Citation Nr: 18158532 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 13-15 843 DATE: December 17, 2018 ORDER Entitlement to service connection for a bilateral knee disability is denied. FINDING OF FACT The Veteran’s bilateral knee disability was not shown in service or within the first post-service year, and has not been shown to be related to a disease or injury of service origin, or to have been caused or aggravated by a service-connected pes planus disability. CONCLUSION OF LAW The criteria for service connection for a bilateral knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1975 to August 1979, with subsequent service in the National Guard. In a May 2018 Appeals Management Center (AMC) decision, the AMC granted service connection for unspecified anxiety disorder (claimed as PTSD), tinnitus, and bilateral hearing loss. As such, the benefits sought have been granted in full and are no longer before the Board on appeal. In his May 2013 substantive appeal, the Veteran requested a Board hearing. See May 2013 VA Form-9. In December 2016, the Veteran withdrew his hearing request. See December 2016 Hearing Request Correspondence. Service Connection A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, a veteran 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). Under section 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Bilateral knee disability The Veteran filed a February 2012 claim for service connection for problems with his bilateral knees. See February 2012 VA Form 21-526. He contends that his knee problems are secondary to his service-connected pes planus. Regarding the first Shedden and Wallin elements, the Veteran has currently diagnosed bilateral knee strains with the date of diagnosis in August 2017. See August 2017 VA examination report. Turning to the second Shedden and Wallin elements, regarding the second Shedden element, service treatment records (STRs) include an April 1979 report of medical examination that indicated the Veteran had normal lower extremities. Regarding the second Wallin element, the Veteran is service-connected for bilateral pes planus. Finally, with regard to the third Shedden and Wallin elements, the August 2017 VA examiner opined that the Veteran’s bilateral knee strains are less likely as not incurred in or caused by illness, event, or injury that occurred during service and opined that his bilateral knee strains are less likely as not incurred or caused by the initial manifestation of arthritis within one year after his August 1979 separation from active service. In support of his opinions, the examiner stated that there are no entries in the Veteran’s military service medical records which reference knee pains or knee conditions, including no knee x-rays on file in the Veteran’s military service medical records. The examiner concluded that therefore, there are no records to support the Veteran’s claims. The August 2017 VA examiner further opined that the Veteran’s bilateral knee strains are less likely than not proximately due to or the result of the Veteran’s bilateral pes planus. In support of his opinion, the examiner stated that there is no pathologic link between pes planus and knee pathology/knee strain. The examiner stated that the condition of pes planus is not associated with, and there is no medical literature to support, a causal link between pes planus and pain or debility in the knees. The August 2017 examiner also opined that the Veteran’s currently diagnosed bilateral knee strains were less likely than not aggravated beyond their natural progression by the Veteran’s bilateral pes planus. In support of his opinion, the examiner reiterated that there is no pathologic link between pes planus and knee pathology. Further, the examiner stated that, while the Veteran does have service-connected bilateral pes planus, he has normal gait and ambulatory function. The examiner explained that there is no pathology or physical mechanism to connect his service-connected pes planus to his bilateral knee condition. The Board affords the August 2017 VA examination report great probative value as it is based on a review of the claims file and thorough examination of the Veteran. The examiner provided a complete rationale for the conclusions provided, and the Board finds them persuasive. The Board has considered the Veteran’s contentions. However, as a lay witness, the Veteran is only competent to report on factors such as observable symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Determining the possible cause of his bilateral knee strains is beyond the scope of lay observation. Thus, a determination as to the etiology of his bilateral knee strains requires specialized training. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno, 6 Vet. App. at 469-70. As such, the Veteran’s lay assertions do not constitute competent evidence concerning the etiology of his currently diagnosed bilateral knee strains. Moreover, as detailed above, there is no competent evidence of record indicating that the Veteran’s bilateral knee disability is etiologically related to his active military service or service-connected bilateral pes planus. (CONTINUED ON NEXT PAGE) In summary, the competent medical evidence of record weighs against the claim, the Board finds that entitlement to service connection for bilateral knee disability is not warranted on a direct or secondary basis. As the preponderance of evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Schick, Associate Counsel