Citation Nr: 21001148 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 18-50 628 DATE: January 7, 2021 ORDER Entitlement to service connection for a left knee disability, characterized as a left knee strain and patellofemoral pain syndrome, is granted. Entitlement to service connection for a right knee disability, characterized as a right knee strain and patellofemoral pain syndrome, is granted. FINDING OF FACT Resolving reasonable doubt, the Veteran’s left and right knee conditions onset during his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left knee disability, characterized as a left knee strain and patellofemoral pain syndrome, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303(d). 2. The criteria for entitlement to service connection for a right knee disability, to include a right knee strain and patellofemoral pain syndrome, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303(d). REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from August 2003 to May 2007. In August 2019, the Board denied entitlement to service connection for left knee and right knee conditions. The Veteran appealed the August 2019 Board decision to the Court of Appeals for Veterans Claims (CAVC or Court), which vacated the decision and remanded it back to the Board for further development in August 2020, pursuant to a Joint Motion for Remand (JMR). Specifically, the JMR directed that the Board remand the claims to obtain another opinion regarding the nature and etiology of the Veteran’s bilateral knee condition. In this regard, the Board notes, however, that the above development is unnecessary because this decision results in a favorable outcome for the Veteran in light of a thorough reexamination and reconsideration of the evidence on the record. See McBurney v. Shinseki, 23 Vet. App. 136, 150 (2009) (stating that Board has a duty on remand to ensure compliance with the favorable terms stated in the joint motion for remand or explain why the terms will not be fulfilled.); Forcier v. Nicholson, 19 Vet. App. 414, 426 (2006); & Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, the Veteran will not be prejudiced by the adjudication of this matter. Entitlement to service connection for a left knee disability Entitlement to service connection for a right knee disability Service connection is warranted where evidence shows that an injury or disease that results in a current disability was incurred during service or was aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. §3.303(a). To be entitled to service connection, the evidence must support (1) a current disability; (2) an in-service injury or event; and (3) a nexus between the current disability and the in-service injury or event. 38 C.F.R. §3.303(a). In the current appeal, the Veteran contends that he developed left and right knee disabilities during his service. The evidence of the record establishes that the Veteran has current diagnoses of left and right knee strains. See September 2017 VA Examination Report. Also, VA medical treatment records show that the Veteran has been assessed to have bilateral knee pain consistent with patellofemoral pain syndrome (PFPS). See April 2018 Orthopedic Surgery Consult Note (September 2019 VA Medical Treatment Records [CAPRI]). Regarding an in-service injury or event, the Board notes that service treatment records document several complaints of knee or leg pain. In March 2004, the Veteran complained of pain in the anterior tibia bilaterally, which was noted to have started two weeks prior while running. The assessment given at that time was shin splints. In September 2004, the Veteran complained of left knee and shin pain. The assessment given was left knee pain and likely tendonitis. In April 2004, the Veteran complained of bilateral shin pain when running for the past three weeks. The assessment provided was shin splints. In April 2005, the Veteran complained of bilateral knee pain, with a duration of three months. The Veteran felt that he had arthritis. One of the assessments given was retropatellar pain syndrome (RPPS). On the February 2007 Post-Deployment Health Assessment, the Veteran noted that he developed bilateral knee pain during his deployment. At the time, he expressed that he had questions and concerns regarding his bilateral knee pain. It was also indicated that there was need for further evaluation of the Veteran’s bilateral knee pain. See June 2007 Service Treatment Records (STR). As to whether a nexus exists between these in-service episodes and the current bilateral knee diagnoses, the Board notes that the September 2017 VA examiner opined that it was less likely than not that the Veteran’s bilateral knee condition was incurred in, or caused by, his service. The rationale provided was that, during his service, the condition was acute only and that there was no evidence of chronicity of care. As outlined in the August 2020 JMR, the September 2017 examiner’s opinion is flawed in several ways. First, the examiner did not thoroughly address the in service treatment records noting the symptoms and assessment of the Veteran’s knee conditions. The examiner did not offer a thorough explanation as to why the in-service symptoms and diagnoses were not related to the Veteran’s current condition. Second, the examiner did not consider or address the Veteran’s statements regarding experiencing continuous knee pain since service. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue"). In this matter, the Veteran has continuously asserted that he has experienced knee pain during, and since, his service. The February 2007 Post Deployment Health Assessment shows that the Veteran expressed concerns regarding his bilateral knee pain, and it was noted that further evaluation was needed regarding such symptoms. In the post-service treatment records, the Veteran reported experiencing bilateral knee pain for “10 years or more.” The Veteran reported the same, or similar, symptoms that he reported during his active service. He also currently experiences the same, or similar, limitations that he did during his active service. He was assessed to have retro-patellofemoral pain syndrome during his service, and was assessed to have patellofemoral pain syndrome post-service. When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not prove or disprove the claim satisfactorily. It is a substantial doubt and one within range of probability as distinguished from pure speculation or remote possibility. 38 C.F.R. §3.102. After a thorough consideration of the evidence above, the Board finds the Veteran's statements and testimony as to onset and continuity of symptomatology regarding his knee conditions to be credible. His statements have been consistent with each other, his service records, and post-service treatment records. While the theory of continuity of symptomatology does not apply in this case [see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)], the Board observes that the Veteran's accounts of his symptoms during and after service, when considered in tandem with the symptoms and diagnosis identified in the treatment records and VA examination, nonetheless, raise a reasonable doubt as to the initial onset of his knee conditions. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Resolving all reasonable doubt in favor of the Veteran, the Board finds that his bilateral knee condition is related to his in service complaints. 38 C.F.R. § 3.303(d) (which stipulates that service connection may be granted for any disease diagnosed after discharge). Accordingly, the Board determines that the criteria for service connection have been met and that entitlement to service connection for left and right disabilities, characterized as knee strain and patellofemoral pain syndrome, is warranted. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Middleton, 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.