Citation Nr: 21061686 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-48 347 DATE: October 5, 2021 ORDER Entitlement to service connection for a right knee condition is granted. Entitlement to service connection for a left knee condition is denied. FINDINGS OF FACT 1. Resolving all doubt in the Veteran's favor, the evidence reasonably supports a finding that a diagnosed right knee disability had its origin during active service. 2. The preponderance of the competent medical evidence does not demonstrate that the Veteran's diagnosed left knee condition was incurred in service or is otherwise attributable to his service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee disability have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.159, 3.303, 3.304. 2. The criteria for entitlement to service connection for a left knee condition have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1985 to April 1995, September 2001 to March 2003, and August 2004 to January 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. This matter was previously before the Board in March 2019, when it was remanded for further development to include obtaining updated VA treatment records from June 2017 to the present, ask the Veteran to complete a VA Form 21-4143 Authorization to Disclose Information for any private treatment providers who treated him for knee complaints since service and take all appropriate action to obtain any identified records, and to afford the Veteran a VA examination to determine the current nature and likely etiology of any identified right or left knee disability. The Board notes that, to the full extent possible, VA complied with the remand instruction requests, and there exist no deficiencies in VA's duties to notify and assist in that regard. See Stegall v. West, 11 Vet. App. 268 (1998); but see D'Aries v. Peake, 22 Vet. App. 97, 104 (2008). The matters have returned to the Board for further appellate review. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. It is only when the weight of the evidence is against the claim that the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for a right knee condition The Veteran contends that his diagnosed right knee disorder is related to a fire drill accident during basic training. See August 2017 VA Form 9 formal appeal. After a thorough review of the claims file, the Board finds that service connection is warranted, although not based on the reported fill drill accident. The Board acknowledges that the Veteran had a diagnosis of right knee joint osteoarthritis confirmed during this appeal. See December 2019 VA knee and lower leg conditions examination. Thus, the only question for the Board is whether his right knee condition began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran's service treatment records (STRs) contain a complaint, treatment and diagnoses concerning the right knee. A June 2008 emergency medical services record noted the Veteran was seen for right knee pain after colliding knees with another player during a basketball game. Specifically, the provider noted mild right knee patellar tenderness a positive McMurray's test, and mild medial effusion. The treatment record also noted pain and swelling were not severe enough to warrant a dressing. The treatment provider diagnosed right knee effusion. In a separate June 1988 STR record, the Veteran was placed on a 6-day profile that included no running, jumping, squatting or extended walking. The STRs also include multiple reports of medical history (RMHs) dated March 1985, September 1987, October 1988, and August 1999, wherein the Veteran denied any knee issues. Reports of medical examination (RMEs) dated March 1985, September 1987, October 1988, February 1994, and August 1999 note the Veteran's lower extremities are normal and are silent to any knee issues. Post-service treatment records in the claims file include a May 2016 VA primary care record wherein the Veteran reported bilateral knee pain, left greater than right. The same record noted pain classified as up to 9/10, no direct trauma noted other than jumping into trucks during service, and the Veteran was not taking any medications. No knee swelling or effusion noted on examination. A separate May 2016 VA rehabilitation record noted the Veteran was issued and instructed on the use of bilateral knee sleeves. A September 2016 VA primary care record noted a complaint of chronic bilateral knee pain since service, no swelling noted on examination, and a review of x-rays showed no acute etiology. A November 2018 community care physical therapy consultation noted the Veteran was entitled to 14 treatments for his knees. The claims file includes a December 2019 VA knee and lower leg conditions examination and medical opinion. Following an in-person examination and review of the medical record, the examiner confirmed a diagnosis of right knee osteoarthritis from 2016 and noted traumatic right knee effusion. The examiner opined that the Veteran's right knee traumatic effusion is less likely as not related to military service. As a rationale for the medical opinion, the examiner noted that while the STRs indicate the Veteran had a single visit for a traumatic right knee effusion in 1988, the STRs do not indicate any follow-up care for this condition. This it is most likely a self-limited condition. The Board is mindful of the negative etiological opinion in this matter. However, the Board observes that beyond the emergency medicine treatment for his right knee, the STRs also reflect that the Veteran was placed on a six-day profile as part of his treatment for the knee injury. Post service treatment records indicate that the Veteran is still reporting knee pain. Applying the benefit-or-the-doubt standard of proof, the Veteran's claim of service connection for a right knee disability is granted. 38 U.S.C. § 5107(b). 2. Entitlement to service connection for a left knee condition The Veteran also contends that he is entitled to service connection for a left knee disorder because of the basic training accident. See August 2017 VA Form 9 formal appeal. After a thorough review of the claims file, the Board finds that service connection for a left knee condition is not warranted. During this appeal a diagnosis of left knee joint osteoarthritis was confirmed. See December 2019 VA knee and lower leg conditions examination. Thus, the only question is whether the Veteran's left knee condition began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board observes that the Veteran's STRs are entirely silent as to a diagnosis, complaints of, or treatment for symptoms related to his left knee, unlike with the right knee. Post-service medical records pertaining to the Veteran's left knee include multiple records that note bilateral knee pain. A May 2016 VA primary care record noted that the Veteran rated his bilateral knee pain at up to 9/10, with left knee pain greater than right knee pain. The same record noted no swelling or effusion on examination. A separate May 2016 VA treatment record noted that the Veteran was issued bilateral knee braces. A May 2016 rehabilitation record noted a report of bilateral knee pain within the past 30 days. A September 2016 VA primary care record noted a complaint of bilateral knee pain since service. A review of knee x-rays showed no acute etiology. As noted above, the Veteran was afforded a December 2019 VA knee and lower leg conditions examination. After confirming a diagnosis of bilateral knee joint osteoarthritis from 2016, the examiner opined that the Veteran's left knee condition is less likely than not (less than 50 percent probability) related to military service. As a rationale for that opinion, the examiner noted STRs are silent for a left knee condition. The examiner concluded by noting that the current degree of knee arthritis is more likely to be an age-related condition. The Board considered multiple lay statements from the Veteran regarding his claimed left knee condition. For example, in his September 2017 VA Form 9 Formal Appeal, the Veteran described the basic training injury noting he was trying to exit the barracks shower during a fire drill when he fell and hurt his knees. The Veteran also acknowledged that he did not report this injury as he was discouraged from seeking treatment for training injuries that would result in being held back or disqualified from further training. The Veteran described training that consisted of low crawling across obstacles, running and dropping on any surface, and jumping from trucks. The Veteran also reported that the unreported injuries have intensified and worsened. The Board also reviewed a June 2020 correspondence from the Veteran that explained the fire drill injury and asserted similar injuries throughout his further active service that were never reported based on the fear that doing so would hinder advancement. The Board notes that the Veteran is competent to report on that of which he has actually observed and is within the realm of his personal knowledge, including the type of accidents and the subsequence presence of any pain. Layno v. Brown, 6 Vet. App. 465 (1994). However, the question of whether the Veteran's left knee osteoarthritis is related to his service is medically complex, and beyond the scope of lay observation; it requires medical training and credentials. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As the Veteran is a layperson, and does not cite to supporting clinical data, a supporting medical opinion, or supporting medical literature, his opinion regarding a nexus between his left knee condition and service is not competent evidence and lacks probative value. Consequently, the Board gives more probative weight to the opinion of the December 2019 VA examiner who indicated that the left knee condition is more likely related to age. In the absence of competent evidence supporting the Veteran's claim for service connection for a left knee condition, the Board finds that the preponderance of the evidence is against the Veteran's claim, and service connection is not warranted. There is no reasonable doubt to be resolved, and the claim of entitlement to service connection for a left knee condition must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Banks, 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.