Citation Nr: 21062191 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 18-17 710 DATE: October 6, 2021 ORDER Entitlement to service connection for left knee disability is denied. FINDING OF FACT The left knee disability did not originate in service, within a year of service, or is otherwise etiologically related to his active service. CONCLUSION OF LAW The criteria for service connection for left knee disability have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1975 to February 1976. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision by a Department of Veterans Affairs Regional Office (RO). In March 2020, the Veteran testified at a Board videoconference hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. The Board held the record open for 90 days for the Veteran to submit additional relevant evidence. In August 2020, the Board remanded this case and instructed the Agency of Original Jurisdiction (AOJ) to obtain a VA examination. The Board notes that the requested VA examination has been obtained and associated with the claims file. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Left Knee Disability The Veteran seeks entitlement to service connection for left knee disability. Specifically, he asserts that he sustained an injury to his left knee during basic training. The evidence of record includes service treatment records (STRs), including a December 1975 enlistment examination noting normal lower extremities and showing the Veteran reported having cramps in his legs. He denied any trick or locked knee. A January 1976 psychiatric evaluation found the Veteran to be a training failure who could not meet the minimum standards due to a lack of general ability. He was not found to present with any incapacitating physical or mental disabilities. He was found to have difficulty handling pressure of a training environment and was further noted to have a history of emotional lability and found unable to expand efforts constructively. He was also noted to have a resolving knee problem. Post-service evidence includes an October 1976 VA medical record noting a negative X-ray study of the left knee. See VA Medical Records Received June 2017. Another October 1976 VA medical record shows the Veteran reported a bayonet injury to the medial aspect of his left knee with pain and stiffness reported since that time. He was assessed with post-trauma knee pain. See VA Medical Records Received November 1976. A November 1976 VA medical record noted that nothing was objectively wrong with the left knee. The physician noted that the condition was being treating as if it were chondromalacia. See VA Medical Records Received May 1995. A VA psychiatric and orthopedic examination was obtained in November 1976. A special psychiatric examination noted the Veteran reported being injured during bayonet practice at which time he was struck in the left knee. He also stated that as far as he knew, there was no definitive diagnosis made at that time. He did report being placed on light duty and that he was eventually discharged. The examiner noted that the Veteran was vague about the circumstances surrounding his reported in-service knee injury. Pain was also reported as continual since the incident. The orthopedic examination shows the Veteran reported having received a blunt injury to the medial aspect of the left patella. He also reported being treated with a wrap following his in-service injury, and that due to continued complaints of left knee pain he was discharged from service. In addition, he reported pain over the medial and anterior aspect of the left patella, with pain accentuated with flexion. A radiological study revealed intact bone and joint structure and no appreciable degenerative disease or other significant pathologic process. The examiner noted the Veteran was extremely difficulty to examine as he complained of pain even when tape was being placed around his knee. The examiner stated that he did not think that pain was coming from the joint line. Based on difficulty examining the Veteran, the examiner stated that it was impossible to state whether the left knee was normal on clinical grounds, although the examiner did state that there was no evidence of any organic disease. Additionally, the examiner stated that based on his uncooperativeness, that the examination was not totally satisfactory. In April 1977, a VA medical record shows the Veteran reported having a floating knee cap. No acute problem was found. See VA Medical Records Received May 1995. The Veteran underwent another VA examination in June 1977, during which he reported having sustained a stab wound to the inferior medial aspect of his left knee in 1976. He currently complained of weakness and pain in his left knee with an inability to perform normal activities. The examiner noted a small scar on the inferior medial portion of the patella retinaculum. The examiner also noted full ROM without synovial thickening or joint fluid. In addition, the examiner noted that due to "voluntary contractions of his quadricep muscles," conducting drawer and McMurray's testing was almost impossible. The Veteran was also noted to walk with a strange antalgic gait. An X-ray study revealed no bony abnormalities or soft tissue swelling. He was assessed with mild chondromalacia which was found possibly related to the reported in-service stab wound. However, the examiner further stated that it was difficult to assess the knee function due to strange voluntary contractions during the examination and a strange gait. A September 1978 memorandum from the Central Physical Evaluation Board to the Chairman, Board for Correction of Naval Records, noted that a review of the records did not reveal evidence of a medically unfitting condition or any reason for a medical discharge. Additionally, it was noted that the Veteran was administratively separated based on a January 1976 psychological evaluation which found him unsuitable for service. It was further noted that during the in-service psychological evaluation, he was noted to have a resolving knee problem, and that he was medically cleared in February 1976. A December 1980 VA orthopedic consultation noted the Veteran repeatedly complained of left knee pain. No evidence of any organic disease was found. Additionally, the orthopedist stated that he would not recommend an arthroscopy. See VA Medical Records Received May 1995. In June 1995, the Veteran underwent an orthopedic evaluation to assess a possible meniscal injury. No clinical evidence of a meniscal condition was found upon examination. A September 1995 X-ray study revealed normal bone mineralization and well maintained joint spaces. Minimal sharpening of the tibial spines with evidence of marginal osteophyte formation was also noted. See VA Medical Records Received November 2016. In April 2013, the Veteran reported that he was discharged with a 10 percent disability rating for a left knee injury. See April 2013 Claim. In October 2015, a VA medical record shows a report of a painful left knee which ranged from 6 to 10 on a scale to 10. Pain was reported as throbbing and limiting his ability to work. The Veteran stated that he injured his leg during service in 1976. He was assessed with chronic left knee pain. A January 2016 VA orthopedic consultation shows the Veteran initially reported injuring his left knee in a lifting injury during service. The physician noted that he then changed his story and stated that he had been struck by a bayonet in the medial aspect of his knee. He currently reported jerking knee pain and some instability. An examination of the knee revealed a 2 cm medial wound. ROM was noted between 5 degrees extension and 100 degrees flexion. The physician also noted diffuse tenderness to light tactile stimulation diffusely about the knee in non-dermatomal distribution. Imaging studies revealed a normal left knee. The physician concluded that the left knee pain was unlikely due to any anatomical pathology. See VA Medical Records Received April 2019. Social Security Administration (SSA) records include a December 2005 medical record showing complaints of low back pain since active duty service in 1974, and that pain sometimes radiated into his left leg. The Veteran did not report any in-service left knee condition, or any current left knee pain. The physician noted normal ROM in all joints, no trouble walking, and that the Veteran was able to stoop, climb, kneel and crawl. At a March 2020 Board hearing, the Veteran testified that he had a left knee condition that would swell. In this regard, he reported that his left knee swelled if he walked approximately 4 hours, and that he was unable to drive more than 10 to 15 minutes due to getting dizzy. He further testified that his in-service injury occurred on the inner side of the left knee, and that all the clinicians could see was a little abrasion. Lastly, the Veteran underwent a VA examination in July 2021. A diagnosis for left knee osteoarthritis was provided as confirmed by an X-ray study. The examiner opined that it was "less likely than not (less than 50 percent probability)" that the left knee disability was etiologically related to service. In support of this opinion, the examiner noted no evidence that the current left knee condition was consistent with any reported in-service injury. In this regard, the examiner noted that although the Veteran reported a bayonet injury resulting in a left knee contusion, no records documented any such injury. However, even considering the assertion of an in-service left knee contusion, the examiner noted that contusions to joint were self-limited and would not leave any lasting long term complications. This was found evident by a lack of in-service evidence of substantial damage such as a ligament or meniscus tear, or even years of wear and tear from joint pressure or trauma as he had been in service for only 6 weeks. This finding was further found evident in consideration that the Veteran was examined repeatedly in the 1 to 2 years after service with no objective clinical findings or actual pathology. Repeated X-rays over the past 20 years were also noted as normal. Instead, the examiner did note that he had sustained subsequent post-service trauma to his left leg including a 2,000 pound trailer rolling over him resulting in a tibial/fibula fracture. After a review of the evidence of record, the Board finds that entitlement to service connection for a left knee disability is not warranted. In this regard, the Board finds the July 2021 VA examination report the most probative evidence of record. The examiner considered the evidence, including lay statements as to in-service incurrence. However, based on this evidence, the examiner concluded that it was "less likely than not" that the currently diagnosed left knee osteoarthritis was etiologically related to service. The Board finds the examiner's rationale well supported by the record. Specifically, the examiner's conclusion that any in-service left knee injury was self-limited and would not have led to any long term complications. The Board finds this conclusion supported by the medical evidence of record which does not document any left knee condition shortly after his separation from service, including repeated X-ray studies noting a normal left knee. The Board has also considered the Veteran's lay statements, however, the Board notes that he has provided conflicting statements as to the nature of his left knee injury. For instance, during his November 1976 VA examination, he reported being discharged due to his left knee, and in his April 2013 claim, he asserted that he was discharged with a 10 percent left knee disability rating. Both statements are directly contradicted by the evidence of record. As noted by the September 1976 memorandum, the Veteran was separated from service based on a psychological evaluation. With regard to any left knee condition, the memorandum noted that the Veteran was medically cleared at the time of his separation from service. Moreover, the Veteran has never been in receipt of any VA disability related to his left knee. Accordingly, the Board finds him to be an unreliable historian and provides his lay statements little probative value. In any event, the July 2021 VA examiner did consider the lay statements, but still found that it was less likely than not that any reported service-related left knee injury was etiologically related to the current left knee osteoarthritis. The examiner has training, knowledge, and expertise on which she relied to form her opinion, and she provided a persuasive rationale. Importantly, there is no medical evidence to the contrary. (Continued on the next page) Thus, the Board finds that the third Shedden requirement has not been met. Although the Veteran is entitled to the benefit-of-the-doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for service connection for left knee disability. The claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lamb, 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.