Citation Nr: 21063747 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 14-32 815 DATE: October 15, 2021 ORDER Entitlement to service connection for a right knee disability, diagnosed as mild degenerative arthritis, is granted. Entitlement to service connection for a left knee disability, diagnosed as mild degenerative arthritis, is granted. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran's right knee disability was incurred in or caused by his active-duty service. 2. The evidence is in equipoise as to whether the Veteran's left knee disability was incurred in or caused by his active-duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for right knee disability, diagnosed as mild degenerative arthritis, 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 mild degenerative arthritis, 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 November 1965 to November 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. This case has a long procedural history. In April 2018, June 2020, January 2021, and July 2021, the Board remanded the claims for further evidentiary development to include VA examinations, etiological opinions, and addendum opinions. The requested development has been completed and the matters are again before the Board for additional appellate consideration. 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 connection for a right knee disability, diagnosed as mild degenerative arthritis 2. Entitlement to service connection for a left knee disability, diagnosed as mild degenerative arthritis In the interest of economy, the Board will discuss the issues of entitlement to service connection for a right and left knee disability together. In this post-remand case, the Veteran seeks service connection for bilateral knee disabilities. The Veteran contends his bilateral knee disabilities are the result of his active-duty service, specifically, they resulted from physical training in military boots, including road marches, and lifting heavy equipment. He maintains that he has experienced knee pain continuously since active duty. In support of his contentions, a buddy statement was provided by another service member that served alongside the Veteran. In the buddy statement, the Veteran attested to the fact that in the military occupational specialty, performance of their duties required significant physical exertion. First, the Veteran was afforded a VA examination in October 2019. The examiner opined that the Veteran's bilateral knee condition is less likely than not related to his military active-duty military service. The examiner noted the Veteran's bilateral knee pain began 2010. However, the examiner did not discuss the Veteran's contention that he has experienced knee pain since service, and it is not clear from the opinion and report of that examination whether the examiner considered the Veteran's contentions to that effect. As such, the Board concluded a remand was necessary in order to provide the Veteran with an additional VA examination and etiological opinion. Next, the Veteran appeared for an additional VA examination in September 2020. The examiner determined the Veteran had a bilateral knee strain. However, he stated that the Veteran's knee strain was less likely than not related to his active service because the record showed no complaints of, treatment for, or diagnosis of knee pain in service. Additionally, though noting that the Veteran reported experiencing knee pain in service, the examiner opined that the Veteran had not sought treatment for knee pain since his 1968 separation from service. However, the Board found this examination and opinion to be inadequate. Finally, the Veteran was afforded an additional VA examination in April 2021. The examiner noted diagnoses of bilateral knee strain and knee joint osteoarthritis. The Veteran reported that he began to experience knee pain while in Korea, however, he did not seek medical treatment at the time. He reported that he currently experienced knee pain and stiffness, which had worsened. After examination of the Veteran and review of the claims file, the examiner rendered a negative etiological opinion regarding the Veteran's right and left knees. The examiner opined that his osteoarthritis is consistent with expected age-related changes of the knee. The examiner noted that his STRs and claim's file are silent for complaints of knee pain or condition from dates of military service until 2019, when he was diagnosed with mild osteoarthritis. As such, the examiner concluded the Veteran's bilateral knee disability is less likely than not related to his military service. However, the Board found this examination and opinion to be inadequate. Per the Board's July 2021 remand directives, an addendum opinion regarding the nature and etiology of the Veteran's bilateral knee disabilities was to be obtained. An opinion was provided in September 2021. The examiner stated that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by his active-duty service. In the reviewing examiner's rationale, she first noted that there is no evaluation, treatment, or diagnosis of a bilateral knee disability in service. She states that symptoms are self-reported and subjective. Second, the examiner noted that October 2019 and April 2021 DBQs contained a diagnosis of bilateral knee strain and bilateral joint osteoarthritis. However, the examiner notes that the objective findings do not support this diagnosis because available medical records do not contain x-ray imaging confirming osteoarthritis of the knee. The examiner concluded there is a lack of sufficient objective evidence in the available medical records showing a link between the Veteran's current reported bilateral knee disabilities and his time in service. Despite the disagreement amongst examining physicians as to whether there is x-ray confirmation of the Veteran's bilateral knee mild degenerative arthritis, the Board finds no reason to dispute the October 2019 examiner's reference to x-ray support. The Board will therefore give the Veteran the benefit of the doubt and find sufficient basis to conclude that he currently had mild bilateral knee arthritis. Otherwise, all opinions obtained as to this claim have been found to be deficient is some material aspect, and are, therefore, of little, if any, probative value. Therefore, the Board finds the evidence to be in equipoise. As such, the Board will additionally afford the Veteran the benefit of the doubt as to whether his bilateral knee mild degenerative arthritis was caused by or related to his active-duty service. Furthermore, the Board notes that chronic diseases, such as arthritis, are capable of being linked to service by way of a credible showing of continuity of symptoms. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The Veteran has credibly reported the onset and continuation of his symptoms since service and there is no evidence to directly contradict his assertions. Accordingly, based on all of the foregoing, the Board finds a nexus to service has been established and that service connection for right and left knee mild degenerative arthritis is warranted. 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.