Citation Nr: 18154329 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 15-31 024A DATE: November 29, 2018 ORDER Entitlement to service connection for a right knee disability is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his right knee disability, to include right knee degenerative arthritis and right knee meniscal tear status post surgical repair, is at least as likely as not related to the in-service meniscal tear. CONCLUSION OF LAW The criteria for service connection for a right knee disability, to include right knee degenerative arthritis and right knee meniscal tear status post surgical repair, are met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION Generally, service connection may be granted for a disability or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board concludes that the Veteran has a current right knee disability that is related to service. 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). The first element of service connection, a current diagnosis, has been met. A December 2017 notes diagnoses of right knee degenerative arthritis and right knee meniscal tear status post surgical repair. The second element of service connection, an in-service injury or event, has been met. A November 1962 service treatment record (STR) notes the Veteran’s complaints that he injured his right knee 7 years prior and developed trouble with knee locking. He was assessed with a right medial meniscal tear. In December 1962, he underwent an arthrotomy of the right knee with findings of a bucket handle tear of the medial meniscus. By January 1963, he was noted to have made an uneventful recovery and was discharged to full duty. The third element of service connection requires a medical nexus. Here, the record contains competing medical opinions. In June 2015, a VA examiner determined that the Veteran’s right knee condition was less likely than not incurred in or caused by the in-service injury. He noted that STRs showed the Veteran made an uneventful recovery and was released to full unrestricted duty after the December 1962 surgical repair. He additionally noted that treatment records were silent for any complaints of right knee pain for over 50 years. He commented that similar arthritic findings were identified in both knees on imaging, and that there was no evidence that the right knee had been made worse by the in-service injury. In December 2017, a VA examiner opined that the right knee condition was less likely than not incurred in or caused by the in-service injury. She noted the Veteran’s full recovery after the in-service injury, lack of follow-up assessment for the remainder of service, discharge examination noting normal lower extremities without any mention of a knee disability, and the lack of objective evidence of any knee assessment for 55 years after service. She commented that X-ray imaging shows chondrocalcinosis caused by calcium pyrophosphate deposition disease (calcium deposits in cartilage/joints) that is known to cause different types of arthritis such as chronic arthritis and osteoarthritis. Of note, the examiner stated that physical examination revealed equal bony enlargement bilaterally, relatively the same limited range of motion and pain bilaterally, and crepitus bilaterally. The examiner concluded that the Veteran’s bilateral knee condition was more likely caused by years of physically demanding work leading to overuse injuries, chondrocalcinosis damaging knee joints, and the normal aging process. In contrast, in May 2018, clinician C.H. opined that it is as likely as not that the Veteran’s chronic knee condition is due to the injury and subsequent treatment during military service. He provided range of motion testing and crepitus results. In June 2018, physician J.A. opined that it is as likely as not that the Veteran’s right knee disability is related to the injury suffered during active service. He stated that due to the meniscectomy, he expected increased deterioration of articular surfaces on the right side, which appeared to be the case. He noted that it was somewhat puzzling and that he could not comprehend why there were no orthopedic evaluations in the subsequent 54 years after service. However, he concluded that by taking into consideration the natural progression of osteoarthritis and the 1962/1963 intervention, the Veteran would indeed be experiencing similar symptoms to those described today. He further noted that any person who is at the Veteran’s current state of life would likely have osteoarthritis that is painful and troublesome, but that he cannot quantitate the pain experienced in the knees as to whether it is appropriate for a specific age range, whether or not the joint suffered some injury 62 years ago. Finally, he commented that, to his knowledge, the Veteran did not suffer any additional injuries to his right knee since discharge and through 2017. Having reviewed these opinions, the Board finds that the evidence is in equipoise on whether the Veteran’s current right knee disability is related to the in-service injury. The June 2015, December 2017, and June 2018 opinions are probative as they are supported by rationales. However, the Board finds that C.H.’s May 2018 opinion holds minimal probative value due to lack of a supporting rationale. C.H. did not provide a rationale to support his opinion that the current right knee disability is related to service. Rather, he merely recommended further evaluation by an orthopedic specialist to determine the degree to which the initial injury and treatment contributed to the Veteran’s knee problem. Accordingly, the record contains two probative negative opinions and one probative positive opinion. However, the Board finds that nevertheless, the evidence is in equipoise as to whether the current right knee disability is related to service. The June 2015 and December 2017 examiners found that the Veteran’s right knee disability was less likely related to service because STRs showed that the Veteran made a full recovery after the surgical repair, the record did not contain objective evidence of complaints or treatment for the remainder of service and for over 50 years after service, and there was no evidence that the right knee had been made worse by the service injury as similar arthritic findings were discovered in the uninjured left knee. Significantly, however, the June 2018 physician noted that there was increased deterioration of articular surfaces on the right, which was expected after the in-service surgical repair. Additionally, there is evidence indicating that the Veteran continued to experience symptoms after the in-service surgical repair. Though STRs document that the Veteran made a full recovery after the December 1962 surgery, the January 1963 operative report documented the Veteran’s statement that he still experienced occasional giving away of the knee and felt as if there was a knot under the patellar. Additionally, though the Veteran admitted that he did not seek treatment for over 50 years, he has consistently provided lay testimony indicating that he continued to experience right knee symptoms since service. In light of this, the Board finds that the evidence is in equipoise. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As such, the Board will resolve doubt in the Veteran’s favor and find that service connection is warranted. The claim for a right knee disability is granted. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Vang, Associate Counsel