Citation Nr: 18154810 Decision Date: 12/03/18 Archive Date: 11/30/18 DOCKET NO. 16-62 685 DATE: December 3, 2018 ORDER Entitlement to service connection for right knee disability is denied. FINDING OF FACT The Veteran’s current right knee disability has not been shown by competent evidence to be etiologically related to service, including treatment for tendonitis therein. CONCLUSION OF LAW The criteria for entitlement to service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1988 to September 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Veteran contends that his right knee disability is related to active duty service and therefore should be service connected. Service connection may generally be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. See 38 C.F.R. § 3.303(d). Certain chronic disabilities, such as arthritis, are presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). To establish service connection for a disability, there must be competent evidence of: (1) a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). The Board acknowledges that the Veteran meets the current disability element of service connection, as he was diagnosed with right knee osteoarthritis. See November 2013 and June 2017 diagnostic imaging reports. Turning to the in-service element of service connection, the Veteran asserts that patella tendonitis documented in service treatment records (STRs) dated April 2005 left his knee more susceptible to additional injury, which manifested itself as a meniscal tear noted in diagnostic imaging results from April 2014. The Board notes that the Veteran complained about joint pain on a December 2006 periodic health assessment but failed to specify which joints. In a July 2008 report of medical history prepared for retirement, the Veteran noted knee issues but specified those issues in his left leg. The nexus element of service connection was addressed in a January 2016 VA knee and lower leg disability Benefits Questionnaire (DBQ). The examiner noted the Veteran’s report of knee pain since active duty and its effect on his daily activities. The examiner reviewed the STRs and post-service imaging results before opining that the Veteran’s right knee disability “is less likely as not (less than 50 percent probability) incurred in or caused by (the) right knee pain during service.” In providing a rationale, the examiner confirmed the presence of patella tendonitis in service, but noted that there was no evidence for chronic patella tendonitis after service or on examination, and thus found the condition to be resolved without residual. The examiner found no objective evidence for a chronic right knee condition treated in active duty. Moreover, the examiner noted objective right knee findings (a lateral meniscus tear, degenerative joint disease, calcium pyrophosphate dihydrate deposition disease (CPPD)) shown in 2012 or later but stated that there was no objective evidence linking these findings to service, and no medical literature linking degenerative joint disease or CPPD to service. The Veteran’s representative asserted that the January 2016 medical opinion was inadequate because it was issued by a nurse practitioner, and not a physician. The representative requested that this matter be remanded for examination by an orthopedic specialist. The United States Court of Appeals for Veterans Claims (Court) addressed the question of the adequacy of certain medical professionals for examination purposes in Cox v. Nicholson, 20 Vet. App. 563, 569 (2007), holding that VA may satisfy its duty to assist by providing a medical examination conducted by someone who is able to provide “competent medical evidence” under § 3.159(a) (1). The Board notes that there is no indication that the VA examiner was biased against the Veteran or that the nurse practitioner was not competent to perform the required examination. The Board finds the examination fully adequate to adjudicate the issue on appeal, as it encompassed objective right knee testing, and the report contained a detailed rationale. The Board notes that there is no other medical opinion regarding the right knee disability in the Veteran’s claims file. The Board has considered the Veteran’s lay contentions and notes that he is certainly competent to observe pain and potentially other symptoms of the right knee. That having been said, he does not have the training or credentials needed to competently diagnose a right knee disorder or opine as to its etiology. His lay contentions are thus of markedly lower probative value than the VA examiner’s opinion. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In summary, the Board finds that service connection for the Veteran’s right knee disability is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Banks, Associate Counsel