Citation Nr: 21066594 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 18-39 730 DATE: November 1, 2021 ORDER Entitlement to service connection for left knee disability is denied. Entitlement to service connection for left index finger disability is denied. Entitlement to service connection for tinnitus is denied. FINDINGS OF FACT 1. The Veteran's left knee tendonitis has not been linked by competent evidence to an in-service disease or injury. 2. A left index finger disability has not been linked by competent evidence to an in-service disease or injury. 3. The Veteran's tinnitus did not manifest during service and no probative evidence links it to service. CONCLUSIONS OF LAW 1. The criteria for service connection for left knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left index finger disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1981 to July 1984, with additional service in the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Entitlement to service connection for left knee condition The Board concludes that, while the Veteran has a current diagnosis of left knee tendonitis, and evidence shows that he sought treatment in service for knee pain, the preponderance of the evidence weighs against finding that the Veteran's left knee tendonitis began during service or is otherwise related to an in-service injury or disease. The Veteran's service treatment records indicate that he sought care while in service for left knee soreness in April 1984. VA treatment records indicate that the Veteran received x-rays in May 2015 for his left knee. No degenerative or traumatic arthritis was noted. These records also reflect the Veteran first presented for treatment in May 2014, at which time he did not complain of knee pain, although he mentioned back pain, among other symptoms. The Veteran was afforded a VA examination in September 2015. The VA examiner opined that the Veteran's left knee tendonitis was not at least as likely as not related to an in-service injury or disease. The rationale was that while the Veteran sought care in 1984 while in service, he had not had knee problems until the last 10 years, per the Veteran's history. Further, his VA treatment records first indicated knee pain in May 2015, while previous VA visits did not note that the Veteran had knee pain. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his left knee condition is related to an in-service injury. While the Veteran testified that his left knee symptoms, including pain with weightbearing, have continued since active service, the Veteran in this case is not competent to provide a nexus opinion regarding this issue, or to establish that any post service complaints are associated with the complaint noted in service. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Further, the September 2015 VA examination report indicated that the Veteran did not report knee pain until 2015, which corresponds with the treatment records, and casts doubt on the accuracy of the Veteran's statements suggesting ongoing knee problems since service. Consequently, as the most probative evidence, the September 2015 VA examiner's opinion, is against the claim, a basis upon which to establish service connection has not been presented. Accordingly, the appeal is denied. 2. Entitlement to service connection for left index finger condition The Board concludes that, while the Veteran has a current diagnosis of left finger contusion, and evidence shows that the Veteran injured his left index finger during service, the preponderance of the evidence weighs against finding that a left index finger disability began during service or is otherwise related to an in-service injury or disease. The Veteran's service treatment records note that the Veteran sought care in May 1983 for his left index finger following an incident where his index finger was slammed in a trailer hitch. His post service treatment records do not reflect any finger complaints. The Veteran was afforded a VA examination in June 2018. The VA examiner opined that the Veteran did not have a left index finger disability that was at least as likely as not related to an in-service injury, including the Veteran's finger being slammed in a trailer hitch during service. This was because it was not medically possible to link any current complaints to the in-service injury, when the record is silent for any medical follow-up, as was the case here. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his left index finger condition is related to an in-service injury. While the Veteran is competent to report symptoms of pain and difficulty bending his index finger, the Veteran in this case is not competent to provide a nexus opinion regarding this issue or to establish that any post service complaints are associated with any complaints in service. The issue is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. See Jandreau, 492 F.3d at 1372, 1377; see also Kahana, 24. Vet. App. at 433-34. Consequently, the Board gives more probative weight to the June 2018 VA medical opinion. Here, the most probative evidence addressing whether there is a left index finger disability related to service is contained in the VA examination report. That medical opinion is against the claim. Accordingly, entitlement to service connection for a left index finger disability is denied. 3. Entitlement to service connection for tinnitus Certain chronic diseases, including tinnitus, an organic disease of the nervous system, are presumed to have been incurred in service if manifested to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309; see also Fountain v. McDonald, 27 Vet. App. 258 (2015). The question for the Board is whether the Veteran's tinnitus began during service or is at least as likely as not related to an in-service injury or disease. The Board concludes that, while the Veteran testified that he has tinnitus, and evidence shows that his military occupational specialty (MOS) was combat engineer, the preponderance of the evidence weighs against finding that the Veteran's tinnitus began during service or is otherwise related to an in-service injury or disease. The Veteran was afforded a VA examination in August 2015. The Veteran reported that he had recurrent right ear tinnitus and noted that it had its onset over the past 15 to 20 years. Due to the Veteran's unreliable responses to testing, the VA examiner stated that he was unable to offer an opinion regarding the Veteran's tinnitus. The Veteran was afforded another VA examination in June 2018. The Veteran reported that he first noted tinnitus around 25 to 30 years ago. Again, the examiner stated he could not provide a medical opinion regarding the etiology of the Veteran's tinnitus complaints without resorting to speculation, because the Veteran's responses to testing were unreliable. The Veteran testified at the Board hearing that his tinnitus began during his MOS training and that it became more recurrent as time went on. The Veteran's service records do not reflect any complaints of tinnitus. The August 2015 VA examination noted that the Veteran reported the onset of tinnitus 15 to 20 years ago, while the VA examination in June 2018 indicated that the Veteran's tinnitus onset 25 to 30 years ago. Notably, this would all be after service. Although the Veteran now contends that his tinnitus began during active service, the Board finds that statement lacks credibility, as it is inconsistent with other statements he made to VA providers. While the Veteran believes that his tinnitus is related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1372, 1377; see also Kahana, 24. Vet. App. at 433-34. Accordingly, the Veteran's opinion as to the etiology of his hearing loss and tinnitus is not competent medical evidence. In summary, tinnitus was not shown until after service, and no probative evidence links it to service. Accordingly, the appeal must be denied. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Geer, 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.