Citation Nr: 19141018 Decision Date: 05/28/19 Archive Date: 05/28/19 DOCKET NO. 18-06 920 DATE: May 28, 2019 ORDER Service connection for left knee osteoarthritis, status post-total knee arthroplasty, is granted. Service connection for right knee osteoarthritis, status post-total knee arthroplasty, is granted. Service connection for bilateral knee scars is granted. FINDINGS OF FACT 1. Resolving all doubt in the appellant’s favor, his bilateral knee osteoarthritis, status post-total knee arthroplasty, was aggravated during active duty for training. 2. The appellant’s bilateral knee scars are proximately due to his now service-connected bilateral knee disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for left knee osteoarthritis, status post-total knee arthroplasty, have been met. 38 U.S.C. §§ 101(24), 1110, 5107; 38 C.F.R. §§ 3.1(d), 3.6, 3.102, 3.303. 2. The criteria for service connection for right knee osteoarthritis, status post-total knee arthroplasty, have been met. 38 U.S.C. §§ 101(24), 1110, 5107; 38 C.F.R. §§ 3.1(d), 3.6, 3.102, 3.303. 3. The criteria for service connection for bilateral knee scars have been met. 38 U.S.C. §§ 101(24), 1110, 5107; 38 C.F.R. §§ 3.1(d), 3.6, 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant served on active duty for training (ACDUTRA) in the U.S. Marine Corps Reserve from October 17, 1967, to November 28, 1967. This matter comes before the Board of Veterans Appeals (Board) on appeal from a November 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the appellant testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the undersigned held the record open for 60 days for the submission of additional evidence, which was received in March 2019. 38 U.S.C. § 7105(e)(1). 1. Entitlement to service connection for a left knee disorder. 2. Entitlement to service connection for a right knee disorder. 3. Entitlement to service connection for bilateral knee scars as secondary to left and right knee disorders. A Veteran is a person who served in the active military, naval, or air service and who was discharged or released under conditions other “than dishonorable.” 38 C.F.R. § 3.1(d). The term “active military, naval, or air service” includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). ACDUTRA includes full-time duty performed by members of the National Guard of any State or the Reserve. 38 C.F.R. § 3.6(c). INACDUTRA includes duty other than full-time duty performed by a member of the Reserve or the National of any State. 38 C.F.R. § 3.6(d). In this case, as the appellant only served on ACDUTRA, the advantages of the evidentiary presumptions regarding the presumption of soundness and the presumption of service incurrence of a chronic disease are inapplicable. McManaway v. West, 13 Vet. App. 60, 67; Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991); Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.R.F. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As an initial matter, the Board notes that the record reflects a current diagnosis of a bilateral knee disorder. Specifically, a March 2019 knee and lower leg conditions Disability Benefits Questionnaire (DBQ) reflects a diagnosis of bilateral knee osteoarthritis, status post-total knee arthroplasty. Additionally, a November 2016 VA examination report and the March 2019 DBQ indicates the presence of bilateral knee scars. The appellant’s service treatment records (STRs) reflect that a September 1967 Report of Medical Examination conducted at the time of entrance demonstrates a normal clinical evaluation of the lower extremities. The corresponding Report of Medical History reveals his report that, within the past five years, he had consulted/been treated by clinics, physicians, healers, or other practitioners for his knee, but nothing was found to be wrong. Thereafter, a November 1967 STR notes that an X-ray of both knees was performed, and the results demonstrated an internal derangement of both knees, which existed prior to entry to service. Such record further reflects a finding of moderately advanced degenerative osteoarthritis of both knees, more marked on the left. An additional November 1967 STR reflects that the appellant’s knees gave out after prolonged standing or abrupt halt. Such record further reflects that he had bilateral crepitus and joint tenderness, and an impression of degenerative osteoarthritis, existed prior to entry to service, was noted. In this regard, at his February 2019 Board hearing, the appellant testified that he had a knee injury when he was 16 years old from playing football and believed that he was not eligible for military service as a result of such injury. Nonetheless, he was accepted for service and, during basic training, he experienced hard pounding on his knees from marching, running, and jumping in heavy boots for eight hours a day. He further testified that there was more strain placed on his knees in boot camp than there had ever been prior to such time. Finally, the appellant indicated that his knees deteriorated during service and did not improve after discharge. At a November 2016 VA examination, following an interview of the appellant, a review of the record, and a physical examination, the examiner found that he had bilateral knee scars associated with his total knee replacements. She further opined that the appellant’s bilateral knee scars were at least as likely as not incurred in or caused by his military service. As rationale for the opinion, the examiner indicated that the appellant surgery on both knees, and his STRs showed that, in November 1967, he was diagnosed with internal derangement in both knees followed by osteoarthritis of the bilateral knees. She further noted that the appellant’s report of total knee replacements in 2003 were likely related to the osteoarthritis condition he had while in service; thus, his scars related to the bilateral knee conditions he had during service in 1967. However, a different November 2016 VA examiner, who also interviewed the appellant, conducted a review of the record, and performed a physical examination, opined that the appellant’s bilateral knee disorder, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury, or illness. As rationale for the opinion, he indicated that the appellant was inducted into the service in September 1967 and, while his knees were not mentioned on his induction forms, he was diagnosed with bilateral knee osteoarthritis while in basic training in November 1967. The examiner concluded that it was less likely that the appellant had normal knees at induction that deteriorated in one month during training. In a March 2019 knee and lower leg conditions DBQ, following an interview of the appellant, a review of the record, and a physical examination, Dr. M.C. opined that it was at least as likely as not that the appellant’s bilateral knee disorder was worsened beyond normal progression by his military service. As rationale for the opinion, Dr. M.C. indicated that, at the young age of 24, the appellant had X-ray evidence of bilateral knee degenerative arthritis and such prolonged further over the years and led to bilateral knee replacements. As noted previously, as the appellant is not entitled to the presumption of soundness, the only question before the Board is whether his bilateral knee disorder was incurred or aggravated during his period of ACDUTRA. In this regard, the Board finds that, while the appellant had a knee injury prior to service, the evidence is in equipoise as to whether such bilateral knee disorder was aggravated therein. In this regard, his STRs reflect his contemporaneous report that, while he was treated prior to service for his knee, nothing was found to be wrong, and his lower extremities were normal upon clinical evaluation. However, within weeks, he sought treatment for knee complaints related to his military duties, which was ultimately diagnosed as internal derangement followed by osteoarthritis. Specifically, it was noted that his knees gave out after prolonged standing or abrupt halt and, at his Board hearing, he reported that he experienced hard pounding on his knees from marching, running, and jumping in heavy boots for eight hours a day during service. Moreover, the medical opinions obtained in connection with the appellant’s appeal, to include those rendered by the November 2016 VA examiners and Dr. M.C., provide conflicting findings in regard to whether his bilateral knee disorder was aggravated therein. Consequently, the Board resolves all doubt in the appellant’s favor and finds that his bilateral knee osteoarthritis, status post-total knee arthroplasty, was aggravated during ACDUTRA. Thus, service connection for such disorders is warranted. Further, as noted previously, the evidence reflects that the appellant’s bilateral knee scars are proximately due to his service-connected bilateral knee disabilities. Therefore, secondary service connection for such disorder is likewise warranted. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Koria B. Stanton, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.