Citation Nr: 18150971 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 15-06 347A DATE: November 16, 2018 ORDER Entitlement to service connection for a left knee disability is denied. FINDING OF FACT The Veteran’s left knee disability is not causally or etiologically related to his military service. CONCLUSION OF LAW The criteria for establishing service connection for a left knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1976 to May 1979, and from March 1981 to June 1982. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) that denied the Veteran’s service connection claim for a left knee disability. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. The Veteran asserts that he has a current left knee disability that is related to his military service. For the reasons that follow, the Board finds that service connection is not warranted. 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; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as arthritis. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The medical evidence of record indicates a current diagnosis of mild left knee osteoarthritis, confirmed upon VA examination in August 2012. Thus, the remaining question is whether the current left knee disability is related to service. The Veteran stated in a September 2011 statement in support of his initial claim that he “dislocated” his knee during a morning physical run and went to sick call, where he was referred to physical therapy and placed on limited duty for one month. Service treatment records (STRs) confirm a February 1982 report of knee pain after twisting his knee during a run. The assessment was a left knee strain. The Veteran’s remaining STRs, including a May 1982 separation examination, are negative for any further complaints, diagnosis, or treatment related to any knee injury. He denied any bone or joint deformity, as well as a “trick” or locked knee, in a contemporaneous report of medical history. Post-service, a left knee disability is not shown by medical evidence until many years after the Veteran’s separation, when he reported a history of knee pain since 1982 in an October 2011 VA treatment record. As arthritis is not shown to have been present during service or in the first year after separation of service, and continuity of symptomatology leading to a diagnosis of arthritis is not shown, in-service incurrence of the Veteran’s left knee osteoarthritis cannot be presumed. See 38 C.F.R. §§ 3.307, 3.309(a). To the extent the Veteran asserts a continuity of symptomatology beginning during service, and that he did not report continued knee pain for the remainder of his military service because he was trained not to complain, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran’s report of medical history at separation from service where he denied any joint deformity or a “trick”/locked knee. Had the Veteran been experiencing knee pain or problems at the time of the report of medical history, the Board would expect he would have reported such. The Board finds the report of medical history at separation from service to be more reliable than more recent assertions as it was done contemporaneous to service and for the purpose of identifying disability at that time. The Veteran presented for a VA examination in August 2012, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The Veteran reported to the examiner that he had no treatment for knee pain since service, but that it worsened in 2009 and he then sought treatment. The examiner noted in the examination report that the Veteran’s in-service left knee sprain had resolved without residuals, and that more recent radiography of the left knee that showed mild narrowing of the medial compartment and some mild narrowing of the patellofemoral compartment consistent with mild degenerative arthritis. The examiner opined that the Veteran’s current left knee arthritis was consistent with natural aging, and was not due to the left knee sprain that occurred in February 1982 or that it was worsened beyond its natural progression by his military service. The examiner explained that while a sprain or strain of the joints involves the muscles and ligaments (soft tissues) surrounding the joint region, the degenerative process involves the boney joint spaces, and one is not the cause of, or related to, the other. Osteoarthritis, the examiner continued, results from a complex interplay of multiple factors, including joint integrity, genetics, local inflammation, mechanical forces, and cellular biomechanical processes, and for most people, is linked to one or more factors such as aging, occupation, trauma, and repetitive, small insults over time. The Board finds the VA examiner’s opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran, and it is not in significant conflict with any other medical opinion or competent, credible evidence. The Board acknowledges the Veteran’s argument, through his representative in an October 2018 statement, that it was the in-service trauma that caused his current left knee disability, not age. As the VA examiner noted, however, the evidence indicates that his initial knee strain resolved, and that his current left knee osteoarthritis – a disability with an unrelated degenerative process to a strain – did not manifest for decades after service. The Board has considered the Veteran’s statements, to include his assertions that his left disability began during service. A veteran is competent to describe symptoms that he can perceive through the use of his senses and to give evidence about what he has experienced. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, whether any symptoms the Veteran experienced in service or following service are in any way related to his current disability requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999). While the Board acknowledges that the Veteran’s Military Occupational Specialty during service was a Medical Specialist, he has not demonstrated or asserted that he is qualified to opine as to the etiology of osteoarthritis. The Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against a finding that the Veteran’s left knee disability is etiologically related to his active service. Thus, the claim for service connection must be denied. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Scarduzio, Associate Counsel