Citation Nr: 21063718 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 14-06 916 DATE: October 15, 2021 ORDER Entitlement to service connection for a bilateral knee disability, diagnosed as degenerative arthritis, is granted. Entitlement to service connection for a right wrist disability, diagnosed as degenerative arthritis, is granted. FINDINGS OF FACT 1. The Veteran's current bilateral knee degenerative arthritis is related to his active duty. 2. The Veteran's current right wrist degenerative arthritis is related to his active duty. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral knee disability, diagnosed as degenerative arthritis, are met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for a right wrist disability, diagnosed as degenerative arthritis, are met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from October 1961 to December 1962 and from August 1969 to January 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran testified before the undersigned Veterans Law Judge. The Board remanded the appeal for further development in June 2015. In May 2018, the Board requested a Veterans Health Administration (VHA) expert medical opinion; therefore, the Board remanded the appeal for further development in December 2018. Most recently in April 2021, the Board again remanded the appeal. Service Connection 1. Entitlement to service connection for a bilateral knee disability, diagnosed as degenerative arthritis, is granted. 2. Entitlement to service connection for a right wrist disability, diagnosed as degenerative arthritis, is granted. The Veteran asserts that his bilateral knee and right wrist disabilities stem from repetitive injuries due to falling while working in a slippery kitchen during service. He maintains that the numerous falls caused injuries to his knees and to his right wrist when trying to brace himself from falling and that he has experienced symptomatology since that time. See February 2015 Board Hearing Transcript at 3-6. He also maintains that his bilateral knee and right wrist disabilities are secondary to his service-connected back disability. Id at 22. As the discussion below is favorable regarding direct service connection for both disabilities, no other theory of entitlement will be discussed further. Service connection may be granted for a disability resulting from disease or injury incurred in active service and for in-service aggravation of a preexisting injury or disease. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected; if a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is listed as a chronic disease under 3.309(a). Here, the Veteran has current diagnoses of bilateral knee degenerative arthritis and right wrist degenerative arthritis. See July 2012 (right wrist), October 2015 (bilateral knees and right wrist), September 2019 (bilateral knees and right wrist), and December 2020 (bilateral knees and right wrist) VA examination reports. Thus, element one is met for both disabilities. Regarding the second element of service connection, while the Veteran's service treatment records are silent for complaints, diagnoses, or treatment of any bilateral knee or right wrist disabilities, the Board finds that his reported in-service injuries are consistent with the circumstances of his service while working in the kitchen as part of his military occupational specialty (MOS) as a cook in food service (see 38 U.S.C. § 1154(a); DD Form 214), and that his reports are competent and credible. Thus, the Board concedes in-service injuries to his knees and to his right wrist when trying to brace himself from falling, and the second element is also met for both disabilities. Regarding the third element, nexus, the Board notes the favorable medical literature submitted by the Veteran's representative, which notes that posttraumatic arthritis can develop many years after the initial injury and that symptoms can also appear many years later. See August 2021 Appellate Brief. The Board also acknowledges the VA examinations conducted in July 2012, October 2015, September 2019, and December 2020, the VHA opinion rendered in June 2018 and the addendum opinion rendered in May 2021. However, the Board finds these examinations and opinions inadequate as the July 2012 examiner failed to render a direct opinion on either disability; the October 2015 VA examiner rendered positive direct opinions based on an inaccurate factual premise of injuries in 1963 when the Veteran was not on active duty; the June 2018 VHA expert and September 2019 and December 2020 VA examiners relied on the absence of evidence of either disability in the service treatment records and do not account for competent lay testimony as to onset and continuity of symptoms nor the possibility of delayed development of arthritis years after service as discussed in the medical literature submitted by the Veteran's representative; and the May 2021 VA examiner conceded in-service bilateral knee and right wrist injuries but relied on lapse of time between his right bilateral knee and right wrist complaints/diagnosis post-service and did not discuss whether it is medically plausible for his current bilateral knee and right wrist degenerative arthritis to stem from these in-service injuries, as specifically requested by the Board in his most recent remand. And finally, the Board notes the Veteran has competently and credibly reported that he experienced bilateral knee and right wrist symptomology during and since service due to his in-service injuries and also recalls that his conditions have progressed since discharge. See February 2015 Board Hearing Transcript. See also 38 U.S.C. §§ 1101(3), 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). At this point, a request for another opinion could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews v. McDonough, 34 Vet. App. 151 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim.") Here, given the Veteran's competent and credible lay statements as to continuity of bilateral knee and right wrist symptomatology since service and the favorable medical literature submitted by the Veteran's representative, along with five unfavorable inadequate VA nexus statements, the evidence is at least in a state of relative equipoise. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for bilateral knee and right wrist degenerative arthritis based on continuity of symptomatology is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.