Citation Nr: 18157703 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-63 370 DATE: December 13, 2018 ORDER Entitlement to service connection for osteoarthritis, left knee, claimed as left knee pain is denied. Entitlement to service connection for osteoarthritis, right knee, claimed as right knee pain is denied. FINDINGS OF FACT 1. The Veteran's left knee osteoarthritis was not present in service or for many years thereafter, and is not otherwise etiologically linked to service. 2. The Veteran’s right knee osteoarthritis was not present in service or for many years thereafter, and is not otherwise etiologically linked to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee osteoarthritis are not met. 38 U.S.C. §§ 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). 2. The criteria for service connection for a right knee osteoarthritis are not met. 38 U.S.C. §§ 1111, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1977 to August 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection is awarded for disability that is the result of a disease or injury in active service. 38 U.S.C. § 1131. Service connection requires competent evidence showing: (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, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009); see also Walker v. Shinseki, 708 F.3d 1331, 1334 (Fed. Cir. 2013). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. See Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107 (b)). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 1. Bilateral Knee Osteoarthritis The Veteran contends that his current bilateral knee osteoarthritis is due to service. 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 osteoarthritis, and evidence shows that he was diagnosed with bilateral knee pain in service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of osteoarthritis began during service or is otherwise related to an in-service injury 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). Private treatment records show the Veteran was not diagnosed with osteoarthritis until 2012, 35 years after his separation from service. While the Veteran is competent to report having experienced symptoms of knee pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of osteoarthritis. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic imaging. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, an August 2016 VA examiner opined that the Veteran’s osteoarthritis is not at least as likely as not related to an in-service injury or disease, including bilateral knee pain. The rationale was there is no evidence that the bilateral knee pain became chronic and he was not diagnosed with arthritis until 2012, thus the most likely cause of the Veteran's arthritis is aging. 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). This opinion is supported by both the Veteran's private practitioner Dr. S.D. and the Veteran himself. In an April 2012 treatment note, S.D. remarks that the Veteran broke his left hip in a 1986 work accident. Over time, this injury has affected both knees. In an April 2013 intake questionnaire, the Veteran stated that his knee pain was due to a June 1986 accident in which he broke his left hip. While the Veteran now believes his osteoarthritis is related to an in-service injury or disease, including documented bilateral knee pain, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic imaging. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Additionally, the Veteran's current statements regarding the nature of his knee pain are contradicted by his earlier statements regarding its onset. Consequently, the Board gives more probative weight to the medical opinions of the VA examiner, the Veteran's private practitioner Dr. S.D, and the contemporaneous statements of the Veteran. The Board notes that the Veteran stated the VA examiner did not know about his prior right knee surgery. However, the August 2016 VA examination report clearly indicates that the Veteran had prior surgery on his right meniscus. The Veteran further alleges that due to the short duration of his service, there was not enough time to be clinically diagnosed. However, the Veteran's post service treatment records are silent for any complaints of knee pain until approximately 2002 and the Veteran's own statements and all the medical evidence indicate that his osteoarthritis to be unrelated to service. As such, service connection for bilateral knee osteoarthritis is not warranted. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Uller, Associate Counsel