Citation Nr: 21064848 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 16-07 608 DATE: October 21, 2021 ORDER Entitlement to service connection for a right knee disability, diagnosed as osteoarthritis, is granted. FINDING OF FACT The evidence is in equipoise as to whether the Veteran's current right knee disability was incurred in or caused by his active-duty service. CONCLUSION OF LAW The criteria for service connection for a right knee disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1983 to March 1984 and January 1991 to April 1991. These matters come before the Board of Veterans' Appeals (the Board) on appeal from a June 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in September 2018. Remand directives included instructions to obtain all private (non-VA) medical treatment records and obtain an etiological opinion regarding the nature and etiology of the Veteran's right knee disability. Entitlement to service connection for a right knee disability. In this post-remand case, the Veteran seeks service connection for a right knee disability, currently diagnosed as knee joint osteoarthritis. 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). To begin, the Veteran was afforded a Gulf War examination in September 2011. An x-ray revealed mild degenerative changes in the right knee. Another VA examination was provided in December 2015. The examiner diagnosed the Veteran with right knee joint osteoarthritis. Therefore, the Board finds adequate evidence of a current disability for purposes of service connection. As it pertains to an in-service event or injury, the Veteran contends he injured his right knee during active-duty service in 1991 when he was running to his bunker and felt his knee pop. The Veteran's service treatment records (STRs) contain multiple complaints and evidence of conservative treatment while in service. In February 1984, the Veteran was seen for right knee discomfort and was diagnosed with a right knee strain. A July 1984 treatment record further discusses the Veteran's original right knee injury. The record notes that he originally injured in right knee in February 1984 while doing jumping jacks. When reportedly landed and heard a pop. Since that incident, the note indicates he has had issues with it "giving way" frequently. In May 1991, the Veteran complained of right knee pain while he was doing jumping jacks and re-injured his knee after jumping in a bunker in Saudi Arabia. The Veteran then did followed-up in April 1991 regarding his right knee injury. Later, in a January 1997 medical examination, it was reported that in 1984, the Veteran suffered a right knee injury, and it was noted that he "sometimes gets pain and hears 'popping.'" Given the numerous complaints of right knee pain in service, the Board finds the second element necessary for service connection has been met. With regard to the final element, a nexus, the Board finds the evidence to be in equipoise as to whether the Veteran's right knee disability was incurred in or caused by his active-duty service. First, a September 2011 examiner opined that the normal right knee examination is less likely than not related to an in-service event or injury from Gulf Way service. Second, the December 2015 examiner opined that the Veteran's right knee condition, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury, or illness. The examiner noted that the Veteran injured his right knee in February 1984 while doing jumping jacks, with a "probably" meniscus tear, and also had a strained knee from shoveling snow. The Veteran then reinjured his knee in 1991. The examiner stated that the 1991 x-ray was negative and that there is no documentation after 1991 to show that there was an ongoing chronic knee condition. Therefore, he would be resorting to mere speculation to state that the current knee diagnosis is related to or aggravated by an event in 1991. The Board finds these opinions to be of little probative value and inadequate. A final VA opinion was then obtained following the Board's September 2018 remand. 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. The examiner first acknowledged the Veteran's in-service right knee complaints but provided the rationale that his osteoarthritis is explained by age and the gradual mechanical stress received by the knee over time. The examiner notes that this is "incompatible" with the diagnoses provided to the Veteran while in service. As such, the examiner concluded that the Veteran's current right knee disability is less likely than not incurred in or otherwise related to his active-duty service. The Board also finds this opinion to be of low probative value. The Veteran's in-service right knee complaints continued from his original injury in February 1984 until a January 1997 medical examination. A February 2016 lay statement from the Veteran details his ongoing conservative treatment for his knee. He writes that his knee pain requires him to take over the counter medications and he is unable to receive any relief. He notes that he wears braces on a daily basis and experiences swelling, stiffness, and discomfort. Therefore, the Board finds the evidence to be in equipoise and will afford the Veteran the benefit of the doubt as to whether his right knee disability, diagnosed as osteoarthritis, was caused by or related to his active-duty service. Given his current disability of right knee osteoarthritis, the lengthy history of the Veteran's right knee complaints in service from February 1984 to January 1997, and ongoing treatment for his right knee, the Board finds service connection to be warranted. 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 knee 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.