Citation Nr: 20049943 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 15-30 450 DATE: July 28, 2020 ORDER Entitlement to service connection for a bilateral knee condition is denied. FINDING OF FACT The Veteran’s bilateral knee condition is not etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral knee condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1982 to July 1986. She appeals a March 2016 rating decision denying entitlement to service connection for a bilateral knee condition. In November 2018, the Veteran testified before the undersigned Veterans Law Judge at a hearing held via live videoconference. A transcript of that hearing is of record. The Veteran contends that her bilateral knee condition is attributable to injuries sustained on active duty. Specifically, she experienced falls in service and engaged in physical training on uneven terrain which caused injury to her right knee. She claims that overcompensation for the right knee has led to her left knee condition. Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1131. To establish entitlement to VA disability compensation, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of an injury or disease; and, (3) a causal link between the present disability and the injury or disease incurred or aggravated in-service (“nexus” requirement). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Entitlement to service connection for a bilateral knee condition The Board finds that entitlement to service connection for a bilateral knee condition is not warranted. As an initial matter, the Board acknowledges that the Veteran has been treated for bilateral knee pain and has had an arthroscopic procedure done to her right knee. As such, the threshold element of a present disability has been met. The Veteran testified at her hearing that she was treated at the Frankfurt Military Hospital in Germany after injuring her right knee during a fall. However, review of the Veteran’s service treatment records does not reveal complaints for or treatment of any right knee condition in service. In fact, at her May 1986 separation examination, she reported treatment for stomach problems but was otherwise “in good health.” No knee problems were noted. In addition, the Veteran estimated at her hearing that her knee symptoms did not begin to impact her everyday functioning until approximately 15 years prior to the hearing, or around 2003. Although this is an estimation, such an assertion indicates that the Veteran’s current knee condition began nearly two decades after separation from active service. As a lay person, the Veteran is certainly competent to testify as to observable symptoms, such as knee pain. See Layno v. Brown, 6 Vat. App. 465 (1994). However, once basic competency is established, the Board must consider the credibility of that testimony. See Caluza v. Brown, 7 Vet. App. 498 (1995) (giving factors to consider when assessing the credibility of lay testimony, to include facial plausibility; internal consistency; consistency with other evidence; self-interest or bias; and lay statements made during treatment). In this case, the Veteran’s claims are not supported by the evidence of record. Indeed, statements made at her hearing contradict her assertions that her knee condition began during service. Next, service connection may also be granted if the evidence otherwise indicates a relationship between active duty and her current symptoms. However, no such relationship exists in this instance. Namely, the treatment records do not suggest such a relationship, nor has any treating physician has opined that any relationship exists. In making this determination, the Veteran has specifically considered a statement from the Veteran’s private physician in August 2015, noting treatment for a bilateral knee condition. However, this is of no probative value as to the question of whether her current complaints are related to service. Specifically, although the private physician noted that the Veteran had a history of falling in service, he did not offer an opinion as to whether the Veteran’s current knee condition was related to service. As such, the Board finds this testimony is of limited probative value in assessing this claim. Moreover, as it does not discuss such a relationship, there is no indicated need to obtain a VA examination. Indeed, given the lack of treatment in service, any opinion provided by a VA examiner would be only speculative at best. The Veteran also submitted testimony from her spouse indicating that she was placed in a remedial physical fitness program during service “due to lower extremities.” However, such testimony does not specifically indicate that the Veteran suffered from a right knee condition during service nor does it refute her assertion that her current knee condition began many years after separation from service. In light of the foregoing, the Board must conclude that the Veteran’s current knee condition did not have its onset during active service. In summation, the evidence does not demonstrate a causal link between the Veteran’s current right knee condition and active service. Hence, regarding secondary service connection for the Veteran’s left knee, the threshold element of a service-connected disability has not been met and service connection for the left knee is not warranted. The Board is sensitive to the claims made by the Veteran and recognizes her statements regarding the relationship between her bilateral knee condition and active service. However, as previously discussed, while she is competent to provide testimony regarding observable symptomatology, she is not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377 n.4. Therefore, the unsubstantiated statements regarding the etiology of the Veteran’s erectile dysfunction are found to lack competency.   After thorough review of the evidence and resolving all doubt in favor of the Veteran, the Board finds that service connection for a bilateral knee condition is not warranted. Accordingly, the claim is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, Associate Counsel