Citation Nr: 18123774 Decision Date: 08/03/18 Archive Date: 08/02/18 DOCKET NO. 15-27 214 DATE: August 3, 2018 ORDER Entitlement to service connection for a right knee disability is granted. FINDING OF FACT Right knee degenerative joint disease (DJD) had onset due to injury sustained during the Veteran’s period of service. CONCLUSION OF LAW The criteria for entitlement to service connection for a right knee disability have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1979 to August 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision issued by the RO. This appeal was processed using the Veterans Benefits Management System (VBMS) paperless claims processing system. 1. Entitlement to service connection for a right knee disability Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); 38 C.F.R. § 3.303. In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is a chronic disease. 38 U.S.C. § 1101. Therefore, section 3.303(b) is potentially applicable. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). The Veteran contends that his right knee disability onset from injury sustained during his period of service. April 1982 service treatment records reflect that the Veteran injured his right knee playing basketball. On examination the assessment was acute hemarthrosis of the right knee and possible tear of the lateral meniscus of the right knee. The Veteran was instructed to avoid activities such as prolonged standing, walking, climbing, running, jumping, skipping, climbing ladders or squatting. He was to be evaluated weekly and was placed in a cylinder cast for three weeks. A May 1982 service treatment record documents the Veteran’s complaint of right knee pain. The examiner documented that the Veteran had injured his right knee playing basketball. On examination, the assessment was right knee sprain. After service, a November 2012 private treatment record reflects that the Veteran sought treatment in the emergency room for a two-day history of right knee pain and tingling in the right foot. He denied any fall or trauma or involvement in a motor vehicle accident. He reported that he had torn ligaments in the same knee approximately 20 years earlier during his period of service. On examination, the impression was joint effusion of the knee. June 2013 x-ray findings showed moderate to severe DJD at the patellofemoral joint; moderate DJD at the medial and lateral joint compartments; and, small suprapatellar joint effusion. A July 2013 private treatment record documents the Veteran’s complaint of right knee pain. The Veteran reported that he had a right knee disability that onset due to injury sustained during his period of service in 1982. He stated that he had experienced right knee problems intermittently over the years since sustaining the initial injury playing basketball during his period of service. On examination, the impression was severe right knee DJD. An April 2015 VA treatment record documents the treatment the Veteran received for end stage tricompartmental DJD of the right knee. He reported that he had tried to manage his right knee disability with physical therapy, bracing, pool therapy, and medication. He indicated that he wanted to pursue a total knee arthroplasty (TKA) of the right knee. The May 2015 Report of VA examination documents diagnosis of right knee strain. The Veteran reported that his right knee disability onset during his period of service in 1982. He complained that his right knee disability had increased in severity over the years since the initial injury. On review of the claims file, the examiner opined that the current right knee disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that the Veteran sought treatment for a right knee injury in service in April 1982. However, the examiner explained that after that initial injury, the Veteran did not seek treatment again for a right knee disability until 2012. The July 2016 private treatment record documents that the Veteran sustained a right knee injury playing basketball during his period of service. He reported that he had the knee drained on three separate occasions and was provided a cylinder cast to wear for approximately 2 months. The Veteran reported that he has had right knee problems since the in-service injury. On examination, the diagnosis was severe right knee DJD. The physician opined that it was as likely as not that the Veteran’s in-service right knee injury caused or contributed to his current right knee DJD. The physician explained that the injury would seem to have resulted in a more rapid progression secondary to posttraumatic DJD. On this record, the evidence is in relative equipoise in showing that the Veteran’s current right knee disability had its clinical onset due to injury sustained during a period of service. Reasonable doubt is resolved in the Veteran’s favor and service connection for a right knee disability is warranted. The Board expresses no opinion regarding the severity of the disorder. The RO will assign an appropriate disability rating on receipt of this decision. Ferenc v. Nicholson, 20 Vet. App. 58 (2006) (discussing the distinction in the terms “compensation,” “rating,” and “service connection” as although related, each having a distinct meaning as specified by Congress). Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Jackson, Counsel