Citation Nr: 21002602 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 17-20 112 DATE: January 14, 2021 ORDER The claim of entitlement to service connection for a right leg and knee disorder is denied. FINDING OF FACT Disorders of the right leg (idiopathic livedo reticularis) and right knee (osteoarthritis) were first shown many years after military service and are unrelated to any disease, injury, or event during military service. CONCLUSION OF LAW The criteria for service connection for a right leg and knee disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from January 1952 to March 1955. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision by the Department of Veterans Affairs (VA). This case was remanded in January 2019 and July 2020 for further development. It has now been returned to the Board for further appellate consideration. Service Connection Service connection may be granted for a disability resulting from injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110 (wartime, 1131 (peacetime), 5107 (2012); 38 C.F.R. § 3.303 (2019). Service connection may be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes the disease was incurred in service. 3 8 C.F.R. § 3.303(d) (2019). Certain chronic diseases, such as arthritis, which is manifested to a compensable degree within one year of discharge from active duty, shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such diseases during the period of service. See 38 U.S.C. §§ 1101(3), 1112 (2012); 38 C.F.R. §§ 3.307(a)(3), 3.309 (2019). This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2019). Alternatively, if a chronic disease listed at 38 U.S.C. § 1101(3) (2012) and 38 C.F.R. § 3.309(a) (2019) is noted during service or the presumptive period, but not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b) (2019); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board must determine whether the weight of the evidence supports each claim or is in relative equipoise, with the appellant prevailing in either event. However, if the weight of the evidence is against the appellant’s claim, the claim must be denied. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Background The Veteran seeks to attribute his current right leg and knee disorders to an inservice injury. Review of the service treatment records (STRs) reflects that he was seen in December 1954 for abrasions and contusions of the legs and head. No further treatment as a result is indicated, and no chronic disorders of the right lower extremity were noted upon service discharge examination in March 1955. However, the Veteran has maintained on VA examinations in 2015, 2019 and 2020 that the 1954 injury occurred when he suffered an onboard fall. In support of his contention is an October 2014 statement as provided by a fellow serviceman who recalled that the Veteran fell while half-way down some steps while on board the USS Valley Forge. He hurt his right knee and his head, and they took him to sick bay where he was seen and thought to be “OK.” When examined by VA in June 2015, the examiner found no current right knee disorder. He also provided a negative opinion with respect to a right thigh disorder. Specifically, the examiner found that complaints of thigh pain and discoloration were consistent with livedo reticularis which would more likely that not be due to an unrelated vasculitis condition and would not result from a fall. Moreover, there was no continuity of complaints of treatment after the initial injury. As there was a June 2016 private treatment note which reflected the presence of mild osteoarthritis in the right knee, the Board remanded the claim in January 2019 for additional evidentiary examination and opinion. Pursuant to the January 2019 Board remand, the Veteran was afforded a VA examination for his claimed right leg and right knee disability in August 2019. At the time, the examiner was specifically requested to address the new diagnosis of right new osteoarthritis. After an examination of the Veteran, the examiner opined that the Veteran’s disability was less likely than not related to service. In so opining, the following rationale was provided. Complaints of skin discoloration are consistent with livedo reticularis, idiopathic in nature and not caused by trauma or a fall. Findings of mild osteoarthritis of the right knee per radiograph in 11/14/2016 are not uncommon in an 83-year-old veteran and are consistent with natural again. In the July 2020 remand, the Board noted that while the examiner stated that the osteoarthritis findings were common and consistent with age, he failed to address the Veteran’s competent contentions of pain on the knee in service and since service. It was pointed out that the STRs did document an injury in service and that the Veteran had contended that he had experienced pain in his knee ever since. While the examiner noted the Veteran’s reported history in the examination, to include the reports of increasing pain for the past 50 years, he failed to specifically address these contentions in the rationale. Therefore, as the examiner did not specifically address the Veteran’s lay contentions, a new addendum opinion was requested. In an August 2020 addendum report, the examiner who conducted the August 2019 evaluation again reviewed the claim file. It was his opinion that osteoarthritis of the right knee was less likely than not incurred in or caused by the in-service injury, event, or illness. For rationale, he noted that the Veteran suffered an injury in a fall on board a ship in the 1950s. The Veteran specifically recalled getting his right leg caught in the ladder chain and falling. He was seen in sick bay. He was on bed rest for a couple of days. The Veteran denied any other treatment for the right leg during service. The injury was corroborated by a fellow serviceman. The examiner also noted that the Veteran reported right knee pain ever since the initial injury and denied any additional injury to the knee. The Veteran also reported developing skin discolorations to the right thigh which started about a year after the incident. The Veteran said that the skin discoloration appeared and resolved with no noted precipitating or aggravating factors. He described a dull ache to the right knee without weight bearing and 8/10 right knee pain with weight bearing. The VA examiner stated that his review of the STRs did show that the Veteran was treated in December 1954 for abrasions and contusions of the legs and head. No treatment was required, and the record were not specific regarding location of injuries to the legs. The examiner noted that there were no further right knee or leg complaints during service and that discharge examination showed normal skin and lower extremities. The VA examiner acknowledged that November 2016 X-rays showed mild right knee osteoarthritis, but he also noted that the evidence of record did not show that the Veteran was treated for right knee complaints from service until 2016, approximately 60 years after leaving service. Thus, the osteoarthritis was consistent with the aging process and was not caused by or related to military service. Regarding the Veteran’s lay statements of continuous right leg pain, this was consistent with a history of idiopathic livedo reticularis, a skin disorder that caused lower extremity pain, also not caused by or related to military service. Analysis In this case, the Board finds the most probative evidence weighs against the claim. There is no evidence that the Veteran’s current right knee osteoarthritis or his right lower extremity livedo reticularis were incurred during active service, and there is no evidence that they are otherwise etiologically related to his active service. Although he was treated for leg abrasions/contusions in 1954, there was no followup treatment and no indication that his right leg/knee problems did not completely resolve without residual prior to his separation from service in March 1955. After service, the first documentation of knee problems occurred approximately 60 years after service when arthritis was diagnosed. Moreover, the right lower extremity disorder of livedo reticularis was noted by the examiner to not be related to a fall. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In addition, the VA examiner opined that the Veteran’s current right leg and knee disorders were less likely than not related to his active service. As summarized above, he provided sufficient rationale for his opinions and considered the Veteran’s lay assertions that he had experienced symptoms ever since the initial injury. The opinion is based on an accurate factual premise. As such, the opinion is adequate and the Board accords it great probative weight. Moreover, there is no medical opinion to the contrary. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced; however, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for right leg and knee disabilities is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert, 1 Vet. App. 49. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Hal Smith, 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.