Citation Nr: 21067979 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 15-15 062 DATE: November 8, 2021 ORDER Service connection for a right knee disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from June 1967 to June 1969. 2. A pre-existing right knee disorder was noted at service entrance and did not undergo an increase in severity during service beyond its natural progression. CONCLUSION OF LAW The pre-existing right knee disorder was not aggravated by service. 38 U.S.C. §§ 1110, 1111, 1153, 5013(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.306 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). In addition to the laws and regulations outlined above, a veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). If a disorder is noted, the question is whether it was aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress of the" preexisting condition. 38 U.S.C. § 1153. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b); Falzone v. Brown, 8 Vet. App. 398, 402 (1995). Moreover, "temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered aggravation in service unless the underlying condition, as contrasted to symptoms, is worsened." Crowe v. Brown, 7 Vet. App. 238, 247-48 (1994); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). However, the increase need not be so severe as to warrant compensation. Browder v. Derwinski, 1 Vet. App. 204, 207 (1991). Turning to the medical evidence, the Veteran's right knee disorder pre-existed service. Specifically, the January 1967 induction examination reflected a normal clinical evaluation of the lower extremities; however, the Veteran reported trick knee. Further, he indicated that he had a knee injury that year. In addition, a January 1967 clinical treatment note from the time of induction specifically addressed a right knee injury from 1966 which resulted in pain and minimal locking. As such, the induction medical examination noted a pre-service knee injury. Thus, the presumption of sound condition as it relates to the right knee disorder is not applicable. Because a pre-existing right knee disorder was noted upon entrance to service, service connection may be granted only if it is shown that the right knee disorder was aggravated by service, that is, if the pre-existing right knee disorder was worsened in severity beyond its natural progression during service. To that end, the weight of the evidence supports a finding that the pre-existing right knee disorder did not increase in severity beyond its natural progression. The Veteran contends that he experienced knee pain while repelling during active duty service in the Republic of Vietnam; however, the STRs, which are complete, are absent of any complaints, findings, or treatment for the pre-existing right knee disorder. The Veteran indicated he had a history of a trick or locked knee during the May 1969 separation examination, but there was no evidence that the previous right knee injury was aggravated during service. Further, the separation examination reflected a normal clinical evaluation of the lower extremities. As such, the STRs do not support the in-service aggravation of a right knee disorder. The earliest post-service evidence of right knee symptoms is not shown until 2013, more than 40 years after separation from service, when the Veteran was diagnosed with internal derangement and meniscectomy and degenerative joint disease (DJD). The threshold question is not whether the right knee disorder is worse now, it is whether it was worsened during or because of service. A December 2013 VA examiner opined that a right knee condition clearly and unmistakably pre-existed service and was not aggravated beyond its natural progression by an in-service event or injury. The examiner explained that there was no evidence of an in-service injury that may have aggravated the right knee. Further, he noted that the right knee was stable after separation until a meniscal tear with buckling in 2013. As such, he concluded it was more likely that the current right knee disorder was due to the natural progression of the pre-service injury. This evidence weighs against the appeal. A March 2019 VA examiner found that the Veteran's right knee disorder that pre-existed service was clearly and unmistakably not aggravated beyond its natural progression. The examiner noted that a repelling injury as described by the Veteran could at least as likely as not have resulted in an injury to the bilateral knees; however, he explained that if the injury was significant, it would likely have required treatment during service or soon after separation. As the Veteran was not treated for right knee arthritis until many decades after service, the examiner explained it was at least as likely as not that natural aging resulted in the current knee disorder. Further, he indicated that a new and separate meniscal injury occurred to the right knee. Therefore, he opined it was less likely than not that a pre-existing right knee disorder was aggravated beyond natural progression by events in-service, to include rappelling. This evidence weighs against the appeal. Also weighing against the claim, a May 2021 VA examiner opined that a right knee injury pre-existed service; however, it was less likely than not that the currently-diagnosed right knee conditions had their nexus in service or represented aggravation of the pre-existing knee disorder. Specifically, the examiner explained that there was no medical evidence of a right knee injury during service. Further, he stated that the Veteran's current right knee disorder was a new condition which arose more than 40 years after service. As such, he found that the current meniscal diagnosis did not represent aggravation of the previous condition, but instead was likely a new condition which arose acutely. He also opined that the separate diagnosis of DJD was considered a natural aging process and did not represent aggravation of the pre-existing right knee disorder. In addition, the May 2021 VA examiner noted that the Veteran's claim of a chronic right knee disorder during service was not substantiated by the medical records and pathophysiology of the currently diagnosed conditions. He explained that the long interval between separation and the current diagnoses weighed against the claim. For the foregoing reasons, the weight of the medical evidence demonstrates that the pre-existing right knee disorder did not increase in severity during service beyond its natural progression; therefore, the criteria for service connection for a right knee disorder, based on aggravation in service, have not been met. The Board has considered the Veteran's lay statements that that his current right knee disorder was aggravated by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.