Citation Nr: 21065317 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 13-27 529 DATE: October 25, 2021 ORDER Service connection for a left knee disorder is denied. FINDING OF FACT A left knee disorder was not incurred in service, is not etiologically related to service, and is not secondary to service-connected disability. CONCLUSION OF LAW The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1112; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 1967 to November 1969. A videoconference hearing before the undersigned Veterans Law Judge was held in August 2016. The hearing transcript has been associated with the record. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests arthritis to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. 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, as opposed to merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service (or during any applicable presumptive period) is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The term "chronic disease" refers to those diseases, such as arthritis, listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101(3); 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310(b). The Veteran contends that he has a current left knee disorder due to in-service left knee injury. He has reported injuring the left knee after jumping approximately 15 feet from a helicopter while in Vietnam. In support of this contention, he has submitted lay statements reporting that the Veteran injured his knee in August 1967 to June 1968 while in Vietnam. The statements do not identify which knee was reportedly injured. Service treatment records reveal no abnormal findings or complaints for the left knee, and the October 1969 separation examination reveals normal clinical findings and negative history of "trick' or locked knee" or other history potentially indicative of a chronic left knee disorder. The records do include a May 1968 treatment record for a right knee injury in Vietnam. A March 2000 VA treatment record reveals the Veteran's history of twisting the right knee several days earlier. The diagnosis was strain right knee. An October 2000 VA "initial visit" record reveals the Veteran's history of "occasional knee, hand, and foot discomfort (old service-connected injury)." The Veteran reported joint pain and swelling and indicated that he had not seen a doctor "in years." The Veteran was diagnosed with osteoarthritis. The record indicates that the right foot was the old service connected injury. Another October 2000 VA treatment record from the same date reveals history of right knee sprain. A February 2002 VA treatment record reveals history of "occasional knee, hand and foot discomfort (old service connected injury)." A January 2010 VA treatment record reveals the Veteran's history of left knee pain, especially when driving far. He also reported stiffness. The record reveals diagnosis of arthralgia of the left knee probably secondary to degenerative joint disease. January 2010 X-ray imaging was interpreted as showing possible old trauma to the patella. An August 2011 VA examination record notes that the Veteran reported left knee pain when driving long distance in 2011 and that the service medical evidence was silent for the left knee. The examiner reported the opinion that it was less likely than not that a left knee disorder was incurred in or caused by service because there was no medical data to support left knee injury during service. Another August 2011 VA examination record, prepared by the same examiner, reveals a diagnosis of "left patella deformity (mild) on x-ray" and left patella spurring. The record reveals the Veteran's history of injuring his left knee in Vietnam in 1967 when he jumped out of a helicopter. The examiner noted that previous X-ray imaging was interpreted to show "possible old trauma to the patella." The examiner reported that no opinion could be offered as to whether the reported left knee injury led to the current left knee condition without resort to mere speculation because there was no documentation showing a left knee injury during service. An October 2016 VA treatment record reveals the Veteran's history of injuring the left knee in service when he jumped out of a helicopter from 15 to 20 feet and landed on rocks. He reported that he was provided an ace bandage but never saw a doctor. He reported that the knee had swollen every two to three years since that injury. A December 2017 VA examination record reveals the Veteran's history of injuring the left knee after jumping off a helicopter in Vietnam, for which he was provided an ace bandage. He reported that the left knee swells and stiffens and has had to be drained two to three times. He reported that he was treated in Ohio or Florida in the 1980s or 1990s and once in Alaska in 1970 to 1971 for the knee. The examiner diagnosed arthritis and minimal lateral subluxation of the patella. The examiner determined it was less likely than not that the left knee disorder was incurred in or related to service. The examiner explained that the service treatment records showed no complaints, treatment or diagnosis of a left knee/leg condition or limitation of flexion of left knee and that the separation examination record revealed normal clinical findings, history of "excellent" health, and negative history for a knee/leg condition. The examiner found the current lay statements were not supported by the service records and were contradicted by the Veteran's histories on the separation examination, noting that the reported dates of injury differ. The examiner added that although the Veteran testified that he landed on rocks and "messed" his leg/knee up, there was no objective evidence of scars from falling on rocks either on his left knee or left leg. The examiner reported that there was no medical record from the time immediately post service to establish any chronicity of the claimed left knee condition; the earliest record of treatment for any knee dated in March 2000, when the Veteran reported right knee problem, and the earliest for the left knee dated in January 2010, 40 years after service. The examiner noted that the January 2010 X-ray imaging showed possible old trauma to the patella but explained that October 2016 X-ray imaging failed to duplicate the findings; the examiner reported that there was not corroborated evidence of possible old trauma to the patella and that the subsequent X-ray imaging showed the 2010 X-ray was overread and there was no trauma. The examiner added that the 2016 X-ray imaging showed minimal subluxation of the patella and some degenerative osteoarthritis with no objective evidence of any disability pattern from military service. An October 2020 VA medical opinion reveals the determination that the left knee disorder was less likely than not caused or aggravated by service-connected disability. The medical professional was asked to address whether service-connected disability resulted in obesity that caused or aggravated the left knee disorder. The medical professional reported that diabetes mellitus and psychiatric disability do not cause obesity. The medical professional explained that obesity is a common problem in the general population. A March 2021 VA medical opinion reveals the determination that the Veteran's posttraumatic stress disorder was less likely than not the cause of or contributor to the Veteran's obesity. The physician explained that obesity is caused by taking in more calories than needed and that posttraumatic stress disorder is not an eating disorder and the physician found no evidence of an eating disorder related to posttraumatic stress disorder. An August 2021 VA medical opinion reveals the determination that the left knee disability was less likely than not etiologically related to the reported in-service knee injury. Initially, the medical professional, a nurse practitioner, reported that the service records showed no documented complaint, treatment, or diagnosis of a left knee condition and that the separation physician reported a history of excellent health and no knee/leg condition and normal clinical findings. The medical professional reported consideration of the histories of injury associated with a helicopter, including by landing on rocks. The medical professional noted that there was no objective evidence of scars from falling on rocks. The medical professional stated that if there was injury to the left knee during service, the left knee more than likely would have been worse than it was after 40 years and that more than likely the knee condition was due to wear and tear from age and post-service occupation. After review of the record, the Board finds service connection is not warranted for a left knee disability. Initially, the Board finds the record indicates that a current left knee disorder was not incurred in service or within a year of separation. Service records reveal no finding or history indicative of a chronic left knee disorder, the initial diagnosis postdates service by many years, and VA medical professionals have determined the current left knee disorder was not incurred in service. Additionally, the Veteran has not reported chronic knee symptoms since service. The Veteran initially reported "off and on" symptoms since the reported injury and at the August 2016 hearing, the Veteran reported that he started having problems with the knee approximately two years after separation. To the extent the Veteran's histories can be interpreted as a history of continuous symptoms, the Board finds any such history is not probative because it is contradicted by the negative history at separation, and the initial histories of intermittent symptoms after service until approximately 2010. Regarding the history of intermittent symptoms of the left knee, the Veteran is not competent to attribute intermittent symptoms to a chronic disability as opposed to distinct episodes or even multiple episodes of acute disorder. Although the Veteran believes an etiological link exists, particularly between the current left knee disorder and service, the Veteran is not shown to be competent to determine the etiology of his current disorder. Furthermore, the Board finds the left knee disorder is not etiologically related to service and is not secondary to a service-connected disability, including due to obesity secondary to a service-connected disability. The record includes multiple opinions that there is no nexus between the current left knee disorder and service or between a service-connected disability and the left knee disability, including as secondary to obesity. Notably, the record is absent medical findings that the Veteran's obesity is secondary to any service-connected disability, and the Board finds the article cited in the 2020 brief is not sufficiently probative because it is not specific to the facts and circumstances of the Veteran's case and the article does not report a definitive conclusion but reports that further research is needed. Furthermore, the record does not indicate that the left knee disorder is secondary to obesity; rather, it has been linked to aging and post-service occupation. The Board finds the VA opinions are probative because they are based on explanations that are consistent with the record. The opinions have considered the reported in-service injury and the January 2010 radiographic finding of "possible" old trauma and determined the current left knee disorder is most consistent with aging and post-service occupation than the reported injury. The Board finds no evidence of "prejudice" as contended in the September 2021 brief and notes that the August 2021 medical professional's findings can be interpreted as findings as to the significance of the in-service fall, given that there was no evidence of scarring, rather than the existence of an in-service fall. The Board finds the medical professional did not fail to consider an in-service fall, as instructed by the Board. There is no medical evidence linking the left knee disorder to service or service-connected disability. Although the Veteran believes his left knee disorder is related to an in-service fall, the Board notes that the Veteran is not competent to make such an etiologically determination. Thus, the claim is denied. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Snyder, 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.