Citation Nr: 21001121 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 15-15 972 DATE: January 7, 2021 ORDER Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. FINDINGS OF FACT 1. The Veteran’s low back condition did not have its onset in service or within a year of separation therefrom, and the most probative evidence of record indicates the condition is unrelated to any aspect of active duty service. 2. The Veteran’s left knee condition did not have its onset in service or within a year of separation therefrom, and the most probative evidence of record indicates the condition is unrelated to any aspect of active duty service. 3. The Veteran’s right knee condition did not have its onset in service or within a year of separation therefrom, and the most probative evidence of record indicates the condition is unrelated to any aspect of active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1961 to December 1964. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in September 2017, December 2019, and September 2020. On each occasion, they were remanded for development. They have been returned to the Board for appellate review. The claimant has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 247, 431 (2006). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 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 other organic diseases of the nervous system (which includes sensorineural hearing loss and tinnitus), 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, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. 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 chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Entitlement to service connection for a low back disability The Veteran has current diagnoses of degenerative disc disease of the lumbar spine, spinal stenosis, lumbar spondylosis, and intervertebral disc syndrome. Thus, the current disability requirement is satisfied. The Veteran has averred that his low back condition relates to in-service trauma from heavy lifting and performing jumps off of or out of aircraft. Service treatment records are silent for complaints of low back pain or notation of any injury, and the Veteran acknowledges that he never advanced in-service complaints of low back problems or sought care for the same. VA treatment records during the appeal period reflect current low back symptoms and the aforementioned diagnoses, but do not indicate that these problems are directly related to any aspect of active duty service. In order to explore the etiology of the Veteran’s back conditions, a VA examination was conducted in July 2019. Pursuant to that examination, the examiner opined that because there was no medical evidence of any in-service back injury or chronic condition, and because of the nature of the Veteran’s degenerative back condition and its association with normal aging and wear and tear, it was less likely than not that the condition bore any etiological relationship to service. A second VA examination was conducted in December 2019. The examiner reached essentially the same conclusion with respect to etiology, opining that there was no evidence of any back injury related to heavy lifting or jumping from aircraft in service, and that the Veteran’s current disability did not present as related to any such injury, but rather to the normal aging process, and thus the condition was less likely than not related to service. A final addendum opinion was submitted in October 2020, confirming that the Veteran’s lay statements with respect to in service incurrence were considered, but that because of the lack of any indication in service records or medical records in the wake of service relating the Veteran’s back problems to any aspect of service, because of the apparent onset of the condition in February 2011, many years after separation, and because of the nature of the condition, it was less likely than not that the condition was related to service. The Board regards these opinions, taken together, as the most probative evidence of record on the question of etiology in this case. They benefit from an exhaustive review of the medical file, afford due consideration to the Veteran’s lay statements, and are in general accord with the objective medical evidence in this case. While the Board has considered with sympathy the Veteran’s lay statements, it cannot afford probative weight to his assertions with respect to the etiology of his low back condition in this case. While he is competent to report his experiences and symptoms since service, the Veteran is not competent to provide a nexus opinion regarding the nature and etiology of his condition. Jandreau v. Nicholson, 492 F. 3d 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Veteran’s reports of his symptoms are relevant, competent, and credible; however, the question of the etiology of his low back disorder is limited to the purview of someone with medical knowledge and training, such as the VA medical examiner in this case. In sum, the evidence does not show that it is at least as likely as not that the Veteran’s diagnosed low back disorder is related to active service. The probative value of the Veteran’s assertions is outweighed by the probative value of the thorough and reasoned opinion of the VA medical expert. As the preponderance of the evidence is against the claim, service connection for a low back disorder must be denied.  38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a bilateral knee disability The Veteran has current diagnoses of degenerative arthritis in both knees; thus, the current disability requirement is satisfied. As with his low back condition, discussed above, the Veteran has averred that his bilateral knee condition relates to in-service trauma from heavy lifting and performing jumps off of or out of aircraft. Service treatment records are silent for complaints of knee pain or notation of any injury, and the Veteran acknowledges that he never advanced in-service complaints of knee problems or sought care for the same. VA treatment records during the appeal period reflect current knee symptoms and the aforementioned diagnoses, but do not indicate that these problems are directly related to any aspect of active duty service. The Veteran has been afforded several VA knee examinations in connection with his service connection claim. The first, conducted in May 2019, confirmed his diagnosis of bilateral knee arthritis. However, the VA examiner indicated that because there was no evidence of onset in service or within a year of separation therefrom, nor any objective evidence of an injury or other in-service event that might have played a causative role in the Veteran’s current knee issues, and because the Veteran’s current knee problems are of a kind generally related to the natural aging process, it was less likely than not that the condition bore any etiological relationship to service. A second VA examination was conducted in December 2019, and again, the examiner concluded that there was no evidence of in-service onset of a knee condition, and that the results of the examination and review of the medical file indicated the condition was most likely related to normal aging and wear and tear, rather than to any aspect of active duty service. That opinion was confirmed in a September 2020 addendum opinion, which reiterated that the Veteran’s lay statements with respect to in-service jumps from aircraft and heavy lifting were reviewed and considered, but that the lack of objective evidence of in-service onset, coupled with the nature of the Veteran’s knee condition, convinced the examiner that the Veteran’s current knee disability was less likely than not related to service, and most likely related to the normal aging process. Again, the Board has considered with sympathy the Veteran’s lay statements, but it cannot afford probative weight to his assertions with respect to the etiology of his bilateral knee condition in this case. While he is competent to report his experiences and symptoms since service, the Veteran is not competent to provide a nexus opinion regarding the nature and etiology of his condition. See Jandreau, 492 F. 3d 1372; Buchanan, 451 F. 3d 1331. The Veteran’s reports of his symptoms are relevant, competent, and credible; however, the question of the etiology of his knee disorder is limited to the purview of someone with medical knowledge and training, such as the VA medical examiner in this case. In sum, the evidence does not show that it is at least as likely as not that the Veteran’s diagnosed bilateral knee disorder is related to active service. The probative value of the Veteran’s assertions is outweighed by the probative value of the thorough and reasoned opinion of the VA medical expert. As the preponderance of the evidence is against the claim, service connection for a bilateral knee disorder must be denied.  38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.