Citation Nr: 21068046 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 14-25 620 DATE: November 8, 2021 ORDER Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. FINDINGS OF FACT The most probative evidence is against a finding that the Veteran's current right and left knee disabilities had their onset during active duty service or are related to such service; or that arthritis in either knee was manifested within one year of the Veteran's discharge from active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1978 to October 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2016, the Veteran testified at a Board video conference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. This matter was last before the Board in April 2021, when it was remanded for further development. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). In cases where a veteran served continuously for 90 days or more during active service and arthritis manifests to a degree of 10 percent within one year from the date of service termination, the arthritis shall be presumed to have been incurred in service even though there is no evidence of arthritis during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. 1. Entitlement to service connection for a right knee disability 2. Entitlement to service connection for a left knee disability The Veteran contends that his knee disabilities are due to a January 1979 jeep accident and/or normal wear and tear during active miliary service. He testified that he had a knee surgery four to five months after separation from service. Service treatment records (STRs) indicate that the Veteran reported right knee pain in February 1978. He was assessed with right knee contusion and provided an ACE bandage and Tylenol. In January 1979, the Veteran reported being in a jeep accident and having tightness in his right buttock area. Post service medical records shows the Veteran reporting a history of right knee surgery in 1985. In February 1999, the Veteran reported that his right knee has been bothering him since he had surgery for torn ligaments and tendons. An April 2000 treatment note indicates knee pain and popping upon bending the right knee. In September 2001, the Veteran reported that the hurt his left knee when he ran into another inmate. A 2008 treatment record noted he had right knee arthroscopic surgery in 1989. The Veteran has been diagnosed during the appeal with bilateral knee degenerative arthritis so the first criterion for establishing service connection has been met. The question becomes whether this condition is related to the knee complaints in service or the activities during service. In August 2013, a VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury. The examiner provided the rationale that STRs show two acute complaints of knee pain during service. There are no other notes found to indicate any chronic, ongoing complains regarding injuries to the knees during service. In a May 2021 addendum opinion, a VA examiner opined that the current left and right knee arthritis and/or strain were less likely than not incurred in or caused by the claimed in-service injury. The examiner noted one STR entry in February 1978 with Veteran seeking medical care for right knee contusion, stating that another GI fell on the side of his leg. Possible contusion was diagnosed and an ACE bandage was prescribed. There are no accompanying records showing continuity of care or prolonged limitations from that event. The examiner noted a later entry of January 1979 with Veteran stating that he was in a jeep accident the day prior. The examiner further noted a review of the transcript of the hearing before the Board regarding the jeep accident and notes that there is no written evidence of lingering problems, damage, or limitations. Accompanying records do not show continuity of care or resulting limitations or problems. The Veteran was discharged from active duty in 1981. Further examination of accompanying records finds notation of an ACL tear in 2008 after climbing a pole for work. Other records show right knee arthroscopy in 1989. Health care records in November 2000 show a notation of "chronic left knee discomfort related to an old injury" but that injury is never discussed. The examiner noted that later in 2001, a notation was made of "possible meniscal injury left knee" but no etiology or history was recorded. Based on accompanying records review, the examiner concluded that a link cannot be established between two isolated, apparently self-resolving knee injuries and the currently diagnosed knee arthritis. Upon review of the record, the Board finds that the preponderance of the evidence is against the claims for service connection for bilateral knee disabilities. The Board finds the VA examiners' opinions, combined, are highly probative and entitled to great weight. The examiners reviewed the claims file, examined the relevant facts, and provided reasoned and detailed rationale for the conclusions reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no medical opinion of record linking the Veteran's bilateral knee disability to service. While the Veteran believes that his current bilateral knee is related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. In this regard, the diagnosis and etiology of knee disabilities are matters that require medical training and expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his current bilateral knee disability, is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Further, whether the symptoms the Veteran reportedly experienced in service or following service are in any way related to his current knee disabilities is a matter that requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999). The Board finds the VA examiners' combined opinions to be the most probative evidence concerning the question of whether the Veteran's current bilateral knee is related to service. While the Veteran has alleged that he had symptoms since his injury and had knee surgery a few months after his discharge from service, such assertion is inconsistent with other evidence of record, including his own reports to treatment providers. In this regard, he reported to a treatment provider in 1998 that he had right knee surgery in 1985, and other records show he had the surgery in 1989. Accordingly, the Board finds his assertions are not persuasive. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006) (the lack of contemporaneous medical records, the significant time delay between the affiants' observations and the date on which the statements were written, and conflicting statements of the veteran are factors that the Board can consider and weigh against a veteran's lay evidence). In sum, the most probative evidence indicates that arthritis was not manifested during service or within one year following discharge from service, and that the current bilateral knee disability is not related service. Accordingly, service connection is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Asare, 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.