Citation Nr: 21004910 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 16-52 001 DATE: January 28, 2021 ORDER Entitlement to service connection for a left knee disorder is denied. FINDING OF FACT Left knee disorder did not manifest during active service and is not otherwise related to active service. CONCLUSION OF LAW The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the Army from April 1965 to April 1967. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). This issue was previously before the Board in November 2018 and October 2020 when it was remanded for further development, that development was completed, and the case has since been returned to the Board for appellate review. This appeal has been advanced on the docket. 38U.S.C. §7107 (2012); 38C.F.R. §20.900(c) (2020). Duties to Notify and Assist Neither the Veteran nor his representative has 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). The Board also finds that there has been substantial compliance with the prior November 2018 and October 2020 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The issue was remanded in November 2018 for a VA examination and opinion. The Veteran received an October 2019 VA examination. The issue was remanded in October 2020 for outstanding social security administration (SSA) records. SSA submitted an October 2020 finding that no medical records existed. Accordingly, the Board will proceed with appellate review. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2020). 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 between the present disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 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) (2020). The Veteran alleges that his left knee disorder was due to constant kneeling working on helicopters. In a January 2016 statement, the Veteran attributed his knee problems to constant kneeling. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The October 2019 VA examination diagnosed status post total left knee replacement. The first element of service connection has been met. Second, the Board finds that there was an in-service event but not disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran’s service treatment records (STRs) were silent for knee problems; the separation examination noted a normal clinical evaluation of the lower extremities. In the separation report of medical history, the Veteran denied a trick or locked knee. The Veteran attributed his knee problems to working on helicopters in service. The Veteran’s DD214 showed his military occupation specialty (MOS) as a helicopter mechanic. The Veteran is competent to report as to factual matters of which he or she has first-hand knowledge, to include events he witnessed during service. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Board finds the Veteran’s statements credible as they are consistent with the circumstances of his service. See 38 U.S.C. § 1154 (2012); Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Thus, as competent and credible lay evidence shows kneeling while working on helicopters during active duty, the second element of service connection has been met. Third, the Board finds that the evidence of record does not support a finding that the left knee disorder is related to active service. The Veteran received an October 2019 VA examination. The examiner noted review of STRs, VA treatment records, and an April 2014 VA examination. The examiner noted July 2018 and July 2019 VA treatment for chronic left knee pain. The examiner cited the April 2014 VA mental health examination for occupational history. The examiner opined the left knee disorder was less likely than not incurred in or caused by service. The examiner explained that it was highly unlikely that a few years in military service, during which the Veteran had no documented complaints, or treatment, or surgery for the knee, are the cause of the current knee issues. The examiner stated there was no objective evidence linking service to current knee issues. The examiner noted the Veteran worked over 40 years after service in an assembly unit, doing various jobs such as storekeeper, mechanic assembly, and janitor. The examiner noted those were all physically demanding jobs which require fair amount of use of the knee. The examiner explained that the Veteran’s occupational history combined with age and normal wear and tear on the body are the most likely causes of the Veteran’s current knee issues. The Board affords significant probative weight to the October 2019 VA examination and opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician’s access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). First, the examiner adequately and thoroughly discussed the medical evidence of record. Notably, the examiner reviewed and discussed the April 2014 VA examination regarding the Veteran’s other occupational history. Second, the examiner adequately considered the Veteran’s statements. During the examination the examiner noted the Veteran stated his knee had been bothering him since he left the Army. The examiner noted the Veteran worked as mechanic and on his knees a lot but there was no injury or treatment during service. Notably, in the March 1967 report of medical history for separation, the Veteran noted painful joints but linked that statement to the right shoulder and not the knees. Accordingly, service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Bruton, 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.