Citation Nr: 20039982 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 17-07 733 DATE: June 11, 2020 ORDER Service connection for patellofemoral pain syndrome of the left knee (claimed as a left knee condition) is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s current patellofemoral pain syndrome of the left leg is related to an in-service event or injury, to include a fall injury and/or cellulitis of the left leg. CONCLUSION OF LAW The criteria for service connection for patellofemoral pain syndrome of the left knee (claimed as a left knee condition) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1972 to August 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). In the Board’s January 2019 decision, it remanded the claim to the RO for a new examination. See BVA Decision received 1/31/2019. The Board finds that there has been substantial compliance with the remand directives since the Veteran was given a new examination in October 2019, which was adequate for adjudication purposes. Service connection for patellofemoral pain syndrome of the left knee (claimed as a left knee condition) is denied. The Veteran contends that he injured his left knee in Germany while on active duty in November 1972. See Form 9 received 2/07/2017. Further, he states that although the injury has been present since his service, he did not file for compensation immediately because he was unaware of his right to do so. See NOD received 9/27/2016. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.   The Board concludes that, while the Veteran has a current diagnosis of patellofemoral pain syndrome of the left knee per the 2016 VA examination, and evidence shows that he had a left leg bacterial skin infection during service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of patellofemoral pain syndrome of the left knee began during service or is otherwise related to an in-service injury, event, or disease. The Veteran’s VA treatment records show that the Veteran complained of knee pain beginning in August 2016. See Capri received 9/16/2016 at page 17. However, he was not diagnosed with patellofemoral knee pain until September 2016 during the compensation and pension examination, which is nearly 50 years after his separation from service. While the Veteran is competent to report having experienced knee pain consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his in-service left leg skin infection, diagnosed as cellulitis of the left leg, acute, organism unspecified. The issue is medically complex, as it requires knowledge of the body’s orthopedic system and other things needing medical knowledge, such as the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Veteran’s statement in this regarding are not competent and are entitled to no weight. The Veteran was provided a compensation and pension examination for the knee and lower leg conditions in September 2016. The VA examiner diagnosed him with patellofemoral pain syndrome (left), no other condition was found. The VA examiner noted the Veteran’s statements that the onset was in November 1972 when he slipped and fell of the top of a trailer and landed on his left leg. See C&P Exam received 9/06/2016 at page 4. After conducting the in-person examination and reviewing the Veteran’s file, the VA examiner opined that the Veteran’s patellofemoral pain syndrome is not at least as likely as not related to an in-service injury, event, or disease, including the soft tissue infection of his left leg in November 1972. See C&P Exam received 9/06/2016 at page 1. The rationale was that the soft tissue infection, which was treated in service, was acute and likely resolved since then. Id. at page 2. The September 2016 VA examiner opinion is given minimal weight since the rationale was incomplete since it did not state a basis for its finding that the condition “likely” resolved. See BVA Decision received 1/31/2019. After the Board’s January 2019 remand, the Veteran was provided another compensation and pension examination in October 2019. The October 2019 examination also included diagnostic testing which found no abnormalities and no degenerative changes in the Veteran’s left knee. See C&P exam received 10/16/2019. The October 2019 examiner also reviewed the Veteran’s files and confirmed the diagnosis of patellofemoral pain syndrome of the left knee. See C&P Exam received 10/11/2016 at pages 1&2. After reviewing the Veteran’s medical records, lay statements, and diagnostic testing, the October 2019 examiner found that the Veteran’s patellofemoral pain syndrome was less likely than not incurred in or caused by the claimed in service injury, event or illness. See C&P Exam received 10/11/2019 at page 2. An addendum opinion was also included in the file. A December 2019 VA clinician opined that there was no evidence that the cellulitis, an acute bacterial skin infection, spread to the knee joint which would have predisposed the Veteran to a chronic knee joint condition. Rather, the lack of in-service chronicity of a left knee joint condition, the finding of no knee condition at separation which endorsed “no trick or locked knee”, supports the finding that no nexus is established. See C&P Exam received 12/16/2019. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Consequently, the Board gives more probative weight to the above-mentioned VA examiners’ opinions. Additionally, the Board notes that the addendum opinion by the December 2019 VA examiner is in line with the aforementioned October 2019 VA examiner’s opinion, in that both examiners opined on the unlikeliness of the spread of the left leg bacterial skin infection to the knee causing the Veteran’s patellofemoral pain syndrome nearly 50 years later. See C&P Exam received 10/11/2019; and see also C&P Exam received 12/16/2019. As referenced above, the Veteran attributes his current condition to his in service left leg cellulitis, bacterial skin infection. However, the Veteran is not competent in this case to provide a nexus opinion regarding this issue as it requires a medical determination of the likelihood of this pain being etiologically related to his in service left leg bacterial infection. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that the preponderance of the probative and competent tends to weight against a finding of a nexus between the current left knee disability and his active service. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the Board finds that service connection for left knee patellofemoral pain syndrome (claimed as left knee condition) is not warranted. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Dixon, 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.