Citation Nr: 18110698 Decision Date: 06/14/18 Archive Date: 06/13/18 DOCKET NO. 14-31 302A DATE: June 14, 2018 ORDER Entitlement to service connection for a right knee disorder is granted. Entitlement to service connection for a left knee disorder is granted. Entitlement to service connection for a lumbar spine disorder is granted. FINDINGS OF FACT 1. The evidence is at least in equipoise as to whether the Veteran has a current right knee disorder that is related to active service. 2. The evidence is at least in equipoise as to whether the Veteran has a current left knee disorder that is related to active service. 3. The evidence is at least in equipoise as to whether the Veteran has a current lumbar spine disorder that is related to active service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran’s favor, a right knee disorder was incurred during active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Resolving reasonable doubt in the Veteran’s favor, a left knee disorder was incurred during active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. Resolving reasonable doubt in the Veteran’s favor, a lumbar spine disorder was incurred during active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1985 to March 1994. A videoconference hearing was held before the undersigned Veterans Law Judge in November 2017. At that time, the record was held open for 60 days for the submission of additional evidence. The Veteran subsequently submitted evidence with a waiver of RO jurisdiction. Service Connection In general, service connection will be granted for disability resulting from injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be presumed for certain chronic diseases, including arthritis, if manifested to a compensable degree within one year following discharge from active service. 38 C.F.R. §§ 3.307, 3.309(a). 1. Entitlement to service connection for a right knee disorder 2. Entitlement to service connection for a left knee disorder The Veteran contends he has right and left knee disorders related to active service. At the hearing, he testified that he did not have knee problems prior to service. He reported that he did lots of physical training and running during service and was treated for knee issues. Service treatment records confirm the Veteran was seen on multiple occasions with complaints of right and left knee pain. The diagnoses included retropatellar pain syndrome, popliteal pain, possible semitendinosus strain, probable contusion rule out meniscal tear, possible strained medial collateral ligament, and prepatellar bursitis. Records dated in March 1991 note a two-year history of bilateral knee pain and he was placed on a profile for bilateral patella tendonitis. Complaints or findings related to the knees were not noted at separation in January 1994. Post-service records show that the Veteran injured his right knee in March 2004 and underwent a surgical repair of a right infrapatellar tendon rupture. In June 2010, he hurt his left knee playing basketball and underwent surgical repair of a left knee patellar tendon rupture. The Veteran underwent a VA examination in October 2010. He reported injuring his knees in service while running during physical training exercises and was seen on several occasions for bilateral knee pain. In 2004 he had surgery on his right knee after falling, and in June 2010 he was playing basketball and ruptured the left infrapatellar. The diagnosis was status post right and left infrapatellar rupture repair. The examiner noted that the claims folder was not available for review, but based on the series of events surrounding the injuries, it was her opinion that the bilateral knee infrapatellar ruptures were less likely as not caused by or a result of the knee pain that occurred during service. In a November 2010 addendum, a second examiner reviewed the claims folder and provided a negative etiology opinion. The rationale was that the left knee condition was the result of a recent injury that precipitated repair of the knee and there was no record of periodic treatment for the claimed disability prior to that time. In November 2017, the Veteran’s private physician, Dr. C.B. submitted a statement indicating that she followed the Veteran routinely for medical issues. She noted that the claimant had experience knee pain since 1985 and required surgery to repair both patellar tendons. She further stated that his knee issues started during service and in her opinion, were at least 50 percent related to his military career. As set forth, service treatment records document numerous complaints related to the knees and the Veteran is competent to report continuing knee problems. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). As concerns nexus, the record contains evidence both for and against the claims and is at least in equipoise. Resolving reasonable doubt in the Veteran’s favor, service connection for right and left knee disorders is granted. 38 C.F.R. § 3.102. 3. Entitlement to service connection for a lumbar spine disorder The Veteran contends he has a lumbar spine disorder related to active service. At the hearing, he testified that he did not have back problems prior to service. His military occupational specialty was cannoneer and he reportedly did a lot of heavy lifting. He reported chronic back problems after his initial injuries and that the back issues did not resolve after service. He also testified that following service he “tweaked” his back at work. Service treatment records show the Veteran was seen with complaints of low back pain on various occasions during service, to include following a motor vehicle accident. On separation examination in January 1994, his spine was reported as normal on clinical examination and he denied recurrent back pain. Post-service records show the Veteran was in a motor vehicle accident in May 1999 and was seen for back pain. In September 2001, he suffered a low back strain and sprain while at work. The Veteran underwent a VA spine examination in October 2010. He reported that while in the service he had to lift large weapons and over the years had experienced increasing low back pain which had become more severe and frequent. X-rays showed mild chronic degenerative changes anteriorly. The diagnosis was mild chronic lumbar degenerative disc disease. The claims folder was apparently unavailable for review, but based on the available information, it was the examiner’s opinion that the lumbar degenerative disc disease was at least as likely as not caused by or the result of complaints of lower back pain during service. In November 2010, a second examiner reviewed the claims folder and opined that the Veteran’s low back condition was less likely a result of service as there was no evidence of periodic treatment for the claimed disability. In November 2017, the Veteran’s private physician, Dr. C.B., submitted a statement indicating that she followed the Veteran routinely. She noted that he had a history of back pain since 1990. She indicated that his current issues started during service and in her opinion, were at least 50 percent related to his military career. The 1994 motor vehicle accident exacerbated his back issues that were already starting prior to the incident. On review, the Veteran had a physically demanding job during service and was seen for complaints of back pain. He is competent to report that his back pain continued following service. See Layno. Regarding nexus, the record contains evidence both for and against the claim and is at least in equipoise. Resolving reasonable doubt in the Veteran’s favor, service connection is warranted. 38 C.F.R. § 3.102. In making each of the decisions in this case the Board acknowledges that the Veteran suffered post-service injuries. The issues before the Board, however, are whether service connection is warranted for the claimed disorders. The issues before the Board do not involve what ratings are appropriate. The Board further notes that “[b]y requiring only an ‘approximate balance of positive and negative evidence’…, the nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding… benefits. Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Carsten, Counsel