Citation Nr: 21061545 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 12-17 720A DATE: October 4, 2021 ORDER Entitlement to service connection for left knee strain is denied. FINDING OF FACT The Veteran's left knee strain is not related to active service. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303. CONCLUSION OF LAW The criteria for service connection for left knee strain have not been met. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1977 to August 1978, from July 1982 to September 1991, from February 1995 to July 1995, from September 1997 to April 1998, and from April 2002 to November 2002. The Veteran served with the United States Air Force Reserve from 1977 to 1982 and from 1991 to 2010 with various periods of ACDUTRA and inactive duty for training (INACDUTRA). This case initially came to the Board of Veterans' Appeals (Board) on appeal from a May 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2014, the Board remanded the matter to schedule the Veteran for a videoconference hearing. In July 2016, the Veteran testified during a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In October 2016 and February 2020, the Board remanded the matter for further evidentiary development. The agency of original jurisdiction (AOJ) has substantially complied with the Board's February 2020 remand instructions by providing VA examination to determine the etiology of the Veteran's left knee claim. Thus, no further action is necessary in this regard. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with). 1. Left Knee Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first 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). For the following reasons, the Board finds that service connection for left knee disability is not warranted. The Veteran's service treatment records (STRs) indicates that in December 1995, the Veteran complained that his knees were waking him up with a dull ache pain for the last two nights. A diagnosis of bilateral knees, overuse was noted. In an October 2006 flying class examination report, the Veteran denied having trick or locked knee. At his July 2016 Board hearing, the Veteran testified that he was on active-duty orders and injured his left knee when he was doing summer camp of 15 days at Fort Gordon. He noted the knee injury was approximately in 2005 or 2006. A November 2008 VA clinical record shows the Veteran reported chronic knee pain. The Veteran was afforded a VA examination in June 2021. He reported that he does not remember when his left knee began to bother him. He indicated that he fell several times in service on his knee. The examiner diagnosed left knee strain. The examiner opined that the Veteran's left knee condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner explained that records of a left tibial fracture were found, but these were only as past history in records from 2018. The examiner further explained that an x-ray on the day of the exam did not find any abnormality, so the entry of left tibial fracture may have been an error, especially since the Veteran denied history of fracture to the left tibia. The examiner noted that a separation examination was not located, nor was the record of the noted motor vehicle accident (MVA) from May 2006. The examiner further noted that, however, a Report of Medical Care from October 2006 was located, upon which "no" was marked for trick or locked knee and bone, joint, or other deformity. Also, no notation was made of a knee complaint on this form and the examination conducted the next day was normal. The examiner explained that the Veteran's last active service period was in 2002, and without any findings of a knee complaint, it cannot be said that the left knee strain occurred during active service. The examiner further explained that without notation of a tibial fracture on the October 2006 examination, it is not possible to say that the left knee strain occurred as the result of a MVA in 2006. The examiner concluded that a nexus cannot be established. As the VA examiner explained the reasons for his conclusions based on an accurate characterization of the evidence, to include consideration of the Veteran's lay statement, his opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). Moreover, there is no contrary medical opinion in the evidence of record. During the Board hearing and his VA examination, the Veteran indicated that he injured his left knee in service but did not explicitly state or otherwise indicate that he had continuous knee symptoms since service. For the reasons and bases set forth above, the preponderance of the evidence is against the claim of service connection for left knee strain. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.