Citation Nr: 21065825 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 17-11 003 DATE: October 27, 2021 ORDER Service connection for a bilateral knee condition is granted. FINDING OF FACT The Veteran is reasonably shown to have experienced a bilateral knee condition since his separation from service. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral knee condition are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 2004 to November 2004 and from January 2008 to October 2008. In October 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection generally requires evidence satisfying three criteria: (1) the existence of a present 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. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Entitlement to service connection for a bilateral knee condition The Veteran contends he suffers from a bilateral knee condition that is related to his service. Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of bilateral knee strain as evidenced by the March 2016 VA examination report. See March 2016 VA examination. Additionally, private treatment records from 2013 and 2015 show an impression of osteoarthritis of the knees with some mild varus and some inflammation of the peroneal tendons with a 2016 assessment of primary osteoarthritis of both knees. See Medical Treatment Record and see Notice of Disagreement (Private Treatment Records). Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Service treatment records (STRs) show that in September 2008, on a Report of Medical Assessment for purposes of separation, the Veteran reported knee and back soreness from physical training/running which was managed by over-the-counter medications. The assessment documented the Veteran's report of bilateral knee pain which he said worsened and became persistent in March 2008 after performing runs for physical training. The left knee was indicated to be worse than the right knee. The Veteran's postservice treatment records show that in February 2013, the Veteran sought treatment for pain and stiffness in his bilateral knees. He reported at that time that he had been "rough on his in the past," and that he had been in the military and deployed to Afghanistan. In May 2016, the Veteran consulted with his orthopedic surgeon, Dr. G.K., about his military record and history of bilateral knee pain. Dr. G.K. noted that the Veteran had brought with him his records from January 2008 to September 2008, which he reviewed. After noting the Veteran's present complaints concerning bilateral knee pain, Dr. G.K. stated the Veteran's problems "[went] back to his deployment in Afghanistan" as he did not have any knee pain prior to that deployment. Dr. G.K. stated that following the Veteran's return from his deployment, he had significant bilateral knee pain, as documented in a post appointment medical evaluation that noted the Veteran was having trouble with both of his knees. Dr. G.K. also stated that the Veteran had had recurrent effusions and swelling in both knees since his return from deployment. In February 2020, the Veteran submitted a letter from his primary care physician, Dr. T.N, who noted that he had reviewed the Veteran's medical history, which included the circumstances and events of the Veteran's military history, including his deployment to Afghanistan from January 2008 to September 2008. Dr. T.N. stated he had been treating the Veteran since 2009 and that the Veteran had a diagnosis of osteoarthritis of both knees, with no other known risk factors which may have precipitated his current condition. Dr. T.N. then opined that after reviewing the pertinent records and statements, particularly the Veteran's pre and post deployment health assessments, and the May 2016 treatment record from his orthopedic surgeon, it was at least as likely as not that the Veteran's bilateral knee condition was a direct result of his military service. As rationale for that opinion, Dr. T.N. stated that in his personal experience and in medical literature it was known that excessive use and overloading of the joints could lead to osteoarthritis, particularly of the knees, hips and back. In October 2021, the Veteran testified at a hearing before the Board. He stated that after experiencing bilateral knee pain during his deployment in service, and as documented in his separation Report of Medical Assessment, he had continued to experience bilateral knee pain following service. The Veteran explained that while he did not seek treatment for his knees during his service, he self-managed the continuous symptoms until 2009, when he first sought treatment. He also stated it was not until 2014 when he learned he was able to file a claim with VA for his bilateral knee pain but maintained his knee problems started while he was deployed. Based on the foregoing information, the Board finds it is reasonably shown that the Veteran has continued to experience the same symptoms in his bilateral knees since his separation from service. The Veteran is competent to report that he has experienced bilateral knee pain continuously since service. The Board also finds these statements to be credible and entitled to probative weight, as they are internally consistent and consistent with other evidence of record. In this regard, the records show that at the time of his separation from service, the Veteran reported having bilateral knee pain that became persistent in March 2008. He also reported in 2013, prior to filing his claim with VA and while seeking treatment for the bilateral knees, that he had a history of having been rough on his knees due to his military service and deployment to Afghanistan. Although the evidence of record does not show that the Veteran has sought continuous treatment for bilateral knee pain, he testified in October 2021 that he self-managed his symptoms until 2009, when he first sought treatment. Moreover, the Veteran has submitted two private medical opinions from his treating physicians who relate his current bilateral knee problems to his military service; this includes from Dr. T.N. who has been treating the Veteran since 2009. In finding favorably for the Veteran, the Board acknowledges that also of record is a March 2016 VA examination report wherein the examiner opined the Veteran's bilateral knee osteoarthritis was less likely as not incurred in or caused by or a continuation of complaints of bilateral knee pain on separation from service in 2008. For rationale, the examiner highlighted the fact the Veteran was in service for one year, during which he had one complaint of knee pain on separation examination with no trauma or injury; and that the Veteran did not receive any treatment in service and had no chronic problems or documented continuity of care for the knees for the last 8 years. The examiner then noted that obesity accelerated the wear on the joints and spine; in particular, osteoarthritis (wear-and-tear arthritis) of the knees was increased. The examiner explained that biomechanically the force on one's knees between the patella (kneecap) and its articulation with the rest of the knee was about three times a person's body weight with walking. When adding that by other activities and the number of years people were overweight, that resulted in excessive wear and arthritis. The examiner thus concluded the Veteran's current diagnosis was most likely caused by genetic predisposition and obesity occurring after service and not the service complaint. See March 2016 VA examination and medical opinion. Despite the March 2016 VA examiner's medical opinion, the Board notes it does not address the fact that at the time the Veteran was reported to have persistent bilateral knee pain when separating from service, he also was noted to have lost 60 pounds during his deployment. The Board finds this relevant given the examiner's emphasis on obesity being a contributing factor to the Veteran's current bilateral knee condition. Moreover, the VA examiner does not address the Veteran's competent and credible reports of continuous pain following his separation from service. For these reasons, the Board does not find the March 2016 VA examiner's opinion to be probative. (Continued on the next page) In conclusion, the evidence clearly shows the Veteran experienced bilateral knee pain in service, which was documented at the time of his separation from service. He has also provided competent and credible reports of continuous bilateral knee pain since service, as well as probative medical opinions that are supportive of his claim. Such evidence supports a finding that the Veteran's current bilateral knee condition is related to his military service. Accordingly, the Board resolves all reasonable doubt in favor of the Veteran and finds that service connection for bilateral knee condition is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Churchwell, 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.