Citation Nr: 19174271 Decision Date: 09/24/19 Archive Date: 09/24/19 DOCKET NO. 15-00 549A DATE: September 24, 2019 ORDER Entitlement to service connection for a bilateral knee disability is granted. FINDING OF FACT It is as likely as not that the Veteran’s bilateral knee disability is proximately due to or related to his military service as due to joint trauma caused in part by his pre-existing bilateral pes planus. CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran’s favor, the criteria for entitlement to service connection for a bilateral knee disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1959 to July 1961. A Travel Board of Veterans’ Appeals (Board) hearing was conducted in March 2018. A transcript of this hearing is contained within the claims file. In August 2018, the Board remanded the Veteran’s appeal for additional evidentiary development. It has since been returned to the Board for further consideration. Entitlement to service connection for a bilateral knee disability Generally, service connection may be granted for a disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection for a disability requires evidence of: (1) The existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). See also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). The Veteran seeks entitlement to service connection for a bilateral knee disability. The Veteran contends that he was involved in a car accident that injured both of his knees during his military service, causing his current bilateral knee disability. Regarding the existence of a current disability, VA treatment records from 2011 to present show that the Veteran complained of and has been treated for bilateral knee pain. Specifically, a May 2011 private treatment note shows that the Veteran has a history of low back and left buttock and leg pain with numbness. An August 2012 VA medical treatment note shows that the Veteran presented to the clinic with complaints of ongoing right knee pain. The note contains impressions of moderate degenerative changes of the knees bilaterally and small bilateral suprapatellar joint effusions, with an urgent recommendation that the Veteran visits the orthopedic clinic for a consultation. A November 2012 VA medical treatment note shows that the Veteran presented to the orthopedic clinic for the consultation, at which time he received an injection of corticosteroid to relieve swelling and inflammation of the joint. At this visit, the Veteran reported having injured his knees for the first time while serving in 1960 and that he received a corticosteroid shot in 1995 that helped for quite a while. Regarding an in-service injury, the Veteran’s service treatment records (STRs) are silent as to specific complaints of bilateral knee pain or of the claimed car accident. However, the Board notes that the Veteran’s August 1959 pre-induction examination states that the Veteran has second degree pes planus, symptomatic, mild, class 2 and contains an indication that the Veteran reported hip pain. Additionally, the Veteran’s June 1961 separation examination shows that the Veteran check “yes” for “lameness”, without particular regard as to the cause of the Veteran’s “lameness”. Thus, there is evidence of a current disability and an indication of relationship to service. The remaining question is whether there is a causal connection between the Veteran’s current bilateral knee disability and his service. Per the August 2018 Board remand, in April 2019, the Veteran was afforded a VA examination. The April 2019 examiner confirmed the Veteran’s diagnoses of bilateral knee strain, bilateral knee instability, and degenerative arthritis of the knees. The April 2019 examiner initially opined that the Veteran’s bilateral knee disability was less likely than not incurred in or caused by the claimed car accident. The examiner provided the rationale that the Veteran’s STRs are silent for a car accident during service and a single isolated strain injury without any ongoing complaints during service are less likely than not to have caused degenerative joint disease, and so the Veteran’s knee disability is less likely than not due to the claimed car crash during service. While the examiner opined that the Veteran’s disability is not causally related to the claimed car accident, the examiner also opined that the Veteran’s bilateral knee disability was at least as likely as not manifested in service or was otherwise causally or etiologically related to his military service. The examiner provided the rationale that the Veteran was noted to have bilateral pes planus during the report of medical examination in 1958. In spite of this condition, the Veteran continued to serve on active duty, carrying out the expected physical responsibilities such as ruck marching in combat boots, physical training and heavy lifting. In 2012, clinic records support bilateral medial compartment joint space narrowing with genu varum. On examination, the Veteran is noted to have medial and lateral instability of both knees. Due to the altered knee angulation associated with the Veteran’s pes planus condition, the Veteran has experienced accelerated wear and tear on the medial compartment of both knees which is demonstrated on x-ray. The examiner concluded that this “can be” seen as etiologically related to the Veteran’s military service as he was predisposed to accelerated medial compartment where on the knee joints as a result of his pes planus condition, and the Veteran’s claimed bilateral knee strain and arthritis are at least as likely as not causally or etiologically related to his military service. Again, the examiner noted that the claimed bilateral knee sprain and arthritis are at least as likely as not causally or etiologically related to his military service. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran has a current bilateral knee disability and whether this disability is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a bilateral knee disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Frazier, 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.