Citation Nr: 18150960 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-42 970 DATE: November 16, 2018 ORDER Entitlement to service connection for right knee degenerative arthritis is granted. FINDING OF FACT The Veteran’s right knee degenerative arthritis is related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for right knee degenerative arthritis have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.101, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Navy between September 1976 and September 1980. He was honorably discharged. This matter appears before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision of the Department of Veterans Affairs (VA) regional office (RO) in Houston, Texas. Entitlement to service connection for right knee arthritis The Veteran contends that his right knee degenerative arthritis is a result of an in-service injury and thus is entitled to service connection. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Generally, the evidence must show: (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, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). The Veteran carries a diagnosis of right knee degenerative arthritis. Shedden element (1) has been met. As to the Shedden element (2), the Veteran’s service treatment records (STRs) note two instances of a right knee injury. The first injury occurred during a football game in November 1977 which caused the Veteran to seek treatment. The Veteran complained of right knee swelling, pain and trauma. The physician recommended the Veteran “apply hot soaks.” The second notation occurred in March 1978 where the Veteran stated he experienced “trick” or locked knee. Turning to Shedden element (3), the Board finds there is sufficient evidence in the record to find that it is as likely as not that the Veteran’s right knee degenerative arthritis was incurred in or aggravated by his in-service injury. The Veteran submitted private medical records including the opinion of an expert physician, Dr. D.S., who examined the Veteran in August 2016. Dr. D.S. is competent to provide a medical opinion as to the etiology of the Veteran’s right knee degenerative arthritis. Dr. D.S. considered the Veteran’s testimony and examined the Veteran. He observed genu varum deformity and slight swelling. Additionally, Dr. D.S. noted tenderness of the medial joint line, confirming the VA examiner’s findings. The Veteran exhibited pain at extreme limits of range of motion. Based upon his examination, conversations with the Veteran and reviewing current x-rays, Dr. D.S. opined there existed a “definite possibility” between the in-service injury and the Veteran’s current arthritis. The Board finds Dr. D.S.’s opinion to be probative. However, the strength of the opinion is weakened by the overall lack of rationale. The Veteran stated he experienced knee pain for 35 years and did not believe it required medical attention beyond over-the-counter pain relievers and ice. The Board finds the Veteran’s competent and credible reports of progressive knee worsening to be probative. The Veteran is competent to discuss observable facts such as knee pain, progressive pain over three decades and daily use of a knee brace for employment. In April 2013, a VA examiner conducted an in-person examination of the Veteran but did not believe a nexus existed between the Veteran’s in-service injury and his current condition. The basis of her opinion was that the record lacked evidence of treatment records between 1977 and 2013 and any signs of continuity of symptomatology explaining the current disability. The VA examiner noted the Veteran did not attend physical therapy after a 1984 right knee surgical procedure and regularly wore a knee brace while at work. Little, if any, consideration appears to have been given to the Veteran’s lay history. The medical evidence with respect to the nexus question is conflicting. The positive private opinion lacked rationale. The negative VA opinion did not adequately address the Veteran’s complaints of knee pain since his in-service injury. That history is deemed competent and credible. Therefore, the Board finds the evidence is at least in equipoise on the question of a nexus. Shedden element (3) is met. In view of the totality of the evidence the Board finds the evidence is at least in relative equipoise regarding right knee degenerative arthritis. When the evidence is in relative equipoise, the benefit of the doubt doctrine provides that such reasonable doubt will be resolved in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection for right knee degenerative arthritis is warranted. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Mahmoudi, Associate Counsel