Citation Nr: 21064430 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 18-01 233 DATE: October 20, 2021 ORDER Entitlement to service connection for a right knee disorder is denied. FINDING OF FACT A right knee disorder was not incurred in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a right knee disorder are not met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1984 until April 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In June 2020, the Veteran testified in a hearing before the Board. A transcript of the hearing is included in the electronic claims file and has been reviewed. In May 2021, the Board remanded the claim on appeal for additional development. The case is again before the Board for appellate review. Service Connection The Veteran claims that he incurred a right knee disorder during service. Relevant legal authority Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a disability, a Veteran 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 or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic disorders such as arthritis are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307 (a), 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303 (b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those disabilities specified as chronic under 38 C.F.R. § 3.309 (a)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Evidence and analysis The Veteran asserts that he injured his knee during active duty and developed a chronic knee disorder as a result. The evidence addressing this claim consists of the Veteran's lay assertions, service treatment records (STRs), VA treatment records, private medical opinions received in February and October 2017, and March 2017 and July 2021 VA compensation examination reports and opinions. This evidence documents that the Veteran has a right knee disorder. The July 2021 VA report notes residuals of a right meniscus injury. The evidence also documents that the Veteran complained of knee pain during service, as shown by STRs dated in December 1986 and April 1987. The December 1986 STR indicates an injury while playing basketball, while the April 1987 STR indicates continuing pain since the injury and a "knot" just below the knee. However, a preponderance of the evidence indicates that the in-service injury and complaints are not related to the current disorder. The STRs dated after April 1987 are negative for a right knee problem. The record contains no medical evidence addressing a knee problem in the years after service. The earliest evidence of record addressing a knee problem is found in private medical evidence indicating that the Veteran sought medical care for right knee pain due to meniscus injury in the 2000s, over 20 years following discharge from service. Thus, the medical evidence indicates that from 1988 until the 2000s the Veteran did not have a chronic right knee disorder at the end of service or for many years following service. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012). The evidence indicates that, for at least 20 years following service, the Veteran did not have the characteristic manifestations sufficient to identify a chronic disease entity involving the right knee. See 38 C.F.R. §§ 3.303, 3.307, 3.309. Moreover, the probative medical evidence addressing the claim indicates that a right knee disorder is not related to service. The July 2021 VA examiner found it less than likely that service related to the knee disorder. The examiner stated that she considered the Veteran's assertions of experiencing pain since service but indicated that the most likely source of the current disorder was the right knee meniscus injury in the late 2000s, over 20 years after service discharge. The Board finds the opinion probative because it is explained with citation to facts in the record, is based on a review of the claims file, and is based on an examination and interview of the Veteran. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). The Board finds the other opinions less persuasive. As indicated in the Board's May 2021 remand, the March 2017 VA opinion written by the author of the July 2021 VA report was incomplete and will not be relied on here. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The February and October 2017 private opinion are not persuasive either. In them, the Veteran's physician connects the complaints of pain during service to current knee pain, without addressing what disorder the Veteran now has, and without addressing evidence the physician cited elsewhere, that the Veteran injured his meniscus in 2008. Further, the physician did not address the fact that the record is silent regarding a right knee problem for over 20 years after service. See Horn, supra. As such, these opinions are of limited probative value. See Bloom, supra. In assessing the claim, the Board has considered the lay statements of record. Lay statements may be probative because laypersons are competent to describe observable symptomatology such as knee pain and limitation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, lay persons are not competent to determine matters such as diagnosis and etiology. The question of whether the Veteran incurred a right knee disorder during service is a complex medical issue involving internal pathologies. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). For this reason, the weight of the July 2021 VA opinion preponderates against the lay evidence here. Indeed, the VA opinion is more credible with regard to the question of whether the right knee problem is service related. See Smith v. Derwinski, 1 Vet. App. 235 (1991) (credibility is determined by the fact finder). Based on the foregoing evidence, the Board finds that the evidence of record preponderates against the claim of entitlement to service connection for a right knee disorder. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.