Citation Nr: 21062060 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 18-15 896 DATE: October 6, 2021 ORDER Entitlement to service for a right knee disability, diagnosed as rupture of the anterior cruciate ligament and meniscus tear, is granted. Entitlement to service connection for a left knee disability, diagnosed as rupture of the anterior cruciate ligament and meniscus tear, is granted. Entitlement to service connection for a back disability, diagnosed as degenerative disc disease with lumbar radiculopathy, is granted. Entitlement to service connection for migraine headaches is granted. FINDINGS OF FACT 1. Affording the Veteran the benefit of the doubt, the Board finds the Veteran's right knee disability was at least as likely as not incurred in or caused by his active-duty service. 2. Affording the Veteran the benefit of the doubt, the Board finds the Veteran's left knee disability was at least as likely as not incurred in or caused by his active-duty service. 3. Affording the Veteran the benefit of the doubt, the Board finds the Veteran's back disability was at least as likely as not incurred in or caused by his active-duty service. 4. Affording the Veteran the benefit of the doubt, the Board finds the Veteran's migraine headaches were at least as likely as not incurred in or caused by his active-duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for right knee disability, diagnosed as rupture of the anterior cruciate ligament and meniscus tear, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left knee disability, diagnosed as rupture of the anterior cruciate ligament and meniscus tear, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for back disability, diagnosed as degenerative disc disease with lumbar radiculopathy, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for migraine headaches have been 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 on active duty from June 2000 until June 2005. This matter comes before the Board of Veterans' Appeals (Board) from a July 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office in Milwaukee, Wisconsin. The Veteran was afforded a virtual hearing with the undersigned Veterans Law Judge in July 2021. A transcript of the hearing has been associated with the record. Service Connection In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the present of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although lay persons are considered competent to provide opinions on some medical issues, some medical issues fall outside of the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011). 1. Entitlement to service for a right knee disability. 2. Entitlement to service connection for a left knee disability. In this case, the Veteran seeks service connection for a right and left knee disability. To promote efficiency, these issues will be addressed together. To begin, the Veteran was afforded a VA knee examination in June 2015. The examiner found that the Veteran does not have a current diagnosis associated with any knee disability. The examiner found no reduction in his range of motion (ROM) in either knee, no evidence of instability, and no functional impairment. The Veteran reports flare-ups when physically active resulting in functional loss, however, the examiner found the examination is neither medically consistent nor inconsistent with the Veteran's statements regarding functional loss during flare-ups. The examiner found the Veteran to not have a current diagnosis with his ROM being "essentially within normal limits." However, more recent medical documents from July 2018 indicate that the Veteran has a current diagnosis of chronic pain of both knees to include rupture of the anterior cruciate ligament of both knees. Therefore, given the evidence of a current disability, the Board finds adequate evidence satisfying the first element necessary for service connection. As it pertains to an in-service event or injury, the Veteran's service treatment records (STRs), there are complaints of knee pain lasting two days. The Veteran submitted a lay statement in February 2018 outlining his responsibilities in the Marine Corps. He wrote that he was responsible for lifting heavy objects with no help from machinery. Furthermore, during his July 2021 hearing, he testified that, while he does not recall a specific in-service event, he recalls playing basketball and struggling with knee issues after. The Board finds the Veteran to be competent and credible to discuss his in-service events. Multiple buddy statements were received in support of the Veteran's contentions. An April 2021 statement from fellow servicemember W.W. notes that during their deployment in 2003 they would lift weights together. W.W. recalled how the Veteran was unable to run on the treadmill due to his knee pain. Another servicemember, U.R. submitted a statement in support of the Veteran's contentions. U.R. discussed the intricacies of the Veteran's military occupational specialty (MOS) and how it required them to lift heavy weights that would cause strain on the entire body. Given the evidence of complaints of knee pain in service, the numerous buddy statements outlining the Veteran's symptoms and MOS requirements, the Board finds adequate evidence of an in-service event or injury for purposes of service connection. With regard to the final element necessary for service connection, the Board finds the evidence shows the Veteran's right and left knee disabilities were at least as likely as not incurred in or caused by his active-duty service. The June 2015 examiner found no evidence of a current diagnosis; thus, no nexus opinion was provided. However, a private practitioner, Dr. T. A., has been treating the Veteran since July 2018 and provided a positive nexus opinion. Dr. T. A. stated that, in his professional opinion, it is at least as likely as not that the Veteran's current bilateral knee disability, to include bilateral meniscus tears, is a progression of non-debilitating injuries he sustained during active-duty service. The examiner noted that due to heavy work and wrestling caused knee injuries. Furthermore, the examiner opined that the Veteran's current knee disability is consistent with, or the type of diagnosis one would expect given his in-service. The Board finds these opinions to be supported by an adequate rationale and therefore entitled to at least some probative value. Therefore, given the evidence of a current bilateral knee disability, an in-service knee pain complaint, the Veteran's credible testimony, multiple buddy statements, and at least one positive nexus opinion, affording the Veteran the benefit of the doubt, the Board finds the Veteran's right and left knee disabilities, diagnosed as rupture of the anterior cruciate ligament and meniscus tear, are at least as likely as not incurred in or caused by his active-duty service. 3. Entitlement to service connection for a back disability. The Veteran seeks service connection for a back disability. The Veteran was afforded a VA examination in June 2015. The examiner found the Veteran to not have a current diagnosis of a back disability at the time of the examination. The examiner measured the Veteran's ROM and found it to be "all normal." There was no decrease in ROM for forward flexion, extension, right lateral flexion, left lateral flexion, right lateral rotation, or left lateral rotation. The Veteran described having flare-ups that occur during times of physical activity; however, the examiner found the examination to be neither medical consistent nor inconsistent with the Veteran's statements regarding functional loss during a flare-up. There was no evidence of radiculopathy, ankylosis, or intervertebral disc syndrome (IVDS). More recently, the Veteran's medical record indicates he suffers from chronic low back pain with an onset of February 2016 and leg numbness while sitting in certain positions. More specifically, the Veteran has been treated for "spasm of back muscles" and has been prescribed Baclofen to help alleviate symptoms. Therefore, given the evidence of a current diagnosis with treatment, the Board finds the first element necessary for service connection has been met. As it pertains to an in-service event or injury, STRs from April 2005 note the Veteran has experienced back pain. Specifically, during his five-year physical the Veteran, under "present health," notes "back is sore" and describes "recent back pain." Furthermore, in support of his contentions, during his July 2021 hearing, he described the duties of his MOS. He elaborated on an experience where he had to lift an EAPS barrel, or engine particles separator, and in the process of lifting it he "felt a pop. I felt something. It was bad. I pretty much had to sit down the rest of the day." In addition, multiple buddy statements were submitted to support his contentions. A statement from the Veteran's mother, J.S. describes the Veteran's history of his back pain including instances where she observed the Veteran awaken in the morning and is unable to get out of bed due to back spasms. Another statement from the Veteran's co-worker, A. M., notes his ongoing back pain. Therefore, given the evidence of back pain complaints while in active service, the Veteran's credible testimony, and supporting buddy statements, the Board finds the second element necessary for service connection has been met. With regard to the final element necessary for service connection, a nexus, the Board finds the evidence shows the Veteran's low back disability was at least as likely as not incurred in or caused by his active-duty service. The June 2015 examiner found no evidence of a current diagnosis; thus, no nexus opinion was provided. However, a private practitioner, Dr. T. A., has been treating the Veteran since July 2018 and provided a diagnosis of degenerative disc disease with lumbar radiculopathy and a positive nexus opinion. Dr. T. A. stated that, in his professional opinion, it is at least as likely as not that the Veteran's current back disability was at least as likely as not caused by or related to the "stresses and strains of his military service and/or onset during military service." The examiner provided the rationale that "lifting can cause back injuries." Therefore, given the evidence of a current low back disability, an in-service back pain complaint, the Veteran's credible testimony, multiple buddy statements, and at least one positive nexus opinion, affording the Veteran the benefit of the doubt, the Board finds the Veteran's back disability, diagnosed as degenerative disc disease with lumbar radiculopathy, is at least as likely as not incurred in or caused by his active-duty service. 4. Entitlement to service connection for migraine headaches. The Veteran seeks service connection for migraine headaches. To begin, the Board notes the Veteran has a current diagnosis of "chronic tension-type headaches" based on private medical records from April 2021. Therefore, the first element of service connection has been met. Second, the Veteran's STRs contain two complaints of headaches while in-service. Furthermore, during Veteran's July 2021 testimony, he discussed that before entering service, he rarely had headaches. During service, however, he discussed that he would suffer from headaches, he would "[d]rink a canteen of water" and take some Motrin or "lots of Excedrin." In addition, multiple buddy statements corroborate how the Veteran was suffering from migraine headaches. The Veteran's mother, J.S., discussed the chronicity of his migraines and how they began during service and have continued since he separated. Another statement from his co-worker, A.M., discusses his ongoing complaints of migraines. As such, given his in-service complaints, his credible testimony, and the buddy statements, the Board finds the second element necessary for service connection has been met. With regard to the final element necessary for service connection, a nexus, the Board finds the evidence shows the Veteran's migraine headaches were at least as likely as not incurred in or caused by his active-duty service. VA examiner conducted a review of the available records (without an in-person or video telehealth examination) in July 2015. The examiner noted that there is adequate medical evidence from the STRs for them to assess the severity and etiology of Veteran's currently claimed migraine headaches. The reviewing examiner noted that his STRs contain two instances where the Veteran was seen for two separate acute illnesses both including complaints of headaches. The first, in June 2001, the Veteran was seen with complaints of gastrointestinal complains and headaches for three days. The second, in December 2002, the Veteran was seen for complaints of dizziness, congestion, cough, and headaches. The examiner noted there is no evidence of chronic recurrent headaches. The examiner concluded that, based on the STRs, the headache complaints were the result of acute illness, both of which were treated and resolved with no evidence of the Veteran having any chronic recurrent headaches. It was in the examiner's opinion that it is less likely than not that the Veteran's claimed migraine headache disability is related to the headache symptoms shown in service. In contrast, a private practitioner, Dr. T. A., has been treating the Veteran since July 2018 and provided a positive nexus opinion. Dr. T. A. stated that, in his professional opinion, it is at least as likely as not that the Veteran's chronic migraines had their onset during, and/or are related to his active-duty service. The examiner provided the rationale that his disability "may have stemmed from illness during service." The Board finds this opinion to be of limited probative value given the undetailed explanation and rationale. However, given the evidence of a migraine headache disability, in-service complaints of headaches, the Veteran's credible testimony, multiple buddy statements, and at least one positive nexus opinion, affording the Veteran the benefit of the doubt, the Board finds the Veteran's chronic migraine headache disability is also at least as likely as not incurred in or caused by his active-duty service. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. DeBoer, 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.