Citation Nr: 21067828 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 20-11 431 DATE: November 5, 2021 ORDER Service connection for a left knee disability is denied. FINDING OF FACT The Veteran's current left knee condition is not related to service. CONCLUSION OF LAW The criteria for service connection for a left knee condition are not 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 1960 to November 1964. The case is on appeal from a December 2018 rating decision. In April 2021, the Veteran testified at a Board hearing. In an April 2021 decision, the Board remanded the case for further development. While the case was in remand status, in an August 2021 rating decision, the RO granted service connection for right knee degenerative joint disease. As the benefits sought has been granted in full, the issue is no longer on appeal. As such, the only issue that remains on appeal is the claim of service connection for a left knee disability. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection for a left knee disability. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1101, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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 service." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis The Veteran seeks service connection for a left knee disability. He asserts that during training at Camp Pendleton, he got caught up in concertina wire for which he was treated right away. The Veteran asserts that his current left knee disability stems from that in-service injury/event. See April 2021 Board hearing transcript. Initially, the Board notes that the Veteran has a current diagnosis of degenerative joint disease of the left knee with status post left knee replacement. As such, the current disability element of the claim is established. Service treatment records (STRs) reflect that the Veteran did not report, and the examiner did not find, any left knee problems at his entrance medical examination. See September 1960 Entrance Examination Report. In April 1964, the Veteran complained and received treatment for left knee pain. Progress notes indicate that his left knee was wrapped in ace bandage. STRs do not show any additional complaints or treatment received for a left knee symptom. In May 1964, the Veteran was seen for pain, but on his right knee, after playing football. His injury was assessed as right knee synovitis and the Veteran was placed in crutches for 4 days, wore a long leg cast for 2 weeks, and was placed on light duty. The assessment does not mention a left knee disability or pain. A November 1964 separation examination does not contain reports or complaints of left knee problems or pain besides a small anterior scar. Notwithstanding, given the April 1964 progress note showing treatment received for complaints of left knee pain, the Board finds that the in-service element of the claim has been also established. As to the nexus element, during a February 2020 VA Decision Review Officer (DRO) hearing, the Veteran testified that after his in-service left knee injury, he continued to experience pain but self-treated it with over the counter (OTC) medication and that his pain has continued ever since separation. He also indicated that although he had a post-service injury, his left knee problems predated such injury. During the April 2021 Board hearing, the Veteran testified that he has been told by his physical therapist that the etiology of his left knee disability is most likely related to his in-service injury and that his right knee disability might be as well secondary to his left knee disability for overcompensating for the opposite knee. The Veteran was afforded a VA examination in connection with his claim in December 2018. The VA examination report contains a diagnosis of degenerative arthritis of the knees bilaterally, and left knee cerclage over left patella and patella osteophyte deformity, and status post remote surgical repair of patella fracture which was performed in the 1960's (i.e., 1969). The report reflects that per the Veteran's STRs, a left knee anterior scar was noted along with a history of traumatic synovitis of the right knee in 1964. While the Veteran noted that his bilateral knee pain and discomfort began right after leaving the military around 1964-1965, he also indicated that he underwent a left knee surgery in 1969 as a result of a motor vehicle accident (MVA). The examiner noted that it is since the 1969 MVA that the Veteran has complained of limited motion for the left knee. In sum, the examiner noted that the only left knee residual noted on the separation exam was a scar and that the Veteran's current left knee symptoms are most likely due to the osteoarthritis in the knee joint. In its April 2021 remand, the Board found the December 2018 VA opinion not wholly sufficient as it appeared that the examiner failed to consider the Veteran's lay statements with respect to his self-treatment with OTC following separation from service. The Board remanded the claim for a new VA examination and opinion from an orthopedic specialist to clarify that aspect of the claim. Pursuant to the Board's April 2021 remand, the Veteran was afforded a new VA examination in August 2021. The Veteran reported he initially injured his right knee while training at Camp Pendleton. The physician noted that STRs confirm the Veteran was diagnosed with traumatic synovitis of the right knee for which he received treatment and was placed on light duty. The physician also noted that, while a May 1964 progress note indicates that the Veteran was treated with a long leg cast for his left knee, STRs do not document a diagnosis of a left knee condition, to include his November 1964 separation medical examination which is silent for any history of significant injury or complaint of a left knee condition. In this regard, the VA examiner also indicated that the Veteran denied, or does not recall having a long leg cast placed on his left knee during service. The examiner further stated that while the Veteran reported that upon discharge, he recalls some bothering and discomfort in his knees bilaterally, review of the history provided by the Veteran himself confirms that the traumatic in-service injury occurred to the right, and not the left knee. Moreover, the examiner pointed out that in 1969 the Veteran was involved in an MVA. While seating on a bus stop, a car lost control and jumped the curved impacting him and shattering his left kneecap for which the Veteran underwent left knee surgery. The VA physician opined that such traumatic injury would cause significant biomechanical dysfunction of the left knee post operatively and would account for the current significant degenerative joint disease of the left knee that most recently required a total left knee replacement. In sum, the VA examiner concluded that the claimed left knee disability was less likely than not incurred in or caused by the claimed in-service injury or event. The Board has considered the entire medical and lay evidence of record, including the December 2018 and August 2021 VA examinations and opinions as to the nexus element of the claim and finds that the Veteran's current left knee disability did not have its onset during service and is not otherwise related to service. In reaching this conclusion, the Board has considered that the November 2018 VA examination report seemed to have not considered the Veteran's lay assertions as to his symptoms following service. However, the August 2021 VA opinion, supported by comprehensive rationale based on the Veteran's medical history, his lay statements and recollection of events, and review of the entire medical records and by applying valid medical analysis, rectifies the noted flaw and when considered along with the findings of the August 2021 VA opinion, the Board accords them great probative weight as to the nexus element of the claim. The examiner discussed the Veteran's contention and determined that his current left knee disability is not related to his military service. The examiner's opinion that the Veteran's current left knee disability is not related to his military service is well supported by the Veteran's own statements during his most recent VA examination indicating that he does not recall having a long leg cast in his left knee during service and that it was his right knee and not the left one which got caught and twisted in concertina wire during training. This is also supported by his STRs which are silent for diagnose or complaints of a left knee disability other than the isolated episode of left knee pain treated with an ace bandage in April 1964, and his November 1964 separation medical examination which only noted a small left knee scar. Additionally, while the Veteran reported some bothering and discomfort progressing over the years following his separation from service, the December 2018 VA examiner found that it was after the 1969 MVA that the Veteran began showing signs of limitation of motion. The foreign is supported by the August 2021 VA examiner who noted that such traumatic left knee injury would cause significant biomechanical dysfunction of the left knee postoperatively and would account for the significant degenerative joint disease of the left knee that most recently required a total knee replacement. The Board determines the August 2021 VA opinion is clear and unequivocal and based on the evidence of record, including the STRs, as well as the Veteran's self-reports and his recollection of events. Moreover, the opinion is found to be highly persuasive as it is consistent with the evidence of record and supported by a rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board acknowledges the Veteran initially contended that his left knee disability is related to the reported in-service event training (i.e., see February 2020 DRO hearing; see also April 2021 Board hearing). He later rectified that the traumatic in-service injury occurred to his right knee and not his left. See August 2021 VA examination report. Although the Board has considered all the contentions raised in support of this appeal, a review of the evidence reflects that there is no competent medical evidence suggesting a link between the claimed left knee disability and the Veteran's in-service event. Furthermore, the Veteran lacks the requisite expertise to render a medical opinion as to the etiology of his left knee disability. In conclusion, whether his current left knee disability is related to service is a complex medical question which falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In sum, the Board determines the Veteran's left knee disability is not related to an in-service event. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Therefore, service connection for a left knee disability is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board William Pagan, 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.