Citation Nr: 21062385 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 13-32 927 DATE: October 7, 2021 ORDER Service connection for a right knee disability is granted. FINDING OF FACT The Veteran began experiencing symptoms of a right knee disability during service, and he has continued to experience these symptoms since separating from service. CONCLUSION OF LAW The criteria for service connection for a right knee disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2003 to June 2006. This current matter was previously before the Board of Veterans Appeals (Board) in October 2018 and November 2019, when it was remanded for further development. In April 2020, the Veteran requested a hearing before a Veterans Law Judge (VLJ). In June 2021, he was notified that his hearing was scheduled for August 13, 2021 at the Denver Regional Office. However, he did not appear for the hearing and did not provide good cause for his absence or request that the hearing be rescheduled. Thus, his request for a Board hearing is considered withdrawn pursuant to 38 C.F.R. § 20.704(d). Service Connection Right Knee Disability 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(a). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, service connection can also be established through application of a statutory presumption for chronic diseases when manifested to a compensable degree within a year of separation from service. 38 C.F.R. §§ 3.307, 3.309. If a chronic disease is not manifested to a compensable degree within a year of separation of service, then, generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Furthermore, a layperson is competent to report on the onset and continuity of his or her current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). In the current appeal, the Veteran contends that his right knee disability is due to his active service. Alternatively, he contends that his right knee disability is secondary to his service-connected bilateral ankle strains. His service treatment records are silent for any complaints of, treatment for, or diagnoses of, a right knee disability. However, at his May 2006 separation examination, he reported that he had problems with both knees. Also, his private medical records show that he was diagnosed with a right patellar dislocation in 2009, and, at a May 2019 VA examination, he was diagnosed with patellofemoral syndrome of his right knee. In June 2015, the Veteran's wife submitted a lay statement in which she explained that she has been in a relationship with the Veteran since 2008 and that, throughout their entire relationship, he has complained of pain and discomfort in his right knee. She also stated that, since they have been in a relationship, she has witnessed his knee disability worsen over time. In May 2016, the Veteran provided an examination report from his private physical therapist. The report notes that the Veteran stated that his right knee pain began in 2003, approximately 2 months after he sprained his left ankle, but that he did not seek medical care at that time. The Veteran also reported that he had dislocated his right knee in 2009. Based on the examination and the Veteran's statements, the physical therapist concluded that the Veteran had likely developed patellofemoral pain syndrome. The physical therapist also stated that it is possible that the Veteran's pain is a result of repetitive stress rather than a direct insult or injury to the right knee joint. In May 2018, the Veteran provided a written statement wherein he reported that he first began experiencing right knee pain in service. He explained that he frequently had to ice his knees after performing training exercises and often experienced right knee pain after performing airborne jumps in full battle gear. He also reported that, after he sprained his left ankle, he began compensating with his right leg and soon after began experiencing right knee pain so severe that he could not run. Further, the Veteran also explained that he did not seek any medical treatment for these ailments during service because he believed that there were stigmas within his unit that members who used sick call were lazy or weak. During the course of this appeal, the Veteran has been afforded VA examinations in January 2012, August 2017, and May 2019. However, for reasons discussed in the previous Board decisions, the Board found these examinations to be inadequate. Therefore, they will not be discussed at length in this decision. In January 2020, a VA addendum opinion was obtained. The examiner confirmed the Veteran's diagnosis of right patellofemoral syndrome and noted that the 2009 right knee dislocation had resolved and had not reoccurred. The examiner found that it is less likely than not that the Veteran's right knee disability is related to his service. The examiner explained that there is no evidence in the Veteran's service treatment records that he had a right knee condition during serviceand no evidence that his right knee dislocation occurred until 3 years after he separated from service. While the Board cannot ignore or disregard the VA examiner's medical conclusions, the Board is free to assess medical evidence and is not compelled to accept a medical opinion. Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992). While the examiner noted that the Veteran reported he had "bad knees" at his separation examination, the examiner failed to address the Veteran's competent lay statements regarding the onset of his right knee symptoms. The Veteran has consistently stated that he began experiencing right knee pain in service. As noted above, as a lay person, the Veteran is competent to give evidence about observable symptoms such as pain and onset of symptoms. Layno, 6 Vet. App. at 465. As such, the Board finds his competent lay testimony to be credible. Based on the above, the Board finds that the Veteran began experiencing symptoms of a right knee disability during service and that he has continued to experience these symptoms since separating from service Accordingly, service connection for the Veteran's right knee disability on a direct basis is warranted. In reaching this decision, the Board notes that it need not reach a decision on the issue of entitlement to service connection for a right knee disability on a secondary basis (due to the service-connected bilateral ankle disability). Direct service connection is the greater benefit, as compared to service connection on a secondary basis. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Benson, 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.