Citation Nr: 20026070 Decision Date: 04/15/20 Archive Date: 04/15/20 DOCKET NO. 18-55 012 DATE: April 15, 2020 ORDER Entitlement to service connection for left knee posttraumatic osteoarthritis with possible loose body is denied. FINDING OF FACT The Veteran’s left knee posttraumatic arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is attributable to intercurrent causes; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for left knee posttraumatic osteoarthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from October 1992 to November 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for left knee posttraumatic osteoarthritis with possible loose body The Veteran asserts that his left knee disability is related to the extensive running and climbing that he needed to do during active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran underwent a VA examination in March 2018. The Veteran reported left knee pain, which could be worse if it locks up on him using steps or a ladder. He indicated left knee flares up to 6 to 10 times per month. Medical history revealed that the Veteran received treatment for the right knee, but not the left knee, in September 1999. Treatment providers assessed patellofemoral syndrome of the right knee. The examiner noted a fall injury to the left knee about 2009 or 2010 while the Veteran was playing golf. X-ray imaging of the left knee showed mild scattered osteoarthritic changes and a 3 mm ossicle overlying the patellofemoral compartment that may represent a loos body. The examiner diagnosed posttraumatic osteoarthritis of the left knee. While the examiner offered an initial opinion regarding the left knee, the Board notes that the examiner’s original opinion is internally inconsistent regarding service connection and revised in subsequent addendum statements. In an addendum opinion, the examiner opined that, with respect to the left knee, the claimed condition was less likely than not related to service. The examiner explained that the Veteran has a history of a left knee injury about 2009 while playing golf. This was followed by imaging and arthroscopic surgery at the orthopedic clinic. Service treatment records, however, did not show left knee problems or complaints. The examiner concluded that the Veteran injured his left knee many years after service, and that this progress to the current posttraumatic osteoarthritis condition. The examiner further clarified in a second statement that in the initial opinion in March 2018 he meant to indicate that it is less likely than not that the left knee disability was caused by service. At the VA examination, the Veteran reported that he injured his left knee while golfing, and shortly afterwards that year followed up with West Indianapolis orthopedic clinic. A private orthopedic status report shows placed on full duty following a left knee scope in August 2009. The Veteran has a current diagnosis of posttraumatic osteoarthritis of the left knee as evidenced by March 2018 diagnosis. Osteoarthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Private and VA treatment records show the Veteran was not diagnosed with a left knee disability until 2009 or 2010, years after his separation from service and years outside of the applicable presumptive period. The Veteran reported that he began experiencing pain in the right knee in 1999 following a morning run. However, with respect to the left knee, he reported that his left knee pain did not begin until 10 years after discharge. The Veteran’s reports are show that he denied experiencing left knee pain from 1999 to 2009 and initially reported the onset of pain and instability as approximately 2009, outside of the presumptive period. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). The Board further notes that onset in 2009 is consistent with the intercurrent knee injury reported by the Veteran in the VA examination report. The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are instead attributable to an intercurrent knee injury sustained while golfing after service. The March 2018 VA examiner determined that the symptoms were due to an intercurrent injury, as service treatment records were silent for left knee complaints and the Veteran first sought treatment for left knee issues shortly after the injury. Service connection for osteoarthritis of the left knee may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s osteoarthritis of the left knee and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The March 2018 VA examiner opined that the Veteran’s osteoarthritis of the left knee is not at least as likely as not related to an in-service injury, event, or disease, including running and climbing demands during active service. The examiner explained that the records revealed right knee treatment, but that service records were negative with respect to the left knee. He further noted that the Veteran sought treatment in 2009 or 2010, after sustaining a knee injury while golfing. The examiner concluded by indicating that the Veteran’s left knee disability was a progression from the intercurrent golfing injury. While the Veteran believes his osteoarthritis of the left knee is related to an in-service injury, event, or disease, including significant running requirements during active service, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education and knowledge of pathology. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. (Continued on the next page)   Based on the foregoing, service connection is not warranted. The Board has considered the benefit of the doubt rule; however, the preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for posttraumatic osteoarthritis of the left knee is denied. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Lauritzen, 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.