels of social and occupational impairment are consistent with the criteria for a 70 percent rating under Diagnostic Code 9411. The Board acknowledges that the Veteran is competent to report symptoms of his service-connected psychiatric disabilities, as doing so requires only personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has considered his reported symptoms. The Veteran is also credible in her belief that she is entitled to higher ratings. However, the Board relies on the competent findings of record provided by medical professionals, given the professionals’ expertise in evaluating mental disorders. The probative evidence does not support a finding that a disability rating in excess of the one granted herein is warranted for the service-connected psychiatric disability. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected psychiatric disability, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017).  In summary, the Board finds that, for the service-connected psychiatric disability, a rating of 100 percent is not warranted at any time during the relevant rating period. 4. Entitlement to service connection for right knee status post arthroscopy with arthritis and chondromalacia of the patella (right knee disability). The Veteran seeks service connection for a right knee disability. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In addition, for Veterans who have served 90 days or more of active service after December 31, 1946, there is a presumption for certain chronic diseases, to include arthritis, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” If there is not sufficient evidence that the currently diagnosed chronic disease was chronic in service or within a presumptive period, a veteran may still be entitled to presumptive service connection if continuity of symptomatology is demonstrated. 38 C.F.R. § 3.303 (b); See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309 (a). As to the first element of service connection, current disability, the record indicates that the Veteran has diagnoses of patellofemoral syndrome, degenerative joint disease, and ACL tear. See March 2018 Private Opinion. Therefore, this element is met. As to the second element for direct service connection, in-service incurrence or aggravation of a disease or injury, review of the Veteran’s service treatment records revealed that the Veteran reported right knee pain following twisting his right knee in basic training. Thus, the Board finds that the Veteran experienced an in-service incurrence or aggravation of a disease or injury, and element (2) is satisfied. The question for the Board is whether there is a medical nexus between the Veteran’s current right knee disability and his military service. The Board finds that the evidence is at least in equipoise that the Veteran’s current disability is related to his military service. The Veteran was afforded a VA examination in July 2013 to determine the nature and etiology of his current right knee disability. The examiner opined that the Veteran’s right knee disability was less likely than not incurred in or caused by his military service. The VA examiner stated that the Veteran’s service treatment records do not support the onset of a chronic right knee condition and found no evidence that a mild twisting of the right knee injury resulted in any permanent chronic right knee condition. Moreover, the VA examiner cited post-service vehicle accident, lifestyle, fitness level, and aging. The Veteran submitted a March 2018 private opinion from Dr. H.R., which opined that the Veteran’s in-service right knee injury predisposed the Veteran to develop a right meniscal condition that contributed to his 2013 injury. The private physician cited that the Veteran has reported ongoing knee pain since discharge and research studies supporting his conclusion. He opined that weight bearing joints will heal, but, they heal with scar tissue, which is never as strong nor resilient as the original tissue. Scar tissue affected the Veteran’s mechanics and functionality with high chances of re-injury and lower extremity instability. Thus, the Veteran’s in-service injury caused the Veteran to be more likely to reinjure himself. In this case, as to the issue of whether the Veteran’s right knee disability is related to his military service, the Board finds that the March 2018 private medical opinion is the most probative evidence of record as it was definitive, based upon a complete review of the Veteran’s entire claims file, and in consideration of the Veteran’s reported history. Furthermore, the March 2018 private examiner provided a complete and thorough rationale in support of his opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges the negative medical opinion provided in the July 2013 VA examination, however the Board finds that the examination is inadequate. The VA examiner cited that the Veteran right knee disability was more likely due to lifestyle, fitness, aging, and an alleged vehicle accident. However, the examiner did not provide any specifics. He did not identify what factors of the Veteran’s lifestyle, or the vehicle accident that contributed to the Veteran’s current right knee disability. Moreover, the Veteran stated that although he has been in post-service vehicle accidents, there has been no injury to his right knee as the result of any accident. For failing to provide adequate rationale, the Board assigns limited probative value to the July 2013 VA examination. (Continued on the next page)   Based on the foregoing evidence, the Board finds that the evidence is at least in equipoise that the Veteran’s right knee disability is related to his military service. The Board affords great weight to the March 2018 private physician, who opined that the Veteran is currently diagnosed with a right knee disability and that it is related to his in-service right knee injury. Under such circumstances, and granting the Veteran the benefit of any doubt in this matter, the Board concludes that service connection for a right knee disability is warranted. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. R. Higgins, Associate Counsel