Citation Nr: 18150710 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 17-62 582 DATE: November 15, 2018 ORDER Entitlement to service connection for left knee strain with degenerative arthritis and bursitis is denied. FINDING OF FACT The Veteran’s left knee strain with degenerative arthritis and bursitis 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. CONCLUSION OF LAW The criteria for service connection for left knee strain with degenerative arthritis and bursitis are not met. 38 U.S.C. §§ 1110, 1112, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Air Force from October 1984 to September 1990 and in the United States Coast Guard from September 2001 to December 2001, and from January 2003 to June 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Additional evidence, consisting of VA and private treatment records, and VA examination reports, was received following the issuance of the November 2017 statement of the case and certification of the appeal to the Board. The additional evidence is not relevant to the issue decided herein, such that neither a supplemental statement of the case (as set forth in 38 C.F.R. § 19.37 (a)), nor a solicitation of a waiver (as set forth in 38 C.F.R. § 20.1304 (c)), is necessary. 1. Entitlement to service connection for left knee strain with degenerative arthritis and bursitis The Veteran seeks service connection for left knee pain. The Veteran reports that he initially injured his knee while on active duty in 1985 while playing football. He indicates that he has had ongoing knee pain since that injury, and has just learned to deal with the pain on his own. He reports that he feels his degenerative arthritis is a progression of the knee injury in 1985. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for certain chronic diseases, including arthritis, may be presumed to have been incurred in service by showing that the disease manifested itself to a degree of 10 percent or more, within one year from the date of separation from service. 38 U.S.C. §§ 1131, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The term “chronic disease” refers to those diseases listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101 (3); 38 C.F.R. § 3.309 (a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). For such diseases, the second and third elements of service connection may be established by demonstrating (1) that a condition was “noted” during service; (2) post-service continuity of symptoms; and (3) medical or, in certain circumstances, lay evidence of a link between the present disability and the continuity of symptoms. 38 C.F.R. § 3.303 (b); see Walker, 708 F.3d at 1340. If a chronic condition is noted during service or during the presumptive period, but the chronic condition is not “shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned,” i.e., “when the fact of chronicity in service is not adequately supported,” then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed.” Walker at 1336; 38 C.F.R. § 3.303 (b). A current disability is established in this case. At a VA examination in February 2017, a VA examiner diagnosed knee strain, degenerative arthritis, and bursitis of the left knee. X-rays showed early onset of osteoarthritis. The record also supports the occurrence of an in-service injury. Service treatment records show that in August 1985, the Veteran presented to sick call with a left knee injury. The Veteran indicated that he twisted his knee while playing football, and complained of pain. X-rays were normal. While there is evidence of an in-service injury and a current left knee disability, the preponderance of the evidence fails to show a nexus between the two. As noted, a VA examination was conducted in February 2017. The examiner opined that the left knee condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that while service medical records showed a left knee strain while playing football on active duty in 1985, there was no record of this being an ongoing problem during the remainder of the Veteran’s military career or thereafter. The examiner opined that it was more likely than not, that the Veteran’s left knee problems are both age and weight-related. The examiner noted that the Veteran was 50 years old and weighed over 200 pounds with a body mass index of 36. The Board finds that the opinion of the VA examiner, which was provided after reviewing the claims file and a clinical examination of the Veteran, is persuasive and highly probative as it reflects consideration of all relevant facts and the examiner provided a rationale for the conclusion reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). The Board acknowledges that the Veteran believes his left knee disabilities are related to his in-service injury. The Veteran is competent to report that he injured his knee in service, but he is not competent to provide a nexus opinion for his current knee condition in this specific case because it is medically complex question. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). While it may be intuitive to a lay person that an in-service event led to arthritis and other problems many years later, the Veteran’s unsupported lay opinion is given little evidentiary weight in comparison to the medical opinion provided by the VA examiner -a licensed physician with medical training, knowledge and expertise that the Veteran is not shown to possess. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board has also considered whether service connection may be granted under the theory of chronicity and continuity of symptomatology in light of the Veteran’s competent assertions that he has had knee pain since active service. 38 C.F.R. §§ 3.303 (b); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board observes that arthritis was not noted during service. Further, to the extent that the Veteran credibly asserts a continuity of left knee pain in an effort to link his current arthritis to service, such an assertion is outweighed by the highly persuasive VA medical opinion against a causal relationship. The examiner, a medical professional, reviewed the history and determined that current left knee arthritis was not related to service. Therefore, service connection is also not warranted under 38 C.F.R. §§ 3.303(b). Finally, presumptive service connection is not warranted. Although arthritis is a condition considered to be a chronic disease for which presumptive service connection could be warranted under 38 C.F.R. § 3.309 (a), there is no competent evidence of record that shows that his arthritis manifested to a compensable degree within one year after discharge from service. (Continued on the next page)   In sum, the most probative evidence of record indicates that the Veteran’s current left knee disabilities are not related to his military service. Accordingly, the preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not applicable in this case. Service connection for a left knee disability is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Lauritzen, Associate Counsel