Citation Nr: 19164875 Decision Date: 08/21/19 Archive Date: 08/21/19 DOCKET NO. 16-04 635 DATE: August 21, 2019 ORDER 1. Entitlement to service connection for a left knee disability, to include osteoarthritis, is denied. 2. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. A left knee disability did not have its onset in service, arthritis was not manifested within one year of service discharge, and a left knee disability is not otherwise related to service. 2. The preponderance of the evidence is against a finding that the Veteran has been diagnosed with a psychiatric disorder, to include PTSD, that conforms to Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition or Fifth Edition. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left knee disability, to include osteoarthritis, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for a psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Air Force from October 1978 to October 1982 and from March 2003 to March 2004. The Veteran was afforded a Board hearing via video-conference in January 2019. Service Connection—Generally Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). Where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran’s claim on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000). 1. Entitlement to service connection for a left knee disability, to include osteoarthritis When the Veteran submitted his claim for service connection in August 2014, he wrote that the left knee disability began in 2006. The Veteran subsequently testified at his January 2019 Board hearing that his left knee started hurting during service while he was completing a required physical fitness test. The Veteran testified that it occurred during his second period of service during monthly Reserve training, and that he went to see a doctor about his knee hurting in November 2012 and June 2012. He also stated that his superiors forced him to separate from service because he had trouble completing the run for the physical fitness test. After carefully reviewing the evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for a left knee disability on both a direct and presumptive basis. The reasons follow. Regarding evidence of a current disability, a May 2012 letter from a private physician states that the Veteran has a diagnosis of osteoarthritis in his left knee. Thus, the Veteran meets the first element of the claim for service connection. As to an in-service disease or injury, the Board finds that the preponderance of the evidence is against this element. Initially, as noted above, the Veteran specifically told the undersigned that he was not alleging that he sustained a left knee injury during the period of service from October 1978 to October 1982. The Board has considered the Veteran’s testimony at his January 2019 hearing that he injured his left knee during a physical fitness test during service. However, the treatment records during the second period of active duty do not document reports of left knee pain or a left knee injury during a physical fitness test. For example, in a March 2003 Medical Administration, Health Risk Assessment Questionnaire Detail, the Veteran responded, “No” to the question of, “Do you have any orthopedic problems that prevent regular exercise or become bothersome during exercise?” When seen in December 2003 by VA for follow-up on a different medical problem, the examiner wrote, “He denies any acute complaints.” The Veteran’s lower extremities were examined, and there were no reports or documentation of knee pain. The Veteran again responded, “No” to the question of “Do you have any orthopedic problems that prevent regular exercise or become bothersome during exercise?” on a January 2004 Medical Administration Questionnaire completed shortly before his service discharge in March 2004. These facts tend to show that the Veteran did not sustain an injury to his left knee during the period of service from March 2003 to March 2004, which is consistent with the Veteran’s August 2014 claim for benefits, as he attributed his left knee pain as having its onset in 2006, which was after this period of service. Thus, the Board finds that the Veteran did not experience an in-service disease or injury related to his left knee during his second period of active duty from March 2003 to March 2004. Additionally, the preponderance of the evidence is against a nexus between the current left knee disability and service. For example, the Veteran was seen regularly by VA from 2004 to 2011, and there are multiple medical complaints documented during this seven-year period, but a left knee injury or left knee pain is not a complaint that was documented until May 2012, when an examiner wrote that the Veteran was unable to run because of osteoarthritis in his left knee. When seen in May 2004, it was noted that the Veteran had no significant past medical history except for hepatitis C and what appeared to be a positive hemochromatosis gene. The examiner wrote that the Veteran denied any history of arthralgias. In November 2004, the examiner wrote that the Veteran had no joint pain. In August 2005, the examiner wrote that the Veteran’s musculoskeletal system was normal. In January 2006, the examiner documented that the Veteran had no complaints, and his extremities were noted to be without edema. In December 2006, when listing the Veteran’s past medical history, which included 10 diagnoses, there was no notation of left knee pain or an injury. In October 2007, the examiner wrote that the Veteran had been “extremely active” over the past several months due to his being in the process of moving to another state. He denied excessive arthritic or muscular pain. In the May 2012 letter, the examiner wrote that the Veteran was “[u]nable to run due to osteoarthritis left knee.” In the above paragraph, the Board did not document every treatment record during this seven-year time frame, but rather some of the treatment records to show that during this time period, Veteran was not reporting left knee pain or a left knee injury. His extremities were regularly examined and found to have no edema, cyanosis, or clubbing. The Board finds as fact that the Veteran was not experiencing chronic left knee pain during this time period; otherwise, it would have been documented at some point within the VA treatment records. Accordingly, the preponderance of the evidence is against a finding that the Veteran had the onset of a left knee disability during active duty from March 2003 to March 2004 or the onset of a left knee disability beginning in 2006. A December 2006 memorandum documents that the Veteran was found to be medically disqualified for continued military duty to headquarters but was determined to be fit for military duty and placed on assignment limitation code status. The Board notes that a knee disability was not listed among the reasons that the Veteran was found to be medically disqualified for military duty, and that the Veteran was found to be fit for reserve participation in unit training assemblies and annual tours with no assignments under field conditions. This is further evidence against a finding that the Veteran developed a left knee disability in 2006. The Board has also considered June and November 2012 VA treatment notes submitted by the Veteran that show that the Veteran was diagnosed with left knee pain from osteoarthritis, and a November 2012 letter from a private physician that instructs the Veteran not to run for four months due to arthritis. A June 2012 letter from a private physician states that the Veteran has mild osteoarthritis due to wear and tear, and that the Veteran can walk without trouble but has difficulty running. While these records support evidence of a left knee disability beginning in approximately 2012, they do not support a finding that the Veteran developed a left knee disability during a period of active duty. Regarding presumptive service connection, the Veteran asserted on his August 2014 VA claim form that his left knee disability began in 2006, and VA treatment records show that the Veteran reported he had experienced a left knee sprain in 2006 and was first diagnosed with osteoarthritis of the left knee in 2012, which is many years after service discharge and does not support a finding of arthritis manifesting within one year following a period of active duty. Thus, service connection for a left knee disability is not warranted on a presumptive basis. The preponderance of the evidence is against a finding that the Veteran sustained a disease or injury during a period of active duty. The Veteran is competent to assert that he experienced left knee pain during a physical fitness test; however, to the extent that the Veteran attempts to assert a nexus between that pain and his current left knee disability, such assertion is afforded no probative value, as the Veteran has not been found to possess the necessary training or expertise to render a complex medical opinion. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for a left knee disability, to include osteoarthritis. Thus, as the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim for service connection is denied. 38 U.S.C. § 5107(b). 2. Entitlement to service connection for a psychiatric disorder, to include PTSD On his August 2014 claim form, the Veteran wrote that his psychiatric disorder began in 2004. At the January 2019 hearing, the Veteran testified that he was pressured into separating from service prior to retirement, and that this contributed to a psychiatric disability. The Veteran testified that he wanted to leave service on a happier note, or retire, but decided to leave service before retiring after being treated poorly. After thoroughly reviewing the evidence of record, the Board finds that the preponderance of the evidence is against entitlement to service connection for an acquired psychiatric disorder. The reasons follow. Regarding evidence of a current disability, the preponderance of the evidence is against a finding that the Veteran has a current diagnosis of a psychiatric disorder. For example, a February 2015 VA examiner wrote that the Veteran did not have a current diagnosis of PTSD or any other mental disorder that conformed to DSM-IV or DSM-5. Additionally, a February 2005 PTSD screen was negative. In August 2005, the Veteran’s psychiatric condition was evaluated to be clinically normal. January 2006 PTSD and major depression screens were both negative. A December 2006 depression screen was negative. A January 2007 PTSD screen was negative. A July 2007 VA treatment record also shows that the Veteran’s psychiatric condition was normal. Depression screens in July 2009, October 2010, and May 2013 were all negative, as was a PTSD screen in May 2013. At a December 2014 VA treatment visit, the Veteran denied a history of depression or PTSD. Thus, the Veteran does not meet the first element of a claim for service connection, which is evidence of a current disability, as he does not have a current diagnosis of a psychiatric disorder, to include PTSD. This is evidence against the Veteran’s claim for service connection for a psychiatric disorder. Service treatment records also show that the Veteran did not leave service with a psychiatric disorder. For example, in the January 2004 Report of Medical Assessment, which the Veteran completed a few months before his separation from service, shows that the Veteran checked “No” to the question “Have you suffered from any injury or illness while on active duty for which you did not seek medical care?” and indicated that his health was the same since his last physical examination in March 2003, where he indicated that since his last medical assessment he had not had any illnesses or injuries that caused him to miss duty for longer than three days, and had not been seen by or treated by a health care provider or admitted to a hospital since his last physical examination. This is further evidence against a finding that the Veteran developed a psychiatric disorder during service. The Board affords great probative weight to the opinion of the February 2015 VA examiner, who concluded that the Veteran did not have a current diagnosis of any mental disorder under DSM-IV or DSM-5. This examiner performed an in-person examination and had reviewed the Veteran’s claims file. Additionally, there is no competent evidence to weigh against this medical professional’s opinion. The Veteran is competent to state that he had negative experiences surrounding his separation from service. However, to the extent that the Veteran attempts to assert that he suffers from a psychiatric disorder, such assertion is afforded no probative value, as the Veteran has not been shown to possess the necessary training and expertise to render a complex medical diagnosis. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for a psychiatric disorder, to include PTSD. Thus, as the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim is denied. 38 U.S.C. § 5107(b). A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Caruso, 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.