Citation Nr: 21068513 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 12-21 109A DATE: November 10, 2021 ORDER Service connection for a left knee disorder is denied. Service connection for a right knee disorder is denied. Service connection for headaches is denied. FINDINGS OF FACT 1. The Veteran had active duty from January 2004 to May 2005. 2. The Veteran reported experiencing left and right knee pain in service; however, symptoms were not shown to be chronic; a current bilateral knee disorders, diagnosed as knee pain, knee strain, internal derangement, and chondromalacia patella, are not causally or etiologically related to service. 3. The Veteran sought treatment for headaches in service; however, symptoms were not shown to be chronic; a current diagnosis of headaches is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. A left knee disorder was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). 2. A right knee disorder was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). 3. Headaches were not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a procedural matter, the Veteran testified before the undersigned Veterans Law Judge in December 2018. A copy of the transcript has been associated with the claims file. In August 2019, the Board denied the claims. The Veteran appealed to the Veterans' Claims Court. In an April 2020 Joint Motion for Partial Remand (JMPR), the Court Clerk vacated the Board's decision and remanded the claims. In December 2020, the Board remanded the claims consistent with the terms in the JMPR. These actions stem the basis for the current appeals. 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). Left and Right Knee Disorders As to a current disorder, the Veteran has been diagnosed with bilateral chondromalacia patella, internal derangement of the knees, bilateral knee pain, and bilateral knee strain. Therefore, the first element of service connection is met. As to an in-service incurrence, in a July 2009 VA examination, the Veteran contended that she began to have burning pain in her knees while running in bad weather in Iraq. In an August 2009 statement, she reported going to the clinic once in service for her knees and being told that the stress of wearing her gear caused joint pain. An October 2006 service treatment record (STR) showed that she complained of right knee pain in the Reserve and was diagnosed with patellofemoral syndrome. Further, in a March 2013 statement, the Veteran's ex-husband reported that as a petroleum specialist, she had to climb on to and descend from a variety of objects in order to perform her in-service duties. He stated that she sometimes had to jump from object to object and began to feel sharp pains in her knees afterward. While she went to the clinic in-service for this pain, she told him that she was just given pain medication and sent back to duty. In addition, in a July 2019 statement, she reported having knee pain since 2005. As the Veteran sought treatment for knee pain in service and reported having knee pain in service, an in-service incurrence is shown. As to nexus, in a July 2009 VA examination, the Veteran complained of daily knee pain while running, squatting, and climbing stairs. Upon examination, the examiner determined that a bilateral knee disorder was less likely than not incurred in service. The examiner reasoned that he could not tell if the time that the Veteran complained of knee pain was during her active duty. He also explained that her MRI was normal. Therefore, he could not tell if her knee disorders began in service without resulting to mere speculation. In a subsequent June 2012 VA examination, the Veteran complained of dull numb pain in her knees with occasional sharp pain that worsened with activity. Upon examination, the examiner determined that the knee disorders were less likely than not incurred in service. The examiner reasoned that there was no evidence of a knee disorder that manifested during service or within one year of separation. This evidence weighs against the claims. In addition, in an April 2021 VA examination, the Veteran complained of knee pain beginning in 2004 or 2005 from walking on unleveled surfaces. She reported experiencing current symptoms of stiffness, cracking, pain, and her knees giving out. Upon examination, the examiner opined that a bilateral knee disorder was less likely than not incurred in service. As to the left knee, the examiner reasoned that STRs were silent for a left knee disorder. As to the right knee, the examiner reasoned that the Veteran had one complaint of right knee pain in service and that clinical records were silent for a right knee disorder until 2009, when an X-ray revealed an unremarkable examination. This evidence weighs against the claims. Clinical records were reviewed. While they show on-going complaints of knee pain, no medical professional attributed the pain to service. Based on the above, the medical evidence does not support the claims that left and right knee disorders were incurred in service. Specifically, STRs were absent of complaints, diagnoses, or treatment for a left knee disorder and the Veteran did not seek treatment for a left knee disorder until four years after separation from service. Therefore, the medical evidence does not support the claims of service connection. Headaches As to a current disorder, the Veteran has been diagnosed with tension headaches and migraines. Therefore, the first element of service connection is met. As to an in-service incurrence, in an August 2014 clinical record, the Veteran reported having migraines since service. Further, in a July 2016 statement, she stated that she was treated in service in 2004 for migraines. She contended that she experienced nausea, sensitivity to light, and pain that increased with movement. In the June 2012 VA examination, she reported headaches beginning in 2004 after returning from training. She maintained that she sought treatment at an acute care facility and was diagnosed with stress headaches secondary to heavy gear. At the hearing before the Board, the Veteran recounted an incident in-service where she was found shaking and sweating and taken to the emergency room. She stated that her headaches continued but she was only given over the counter pain relief. STRs are absent of record of emergency room treatment due to headaches; however, in May 2005, the Veteran complained of headaches. Further, in a May 2007 Reserve record, the physician reported that the Veteran had been experiencing headaches since her deployment in 2004. As the Veteran reported having headaches in service and sought treatment for headaches in service, an in-service incurrence is shown. As to nexus, in a June 2012 VA examination, the Veteran complained of pain localized to one side of the head that worsened with physical activity. Upon examination, the examiner determined that it was less likely than not that the Veteran's headaches began in service. The examiner reasoned that there was no evidence of headaches that had manifested to a chronically disabling degree during or within one year post separation. This evidence weighs against the claim. In addition, in an April 2021 VA examination, the Veteran complained of headaches beginning in 2004. Upon examination, the examiner opined that headaches were less likely than not incurred in service. The examiner reasoned that STRs showed one complaint of headaches and that there was no continuity of care since service for nine years after separation. This evidence weighs against the claim. Based on the above, the medical evidence does not support that headaches were incurred in service. Specifically, the Veteran complained of headaches on one occasion in service around 2004-2005 and did not report headaches again until 2012, seven to eight years after separation from service. Therefore, the medical evidence does not support the claim of service connection. The Board has considered the Veteran's lay statements and testimony that these disorders began in service. She is competent to report symptoms because this requires only personal knowledge, as it comes to her through her senses; however, she is not competent to offer an opinion as to the etiology of her current disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the medical personnel who have examined the Veteran during her current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to the lay statements that have been submitted. Therefore, the appeals are 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 D. Ragofsky, 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.