Citation Nr: 20009680 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 17-03 297 DATE: February 6, 2020 ORDER Entitlement to service connection for a right knee disorder is denied. Entitlement to service connection for a left knee disorder is denied. FINDINGS OF FACT 1. The Veteran’s right knee disorder has not been shown to manifest to a compensable degree within one year after service, and it is not etiologically related to any in-service injury, event, or disease. 2. The Veteran’s left knee disorder has not been shown to manifest to a compensable degree within one year after service, and it is not etiologically related to any in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.307, 3.309. 2. The criteria for entitlement to service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty military service in the United States Army from July 1976 to July 1979 and from February 1981 to May 1984. This appeal comes to the Board of Veterans’ Appeals (Board) from a September 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). On the Veteran’s January 2017 VA Form 9, the Veteran indicated that he did not want a hearing. However, in March 2018, the Veteran stated that he would like a hearing at a VA hospital. In December 2019, VA sent a hearing clarification letter to the Veteran. This letter notified the Veteran that he had 30 days to respond, and if no response was received within 30 days, the Board would conclude that he did not desire a hearing. As of this date, the Veteran has not responded to the hearing clarification letter. The Board finds that all due process requirements have been met; thus, the Board may proceed to adjudication of the case. Service Connection 1. Entitlement to service connection for a right knee disorder. 2. Entitlement to service connection for a left knee disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air 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). As a general matter, 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). A disorder diagnosed after discharge may be service connected if all the evidence establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, to include arthritis, may be service-connected on a presumptive basis if manifested to a compensable degree within a specified period of time following separation (one year for organic disease of the nervous system). 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Under 38 C.F.R. § 3.303(b), service connection will be presumed where there are either chronic symptoms shown in service or continuity of symptomatology since service for diseases identified as ‘chronic’ in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013) (holding that continuity of symptomatology is an evidentiary tool to aid in the evaluation of whether a chronic disease existed in service or an applicable presumptive period). With a chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to an intercurrent cause. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). The Veteran is seeking service connection for a right knee disorder and a left knee disorder. The Veteran asserts that he injured his knees while he was in service and has had knee pain ever since service. He asserts that he hurt his knees during basic training. He did not complain about it and just lived with it. See September 2016 NOD. In September 2016, the Veteran submitted a buddy statement from his former military comrade, S.S. S.S. reported that the Veteran tripped and fell on his knees during basic training. The Veteran’s service treatment records show that the Veteran had problems with his right knee and left knee during his military service. In a January 1979 health record, it was reported that the Veteran complained of injuring his left knee in an auto accident; he was assessed with possible muscle spasms and a bruised knee. However, the Veteran’s June 1979 Report of Medical History and Report of Medical Examination were silent for any knee disorders. The Veteran’s February 1981 Report of Medical Examination and Report of Medical History for re-enlistment were also silent for any reports of treatment, diagnosis, or complaints of knee problems. In an April 1981 health record, it was reported that the Veteran had right knee pain. In May 1981, the Veteran had an x-ray of his right knee performed; the radiographic report revealed no significant abnormalities. In August 1983, it was reported that the Veteran sprained his left knee. On the Veteran’s March 1984 Report of Medical Examination and March 1984 Report of Medical History for separation, the clinician noted that the Veteran had a swollen left knee that occurred in 1973 due to falling on concrete; he was treated with bandage and heat. However, there was no indication of a right knee disorder. As the evidence shows that the Veteran incurred injuries to his knees during his time in service, the main issue is whether the Veteran’s right knee and left knee disorders are related to his military service. The Board concludes that his right knee and left knee disorders are not related to his military service for the following reasons. Post-service VA treatment records show that it was not until 2007 that the Veteran was diagnosed with arthritis of both of his knees. In January 2007, the Veteran complained of bilateral knee pain. The VA physician opined that a lot of the Veteran’s knee problems were because the Veteran was sedentary in that he drove a bus and that he gained quite a bit of weight. In September 2015, the Veteran was afforded a VA examination for his knees. The Veteran was diagnosed with bilateral knee degenerative arthritis. The date of diagnosis was 2007 for the right knee and 2011 for the left knee. The VA examiner opined that it was less likely than not that the Veteran’s left knee arthritis was related to his military service. The VA examiner explained that although there was record of treatment in service for a left knee condition, there was no permanent residual or chronic residual disability subject to service connection shown by the service medical records or demonstrated by evidence following service. On January 23, 1979, the Veteran was seen for a bruised left knee after an auto accident. By January 24, 1979, it was noted that the pain had decreased. The discharge physical of June 1979 was silent for a knee condition, and the exam was normal. This implied the acute condition had resolved. The Veteran was able to re-enlist in 1981, at which time the examination was normal. The Veteran was seen for left knee pain in August 1983. He was given a profile for a week. There was no medical evidence of further ongoing treatment for a left knee condition. The discharge physical of March 1984 stated that the Veteran had a swollen left knee, 1973, due to falling on concrete treated with bandage heat. The VA examiner opined that the Veteran’s right knee arthritis was less likely than not caused by his military service. The VA examiner explained that although there was record of treatment in service for a right knee condition, there was no permanent residual or chronic residual disability subject to service connection shown by the service medical records or demonstrated by evidence following service. On May 14, 1981, the Veteran was seen for feeling a “knock” on his right knee and patellar pain. He was told it was not a sick call problem and to make an appointment to be seen. In May 1981, the Veteran was seen for the knee. X-rays on May 21, 1981 did not show any significant abnormality. On June 5, 1981, it was noted that the Veteran’s right knee was much better. The discharge physical of March 1984 was silent for a right knee condition, and the exam was normal. This implied that the acute condition was resolved. There was no medical evidence of a right knee condition until 2007, 23 years after service. During that time, he was able to work as a bus driver. The Veteran was able to do yard work and activities such as softball. The Veteran was diagnosed with arthritis of the right knee in 2007. It would not be unusual to see degenerative changes in a person the Veteran’s age. The Veteran’s BMI was 39.21, which placed the Veteran in the obese category, which could lead to degenerative changes in the knees. The Veteran’s current arthritis of the right knee was less likely than not related to, incurred in, or caused by service. Based on the foregoing, it has neither been shown that the Veteran’s right and left knee disorders manifested to a compensable degree within one year after service, nor has it been shown that the Veteran has had continuity of symptoms since service. First, the Board acknowledges the Veteran’s statements that he has had bilateral knee pain since service and notes that he is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 565 (1994). However, medical records show that it was not until 2007 that the Veteran was diagnosed with arthritis of his knees, which was about two decades after the Veteran separated from service. Therefore, the Veteran’s contentions that he has had knee problems ever since service are not credible. As such, service connection is not warranted under a presumptive basis (as a chronic disease under 38 U.S.C. § 1112) or through a showing of continuity of symptomatology. Next, under the theory of direct service connection, the Board must look to the medical opinions of record to determine whether the Veteran’s right and left knee disorders are related to his military service. The September 2015 VA medical opinion is probative in value and weighs heavily against the Veteran’s claim. The September 2015 VA examiner opined that the Veteran’s bilateral knee disorders were not related to his military service. The September 2015 VA examiner considered all of the pertinent evidence of record and provided a complete rationale, relying on the records reviewed. Moreover, the examiner offered adequate conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). In fact, in a January 2007 VA treatment record, a VA physician attributed the Veteran’s bilateral knee disabilities to his sedentary lifestyle and to the fact that the Veteran was overweight. In their August 2019 brief, the Veteran’s representative alluded to a study in support of the contention that the Veteran’s current knee disorders could relate to remote trauma. Aside from including the name and date of the study, there was no further information specifically provided regarding how that study relates to the Veteran; considering that the study’s title specifically references “posttraumatic ankle osteoarthritis,” the connection between this study and the Veteran’s case appears even more tenuous. Absent specific argument as to why this study is applicable to the Veteran, the Board cannot find that this argument outweighs the objective medical opinions recited above, or that any further medical commentary or opinion is necessary prior to issuing a final decision. Thus, the Board concludes that the preponderance of the evidence is against the claim and service connection for a left knee disorder and a right knee disorder is not warranted. 38 U.S.C. § 5107(b). Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Crawford, 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.