Citation Nr: 21003432 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-23 281 DATE: January 21, 2021 ORDER Entitlement to service connection for a right knee disability is denied. FINDING OF FACT The Veteran’s right knee disability did not manifest in service or within one year of separation from active service and there is no indication that it is causally related to his active service. CONCLUSION OF LAW The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active naval service from March 1975 to March 1979 and from May 1982 to March 1996. This matter comes to the Board of Veterans Appeals (Board) on appeal from a September 2015 rating decision issued by the department of Veterans affairs (VA) Regional Office (RO). In connection with this appeal, the Veteran testified at a hearing before the undersigned Veterans Law Judge in March 2019. A transcript of that hearing has been associated with the claims file. This case was previously before the Board in July 2019, at which time the issue currently on appeal was remanded for additional development. The case has now been returned to the Board for further appellate action. Service Connection-Right Knee The Veteran asserts that he has a right knee disability that is related to his active service. Specifically, the Veteran reported that he tripped and fell on the flight deck of a naval vessel and injured his right knee. The Veteran reported that his right leg was casted for approximately four or five weeks following the injury. Service treatment records (STRs) show that in May 1976, the Veteran reported to medical with complaints of a sore right knee. He reported that he had been wrestling the prior day and heard his right knee “crack.” He reported that he had difficulty walking without pain. At that time, the examiner diagnosed mild strain. On October 29, 1982, the Veteran was seen in medical for an abrasion to the right knee. It was noted that he was seen for the injury the prior night at the emergency room. At that time, the Veteran was noted to have two deep abrasions over the patella. The abrasions were cleansed. X-rays at that time were negative for fracture. A right knee contusion was diagnosed, and the Veteran was placed on light duty for 24 hours. He was told to report to the clinic the prior morning for follow-up. At his follow-up visit on October 30, 1982, the Veteran was noted to report right knee pain, and was noted to have complained about having to work. There was mild swelling noted over the right patella, but range of motion was full. There was a questionable positive McMurray, but otherwise negative apprehension sign and negative drawer test. The examiner diagnosed right knee contusion. The Veteran was placed on light duty for five days and instructed to return to the clinic for follow-up in three days. On November 1,1982, the Veteran returned to medical with reports of continuing knee pain. At that time, the swelling had somewhat resolved; and McMurray, apprehension, and drawer tests were all negative. The examiner diagnosed right knee strain. On November 2, 1982, the Veteran was seen in medical with complaints of having to go up and down stairs, and walking through passageways. At that time, the swelling had complete resolved and the Veteran had full right knee range of motion. the abrasion was noted to be healing. The diagnosis of right knee strain was continued. On November 4, 1982, the Veteran was seen in medical for follow-up. at that time, the Veteran reported pain when walking up and down ladders. There was some mild crepitus, but physical examination of the right knee was otherwise normal. The examiner diagnosed right knee strain resolving. The Veteran was prescribed right knee rehabilitation exercises, and was told to continue light duty for three days and return for follow-up as needed. On November 7, 1982, the Veteran was again seen in medical for right knee follow-up. at that time, he reported that he was feeling better. Physical examination of the right knee was normal. The examiner instructed the Veteran to continue rehabilitation exercises. After reporting back to medical with continued knee pain, the Veteran was referred to orthopedics. On November 22, 1982, the Veteran was seen for an orthopedic consultation for right subpatellar knee pain for the past month. The examiner diagnosed chrondromalacia patella at that time, and prescribed medication for treatment. The Veteran was afforded periodic examinations in May 1983, August 1986, July 1989, and November 1994. There is no indication from those examination reports that the Veteran reported right knee problems. Further, the Veteran’s lower extremities were noted to be clinically normal upon examination at those examinations. The Veteran was afforded a retirement examination in September 1995. At that time, the Veteran did not report any right knee problems, and his lower extremities were found clinically normal upon examination. With respect to the Veteran’s report of having a cast placed on his right leg during service, the Board notes that while there are STRs showing the Veteran had his left arm casted during service, there is no indication from the record that he ever had his right leg casted during service. In April 1996, the Veteran filed a claim of entitlement to service connection for various disabilities, to include “knee” that he reported was from an injury sustained in November 1982. In connection with his April 1996 claim, the Veteran was afforded a VA examination in June 1996. At that examination, the Veteran reported the above described injury that was documented in his STRs. The Veteran reported that his right knee would ache whenever he attempted to squat or perform heavy lifting. X-rays taken of the knee in conjunction with that examination were normal. The examiner diagnosed old, healed lacerations to the anterior aspect of the right knee – no sequela. In a July 1996 rating decision, the Veteran was granted entitlement to service connection for right knee scarring. He did not disagree with that decision, or disagree with the fact that he was not also service-connected for a disability of the actual knee and not just scars. Post-service medical evidence of record shows that the Veteran receives treatment at the VA Medical Center for various disabilities. In January 2004, the Veteran was seen for an initial outpatient treatment history and physical. At that time, the Veteran did not report any issues related to his right knee. He reported the fall and resulting knee abrasion that occurred in service, but it was noted to have been a left knee issue. Regardless, the Veteran did not report any symptoms of problems with either knee that necessitated treatment at that time. In a current “problem list” printed and added to the record in August 2005, the Veteran was not shown to be followed at the VA Medical Center for a right knee disability. In August 2009, the Veteran was seen at the VA Medical Center for intermittent right knee discomfort and an occasional sense of instability that had its onset a “couple months prior.” At that time, the Veteran reported his in-service fall and abrasion to the right knee, but there is no indication from the treatment note that the Veteran reported his current symptoms had been present since the injury during service. the Veteran was diagnosed with right knee arthralgia at that time. In October 2009, the Veteran was seen for an orthopedic consultation. At that time, he reported right knee pain, but he had normal stability, and there was no swelling or crepitus. X-rays were ordered at that time. November 2009 X-rays revealed “questionable” minimal osteophyte formation in the right knee, but a diagnosis of arthritis was not made at that time. In December 2009, the Veteran was seen for a physical therapy consultation for his continued right knee pain. A knee brace was suggested, and he was seen again in March 2010 for a right knee brace fitting for treatment of his right knee arthralgia. In March 2011, the Veteran was seen for complaints of increased right knee pain and decreased right knee motion. He reported that he continued to wear his right knee brace as it supported his knee. There was no diagnosis made in addition to the existing diagnosis of right knee arthralgia. In March 2012, the Veteran was seen for a primary care follow-up appointment, at which time he reported unchanged right knee discomfort. An additional diagnosis was not made at that time. In June 2013, the Veteran was noted to have a diagnosis of right knee arthritis, but there was no X-ray report of record showing objective evidence of a definitive diagnosis of arthritis. The Veteran continued to receive sporadic treatment for right knee pain; however, there is no indication from the record that the Veteran’s right knee disability was related to his in-service fall in 1982. In August 2015, the Veteran was afforded a VA knee examination in connection with his current claim of entitlement to service connection for a right knee disability. At that time, the Veteran reported that he injured his knee during service by falling on the flight deck aboard a naval vessel. He reported that immediately after the fall, he had to realign his right foot and knee prior to receiving medical treatment. He reported that he had to wear a cast for approximately two months. X-rays taken of the Veteran’s right knee at that time did not reveal arthritis. The examiner diagnosed right knee strain and opined that the disability was less likely as not incurred in or caused by the right knee complaints during service. In so finding, the examiner noted that the in-service injury involved knee pain with abrasions, and possible chrondromalacia. The examiner noted that there was no continuity of symptoms in close proximity to the Veteran’s release from service, and the intercurrent history post-service was unknown. The examiner noted that there was no mention of knee complaints at the Veteran’s January 2004 initial evaluation at the VA Medical Center, and he did not have any documented complaints until 2009. In conclusion, the examiner noted that the current right knee complaints many years after service could not be reasonably connected to active service when there were multiple other intervening causes such as aging, occupational stressors, and daily activities. In January 2020, the Veteran was afforded another VA examination of his right knee. At that time, the Veteran again reported his in-service right knee injury. X-rays of the right knee did not reveal degenerative or traumatic arthritis at that time. The examiner diagnosed right knee patellofemoral pain syndrome and opined that it was less likely as not caused by an in-service event. In so finding, the examiner noted that the STRs revealed a right knee injury in 1982, but noted that X-rays at that time were normal and he was diagnosed with a right knee contusion versus chondromalacia patella. The examiner noted that the in-service diagnosis was likely acute and transitory in nature as the remaining 14 years of active duty STRs were silent for any mention of a chronic right knee condition. Further, the examiner noted that the Veteran’s September 1995 retirement examination report was silent for any complaints of a right knee disability. the examiner noted that there was no evidence that the Veteran was medically treated for a chronic right knee disability immediately post-service, or in the years that followed, until 2009. It was noted hat in 2009, the Veteran reported that he had intermittent right knee pain that began a few months prior. The examiner noted that there was no medical literature that could substantiate a claim of right knee pain beginning 27 years following the initial injury/incident The Board finds that the August 2015 and January 2020 VA medical opinions ae adequate, especially when read in conjunction with one another. In this regard, the examiners thoroughly reviewed and discussed the relevant evidence, considered the contentions of the Veteran, and provided a supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Further, there is no medical opinion of record to the contrary. As such, the VA medical opinion are the most probative evidence of record. The Board notes that the Veteran is generally competent to report when he first experienced symptoms of a right knee disability. However, once evidence is determined to be competent, the Board must determine whether such evidence is also credible. Competency is a legal concept determining whether testimony may be heard and considered, and credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Layno v. Brown, 6 Vet. App. 465 (1994). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 133 (Fed. Cir. 2006). The Board may not ignore a Veteran’s testimony simply because he is an interested party and stands to gain monetary benefits. However, personal interest may affect the credibility of the evidence. Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). In this case, the Board finds that the Veteran’s statements that he has experienced right knee pain since his October 1982 in-service knee injury are not credible. In this regard, the Veteran’s statements are inconsistent with the other evidence of record. The Veteran’s STRs are silent for complaints of, or treatment for right knee problems following his orthopedic evaluation following his knee injury in November 1982. The Veteran served for an additional 14 years following that injury, and was seen in medical for a wide variety of complaints during that time. However, he did not report knee pain at any point following the November 1082 orthopedic evaluation discussed above. Further, at his September 1995 separation examination, the Veteran did not report knee pain and his lower extremities were clinically normal upon separation. While the Veteran did file a claim of entitlement to service connection for a “knee” in April 1996; when the Veteran was granted entitlement to service connection for right knee scars, he did not disagree with that determination. Further, his June 1996 VA examination revealed a normal right knee with old, healed scars. Post-service medical evidence of record shows that the Veteran did not begin reporting knee pain to his VA Medical Center treatment providers until August 2009, at which time he reported that he did not start experiencing right knee pain until just a few months prior. The statements made by the Veteran to treatment providers are of significant probative value as it can be assumed that a Veteran would be honest with their treatment providers in an effort to actually improve or abate their symptoms. Further, the Veteran did not file another claim for service connection for a disability related to his right knee until 2016. However, from the time of his original claim in 1996 until the claim underlying the instant appeal, the Veteran filed multiple other claims for service connection and increased ratings. If the Veteran were experiencing symptoms of a knee disability during that time, it stands to reason that he would have filed a claim for such as he was clearly familiar with the process. Further, there are highly probative medical opinions of record indicating that the Veteran’s current right knee disability is not related to his documented in-service injury. As the Veteran’s reports of right knee pain since his documented October 1982 injury in service are inconsistent with the other evidence of record, they are not credible. While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current right knee disability to an in-service injury as that would require medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a right knee disability is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ivan Franklin 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.