Citation Nr: 20009689 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 13-19 687 DATE: February 6, 2020 ORDER Entitlement to service connection for a left knee disorder is denied. FINDING OF FACT The probative evidence of record shows that the Veteran does not have a left knee disorder that is etiologically related to his miliary service. CONCLUSION OF LAW The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1982 to March 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia, which denied entitlement to service connection for a knee condition. In May 2017 and July 2019, the Board of Veterans' Appeals (Board) remanded the issue of entitlement to service connection for a left knee condition to the Agency of Original Jurisdiction for adjudication of the intertwined issue of a left ankle condition. That issue was adjudicated in a July 2019 Statement of the Case. The case is once again before the Board for further appellate consideration. The Veteran requested a hearing but failed to attend or request a rescheduled hearing. The request for a hearing is therefore deemed withdrawn. 1. Entitlement to service connection for a left knee condition Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d). In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. § 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a). If there is no evidence of a chronic condition during service or an applicable presumptive period, then a showing of continuity of symptomatology after service may serve as an alternative method of establishing the second and/or third element of a service connection claim. See 38 C.F.R. § 3.30(b); Savage v. Gober, 10 Vet. App. 488 (1997). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. If service connection is established by continuity of symptomatology, there must be competent evidence that relates a current condition to that symptomatology. See Savage, 10 Vet. App. at 495-498. Lay evidence is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition is capable of lay observation and may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature." Lay evidence can be competent and sufficient to establish a diagnosis when a layperson (1) is competent to identify the medical condition; or, (2) is reporting a contemporaneous medical diagnosis; or, (3) describes symptoms at the time which supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In deciding the Veteran's claim, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or, whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran asserts that service connection for a left knee disorder is warranted as the claimed disability is related to a left ankle and foot injury in service. Service treatment records show no complaints of or treatment for a left knee condition. Notably, on VA examination of June 2012 the Veteran denied in service trauma to the knee. Treatment records of June 1985 do reveal a report of trauma to the left ankle. On physical examination, the Veteran exhibited pain at the inferior aspect of the ankle. No swelling was noted. The Veteran was instructed to treat the area with ice followed by heat after 24 hours. The first post-service evidence of complaints of left knee pain appear in VA treatment records in January 2004. The record contains no objective medical examination from that date. In March 2011, he reported chronic knee pain. Contemporaneous bilateral knee x-ray imaging revealed mild spurring of the tibial eminences, mild narrowing of the medial femorotibial joint spaces and small enthesophytes at the quadriceps tendon insertions. No joint effusion was evident, and no acute fracture or subluxation was seen. The Board has first considered whether service connection is warranted on a presumptive basis. However, the clinical evidence of record fails to show that the Veteran manifested arthritis to a degree of 10 percent within the one year following his discharge from service. In this case, the clinical evidence reveals mild joint space narrowing in the left knee on X-ray in March 2011, nearly twenty years after service discharge. As such, presumptive service connection is not warranted for arthritis. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In VA progress notes of February 2012, a VA primary care physician found it “more than likely” that the Veteran’s left knee degenerative joint disease is related to his “service condition.” No rationale for this finding was provided and the meaning of “service condition” is unclear. The Board notes that at the time this opinion was recorded, the Veteran was not yet service connected for any disability. The opinion was not accompanied by a review of the claim file or a supporting rationale. Therefore, the opinion is afforded no probative weight. 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”). This opinion is therefore entitled to little, if any, probative weight. Degenerative joint disease of the left knee was confirmed on VA knee examination of June 2012. The examiner checked a box that indicated that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The contradictory rationale was provided, however, as the examiner stated that it was at least as likely as not that the left knee injury was due to the left ankle and foot injury that occurred in service. Reasoning that alteration of gait can lead to inflammation, swelling, and muscle injury which can cause degeneration of the joint over time, the clinician opined that the injuries at least as likely as not caused alteration of gait and excessive forces on the left knee. Thus, the VA examiner’s rationale is inconsistent with the opinion rendered and is of no probative value. This opinion is therefore entitled to little, if any probative, probative weight. On October 2017 VA examination, X-ray imaging studies revealed retrocalcaneal spurs of both left and right ankles. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, even, or illness. In support of this opinion, the examiner stated that there was no diagnosis or any chronic disability on the day of the examination and lack of chronicity of care for any injuries obtained during service. In addition, the examiner remarked that the Veteran’s left knee disorder was separate from the acute left ankle soft tissues injury occurring in 1984. He stated that there was no medical evidence to support a soft tissue ankle injury causing left knee arthritis. The medical opinion was based on a review of the claims folder and stated an unambiguous conclusion. Moreover, the examiner provided a thorough analysis and explanation for his opinion, which was supported by other evidence in the record. As such, the Board finds the opinion highly probative. See Id. No contrary probative opinion is of record. In addition to the medical evidence discussed above, the Board has considered the lay evidence of record, including the Veteran’s statement regarding his left knee. However, to the extent the Veteran asserts the existence of a medical relationship between his current left knee disorder and military service, the Board finds that such assertions provide no persuasive support for the claim, as the Veteran is not shown to have the medical training and expertise to competently opine on such a complex medical matter. See, e.g. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Hence, his assertions in this regard have no probative value. Finally, the Board notes the Veteran’s assertions that his left knee disorder was the result of his left ankle disorder. However, as the RO denied service connection for a left ankle condition, service connection on a secondary basis for such left ankle disorder cannot be granted as a matter of law. In summary, the Board finds that the left knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service. Consequently, service connection for such disorder is not warranted. As the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine is not applicable to this claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. KRISTY L. ZADORA Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Duke, 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.