Citation Nr: 21061621 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 16-03 398 DATE: October 4, 2021 ORDER Entitlement to service connection for a low back disability is granted. Entitlement to service connection for a right knee disability is granted. Entitlement to service connection for a left knee disability is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, her low back disability is related to service. 2. Resolving reasonable doubt in the Veteran's favor, her right knee disability is related to service. 3. Resolving reasonable doubt in the Veteran's favor, her left knee disability is related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a low back disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a left knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army Reserve from May 1979 to May 2013, with honorable active duty training (ADT) from May 1979 to November 1979. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to prevail on a claim of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The term "active military, naval, or air service" includes active duty, any period of ACDUTRA which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty. 38 U.S.C. § 101(24) (2012); 38 C.F.R. § 3.6 (2020); Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). INACDUTRA is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. Id. Active service also includes authorized travel to or from such duty or service. 38 U.S.C. § 106(d); 38 C.F.R. § 3.6(e). Service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty for training (ACDUTRA), or from injury incurred or aggravated while performing inactive duty for training (INACDUTRA). 38 U.S.C. §§ 101(24), 106, 1131. When a claim for service connection is based only on a period of ACDUTRA or INACDUTRA, there must be evidence that the Veteran became disabled as a result of a disease or injury incurred or aggravated in the line of duty during that period of ACDUTRA or INACDUTRA. See 38 U.S.C. §§ 101(2), (22), (24); 38 C.F.R. § 3.6(a); Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010); Acciola v. Peake, 22 Vet. App. 320, 324 (2008) (citing Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995)). In the absence of such evidence, the period of ACDUTRA or INACDUTRA would not qualify as "active military, naval, or air service." 38 U.S.C. § 101(2), (24); See Acciola, 22 Vet. App. at 324. 1. Entitlement to service connection for a low back disability With regard to a present disability, the Veteran appeared for a VA back examination in May 2013. At that time, the examiner indicated a diagnosis of lumbar degenerative disc disease (DDD). Thus, the current-disability criterion for service connection is met. See Shedden, supra. Next, the Board must consider whether the Veteran sustained a disease or injury in service. Turning to the evidence of record, a review of the Veteran's service treatment records contains a November 1987 line of duty determination, which reveals the Veteran injured her back while riding in a military vehicle. See Military Personnel Record, p. 1. As such, the Board resolves all doubt in the Veteran's favor, finding an in-service incurrence. Therefore, the second element of service-connection is met. See Shedden, supra. As to the third element of service connection, medical evidence must establish a nexus between the current disability and the Veteran's service. As noted above, the Veteran appeared for a VA back examination in May 2013. The examiner opined that it was less as likely as not that the Veteran's lumbar DDD was incurred in or caused by service. In support of his opinion, the examiner explained that lumbar DDD was considered part of the normal aging process given the Veteran's age. The examiner further noted that the Veteran's 1987 back injury was acute and transient and improved with proper treatment. Moreover, there was no evidence in the Veteran's claims file or private medical records to support a continuation of treatment for two or three years post-service. A private medical opinion was associated with the Veteran's claims file in March 2017. The physician opined that it was more likely than not that the Veteran's back condition was due to her military service. In providing the opinion, the physician stated that trauma, similar to that sustained while riding in a military vehicle during service, can cause degenerative disc disease. He determined that it was medically probably that the Veteran would not have developed degenerative disc disease had she not had an accident in service. The physician indicated that the Veteran's medical records revealed she suffered from chronic pain in the back. In consideration of the evidence of record, the Board finds that the evidence of record for and against the Veteran's claim of service connection for a low back disability is in a state of relative equipoise. 38 C.F.R. §§ 3.303, 3.310 (2020). When the evidence for and against a claim is in relative equipoise, the Board must resolve all reasonable doubt in favor of the Veteran. As such, the benefit-of-the-doubt will be conferred in the Veteran's favor and his claim for service connection for a low back disability is granted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2020); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Entitlement to service connection for a right knee disability 3. Entitlement to service connection for a left knee disability With regard to a present disability, the Veteran appeared for a VA knee and lower leg conditions examination in May 2013. At that time, the examiner indicated a diagnosis of bilateral knee ostearthritis. Thus, the current-disability criterion for service connection is met. See Shedden, supra. Next, the Board must consider whether the Veteran sustained a disease or injury in service. Turning to the evidence of record, a review of the Veteran's service treatment records contains a June 2010 line of duty determination, which reveals the Veteran injured both knees when she tripped and fell with a weapon sling. See Medical Treatment Record Non-Government Facility, p. 7. As such, the Board resolves all doubt in the Veteran's favor, finding an in-service incurrence. Therefore, the second element of service-connection is met. See Shedden, supra. As to the third element of service connection, medical evidence must establish a nexus between the current disability and the Veteran's service. As noted above, the Veteran appeared for a VA knee and lower leg conditions examination in May 2013. The examiner opined that it was less as likely as not that the Veteran's bilateral knee ostearthritis was incurred in or caused by service. In support of his opinion, the examiner explained that bilateral knee ostearthritis was considered part of the normal aging process given the Veteran's age. The examiner further noted that the Veteran's September 2008 knee injury was acute and transient and improved with proper treatment. Moreover, there was no evidence in the Veteran's claims file or private medical records to support a continuation of treatment for at least two years post-injury. A private medical opinion was associated with the Veteran's claims file in March 2017. The physician opined that it was more likely than not that the Veteran's osteoarthritis was due to or aggravated by her military service. In providing the opinion, the physician stated that the Veteran suffered from moderate recurrent subluxation and instability in the bilateral knees, which caused her to suffer multiple falls. The physician stated that trauma, such as falls, can cause osteoarthritis in adults of any age. Common injuries that may lead to osteoarthritis include torn cartilage, dislocated joints, and ligament injuries. Anterior cruciate ligament strains and tears were noted to be particularly problematic, as they have been linked to development of osteoarthritis. The physician indicated that the Veteran's medical records revealed she continues to suffer from chronic pain in the bilateral knees. In consideration of the evidence of record, the Board finds that the evidence of record for and against the Veteran's claim of service connection for a bilateral knee disability is in a state of relative equipoise. 38 C.F.R. §§ 3.303, 3.310 (2020). When the evidence for and against a claim is in relative equipoise, the Board must resolve all reasonable doubt in favor of the Veteran. As such, the benefit-of-the-doubt will be conferred in the Veteran's favor and his claim for service connection for a bilateral knee disability is granted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2020); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tracy O. Joseph, 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.