Citation Nr: 18151245 Decision Date: 11/19/18 Archive Date: 11/16/18 DOCKET NO. 10-20 758 DATE: November 19, 2018 ORDER Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. The appeal of the issue of entitlement to an initial rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is dismissed. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has left knee disability due to a disease or injury in service, to include specific in-service event, injury, or disease. 2. The preponderance of the evidence is against finding that the Veteran has right knee disability due to a disease or injury in service, to include specific in-service event, injury, or disease. 3. In a written statement received in September 2018 the Veteran withdrew her appeal in the matter of entitlement to an initial rating in excess of 70 percent for PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for left knee disability are not met. 38 U.S.C. §§ 1110, 1131 (peacetime), 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for right knee disability are not met. 38 U.S.C. §§ 1110, 1131 (peacetime), 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for withdrawal of the appeal of the issue of entitlement to an initial rating in excess of 70 percent for PTSD have been met. 38 U.S.C. § 7105(d)(5); 38 C.F.R. § 20.204. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS This appeal was most recently before the Board in June 2017, when it reopened the Veteran’s claims of service connection for right and left knee disabilities, and remanded all three issues for additional development. At that time, the Veteran's PTSD was evaluated as 50 percent disabling prior to October 24, 2013, and as 70 percent disabling thereafter. An April 2015 rating decision assigned the 70 percent rating effective the date of service connection. The Board finds there has been substantial compliance with the remand directives for the claims decided here. Stegall v. West, 11 Vet. App. 268 (1998). Withdrawal The Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the Veteran or by his or her authorized representative. Id. By a statement received in September 2018, the Veteran withdrew her appeal seeking entitlement to an initial rating in excess of 70 percent for PTSD. There remain no allegations of errors of fact or law for appellate consideration. The Board does not have jurisdiction to review the claim and it is dismissed. Service Connection The Veteran contends she has bilateral knee conditions that are related to in-service treatment she received for both knees. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of bilateral knee osteoarthritis, and evidence shows that the Veteran received in-service treatment for both the left and right knees, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of bilateral knee osteoarthritis began during service or is otherwise related to an in-service injury, event, or disease. 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), (d). The Veteran’s service treatment records (STRs) reflect that she received treatment for both knees. She first reported left knee pain in November 1988, reporting that her knee began to hurt the night before and that she was struck in the left knee by a metal object 10 years beforehand, prior to service. On physical examination, both knees showed no effusion, were stable, normal patellae, and full range of motion. A left knee x-ray was normal. She again reported left knee pain in September 1991 following a 10-mile run. Minimal edema and a decreased range of motion was noted. A lateral collateral ligament injury and possible chondromalacia patella were diagnosed. In an October 1991 treatment note, the Veteran reported her left knee was improving from strengthening exercise. The Veteran reported right knee pain in December 1991 after falling down stairs. An edema to the patella of the right knee was diagnosed. In the Veteran’s July 1992 separation examination, she reported occasional mild left knee pain when running, and her lower extremities were clinically evaluated as normal. VA treatment records show the Veteran was not diagnosed with osteoarthritis (degenerative joint disease) of the left knee until November 2012 and of the right knee until October 2013, 20 years after her separation from service. On October 1992 VA examination, the examiner noted she had slight crepitus with patellar compression and flexion of each knee. The examiner also noted she had chondromalacia patella, but an x-ray of her left knee was normal and showed no bony abnormalities. While the Veteran is competent to report having experienced symptoms of knee pain and crepitus intermittently since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of either a right or left knee disability. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further the July 2018 VA examiner opined that the Veteran’s bilateral knee joint osteoarthritis is not at least as likely as not related to an in-service injury, event, or disease, including her in-service treatment for both her knees. The rationale was that while the Veteran sustained bilateral knee strains during service, full recovery can be expected after physical therapy, and the Veteran’s knee examinations after her knee strains were normal. Additionally, her current diagnosis of knee arthritis indicates that it is a degeneration process associated with aging and the activities of daily living, and her weight was a significant risk factor for knee osteoarthritis. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). (Continued on the next page)   While the Veteran believes her bilateral knee osteoarthritis is related to an in-service injury, event, or disease, including the in-service treatment for knee pain, she is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the July 2018 VA examiner’s opinion. L. BARSTOW Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Eric Struening, Associate Counsel