Citation Nr: 18123778 Decision Date: 08/03/18 Archive Date: 08/02/18 DOCKET NO. 13-09 189A DATE: August 3, 2018 ORDER Service connection for left knee disability, claimed as injury of left knee with degenerative joint disease is denied. FINDING OF FACT The Veteran’s left knee disability did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for left knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a) (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1973 to November 1975 and from August 1991 to September 1992. This matter has come before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision of the Montgomery, Alabama, Department of Veterans Affairs (VA) Regional Office (RO). In November 2016, the Board reopened the claim of service connection for a left knee disability and remanded this issue for further development. 1. Service connection for left knee disability, claimed as injury of left knee with degenerative joint disease The Veteran contends that her current left knee disability was caused by a fall during her second period of active duty service. Certain chronic diseases, including arthritis, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The Board concludes that, while the Veteran was diagnosed with degenerative joint disease, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not shown in service or manifest to a compensable degree within one year of separation from service and was not caused by service. The first radiologic finding of degenerative changes in the left knee was from a May 2010 VA x-ray perform in conjunction with her June 2010 VA examination, which in turn diagnosed her with degenerative joint disease. Thus, the treatment records show the Veteran was not diagnosed with degenerative joint disease until several years after her separation from service and years outside of the applicable presumptive period. Furthermore, the December 2016 VA examiner found that the Veteran’s current left knee symptoms were attributable to chondromalacia patella, not arthritis, considering the June 2014 MRI findings that failed to show degenerative changes and the July 2015 diagnosis of chondromalacia patella. Chondromalacia patella is not a chronic disease under 38 C.F.R. § 3.309(a). While the Veteran is competent to report having experienced symptoms of left knee pain consistently since service, the Board finds the reports of continuity of symptomatology not credible. Although the Veteran reported an in-service left knee injury in her original April 1997 claim, the record does not include evidence of any left knee complaints prior to that time. Indeed, while she sought treatment for right knee complaints in April 1993, shortly after her separation from service, she did not report any left knee symptoms. This record describes her right knee symptom in depth and discusses blisters on her bilateral heels. The Veteran failure to discuss ongoing left knee symptoms at the time weighs heavily against the credibility of any later assertions of ongoing left knee pain since service. Furthermore, subsequent medical records attributing her left knee symptoms to chondromalacia patella interrupt continuity of symptomatology. Service connection for a left knee disability may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s left knee disability and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The December 2016 VA examiner opined that the Veteran’s left knee condition is not at least as likely as not related to an in-service injury, event, or disease, including the reported in-service fall. The rationale was that the medical evidence supported a finding that her current left knee symptoms were attributable to a recent onset of chondromalacia patella. While the Veteran believes her left knee disability is related to an in-service injury, event, or disease, including an in-service fall, she is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires specialized medical education to determine whether the in-service injury could cause her current disability several years later. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claims of entitlement to service connection for a left knee disability and her appeal must be denied. There is no reasonable doubt to be resolved. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Bridgid D. Houbeck, Counsel