Citation Nr: 20003457 Decision Date: 01/16/20 Archive Date: 01/15/20 DOCKET NO. 14-04 042 DATE: January 16, 2020 ORDER Service connection for degenerative joint disease and chondromalacia of the right knee is granted. FINDING OF FACT Resolving all doubt in the Veteran’s favor, his current right knee disorder, diagnosed as degenerative joint disease and chondromalacia, is related to his military service. CONCLUSION OF LAW The criteria for service connection for degenerative joint disease and chondromalacia of the right knee have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1978 to June 1998. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in October 2011 by a Department of Veterans Affairs (VA) Regional Office. In February 2015, the case was remanded in order to afford the Veteran his requested Board. Thereafter, in March 2018, he testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In May 2018, the Board sought an expert medical opinion from the Veterans Health Administration (VHA) in accordance with VHA Directive 1602-01. Two separate opinions were provided in October 2019 and December 2019. Entitlement to service connection for right knee disorder. The Veteran contends that his right knee was injured during an in-service run when he fell due to lumbar paresthesias and hit his knee on a rock, and has experienced continuous right knee pain since such time. While he has alleged, in the alternative, that he manifested arthritis in the right knee within one year of his separation from service or his right knee disorder is caused or aggravated by his service-connected degenerative arthritis of the lumbar spine with right leg peripheral neuropathy and/or his service-connected degenerative joint disease of the MPJ of the left great toe and associated left bunionectomy, the Board need not address such presumptive and secondary theories of entitlement as service connection is awarded on a direct basis herein. In this regard, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. As an initial matter, the evidence of record reflects a current right knee disorder, diagnosed as degenerative joint disease and chondromalacia. See September 2011 VA examination; VA and private treatment records. Further, the Veteran’s service treatment records, which have been deemed incomplete, contain a March 1997 record noting that he had developed “secondary/compensating knee pain” related to lumbar radiculopathy. Additionally, a June 1997 service treatment record reflects his reports of knee pain and effusion, and a subsequent physical profile restricting running, jumping, physical therapy, and sports due to right leg symptomatology, to include radiculopathy/neuropathy. However, the record contains contradictory opinions as to whether the Veteran’s current right knee disorder is related to his military service. Specifically, a September 2011 VA examiner opined that such disorder is a result of aging, obesity, and civilian work as a forklift operator. The Veteran contends, however, that his knee pain had its onset well before he was of an advanced age; his weight at the time of the examination was irregular as he had recently undergone surgery and had been restricted in his activities; and forklift operating actually does not involve significant knee movement. Thus, the Board finds the opinion inadequate in this regard and, thus, affords it no probative weight. In an October 2019 letter, Dr. J.C., a VA orthopedic spine surgeon, opined it is at least as likely as not that the Veteran’s right knee disorder manifested within one year of discharge from service. Dr. J.C. noted the Veteran’s reports of the onset of his right knee condition when he fell in 1997 and his symptomatology since such time. He also found pertinent that medical records did not show any right knee symptoms prior to 1997. Additionally, Dr. J.C. opined it is at least as likely as not that the progressive worsening knee pain the Veteran reported after his separation from service is an early manifestation of the subsequent arthritis diagnosis. Although the first evidence of osteoarthritis on X-ray examination is dated February 2011, he. explained that it is not unusual for osteoarthritic changes to take 14 years to show up on X-ray reports following trauma. In conclusion, Dr. J.C. opined it is at least as likely as not that the Veteran’s right knee disorder is related to military service, to include his credible reports of hitting his knee on a rock. In this regard, he found that the Veteran’s swelling of the right knee following the injury revealed damage to the lining of the knee joint that progressed to osteoarthritis with time. Conversely, Dr. W.W., a VA orthopedic surgeon, found that there is no evidence demonstrating that the Veteran’s right knee disorder manifested within one year of discharge from service. In this regard, he noted that the earliest mention of a specific right knee condition was in 2010. Further, Dr. W.W. found the Veteran’s ability to work as a fork truck driver for over a decade after service argues against a service-related condition because prolonged strenuous work in a bent knee position would be difficult with underlying patellofemoral chondral injury. In pertinent part, he also opined there is no connection between the Veteran’s right knee disorder and his military service, to include hitting his knee on a rock. Dr. W.W. found important the lack of evidence showing such a fall in the service treatment records. In addition, Dr. W.W. explained that post-traumatic arthritis is a rare result of trauma, and the initial trauma is usually associated with significant symptoms including swelling, pain, and effusion. In this case, Dr. W.W. noted there is no record of such attention or persistent symptoms. After a review of the record, the Board finds that the evidence of record is at least in equipoise as to whether the Veteran’s current right knee disorder is related to his military service. Specifically, Drs. J.C. and W.W. are competent medical professionals who considered all relevant facts and accepted medical principles, and provided complete rationales for the opinions. Consequently, their opinions are entitled to equal probative weight. Therefore, the Board resolves all doubt in the Veteran’s favor and finds that his current right knee disorder, diagnosed as degenerative joint disease and chondromalacia, is related to his military service. Thus, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.