Citation Nr: 21068619 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-01 130 DATE: November 10, 2021 ORDER Entitlement to service connection for a right knee condition is denied. REMANDED Entitlement to service connection for right foot ingrown toenail and onychomycosis, claimed as bilateral toe condition, is remanded. Entitlement to service connection for left foot ingrown toenail and onychomycosis, claimed as bilateral toe condition, is remanded. FINDING OF FACT The Veteran's current right knee condition is not related to his military service. CONCLUSION OF LAW The criteria for service connection for a right 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 had active military service from March 1968 to February 1970. This matter comes before the Board of Veterans' Appeals (Board) from the October 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for a right knee condition The Veteran contends that his right knee condition is related to his military service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of degenerative joint disease of the right knee and evidence shows that the Veteran complained of "vague right knee pain" during his military service, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of degenerative joint disease of the right knee began during service or is otherwise related to an in-service injury, event, or disease. VA treatment records show the Veteran was not diagnosed with a right knee condition until decades after his separation from service. While the Veteran is competent to report having experienced symptoms of occasional knee pain when going up stairs or walking for a prolonged period of time since his service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his in-service knee pain complaints. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the October 2015 VA examiner opined that the Veteran's right knee disability is not at least as likely as not related to an in-service injury, event, or disease, including the Veteran's in-service complaint of right knee pain (made on only one occasion). The rationale was that the Veteran's separation examination was silent for any knee complaints, there is no evidence that the Veteran's in-service knee complaint became chronic, and that there is no objective evidence of any right knee complaint in the time period proximate to the Veteran's separation from the military to the present time. Additionally, the examiner stated that the X-rays obtained during the October 2015 VA examination show evidence of degenerative joint disease of the right knee which is due to the general effects of wear and tear and aging. The Board finds the examiner's opinion to be 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 Board acknowledges that the Veteran believes his right knee disability is related to an in-service injury, event, or disease. However, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. 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. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the October 2015 VA examination and opinion. Therefore, the Board finds that entitlement to service connection for a right knee disability is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b). REASONS FOR REMAND 1. Entitlement to service connection for right foot ingrown toenail and onychomycosis claimed as bilateral toe condition is remanded. 2. Entitlement to service connection for left foot ingrown toenail and onychomycosis claimed as bilateral toe condition is remanded. The Veteran contends that his bilateral ingrown toenail and onychomycosis condition is related to his military service. In October 2015, the Veteran underwent a VA foot examination. The examiner stated that the Veteran is diagnosed with bilateral ingrown toenail of the great toes. However, the examiner opined that the Veteran's bilateral toenail condition is less likely than not related to his military service. The examiner stated that there was no evidence of ingrown toenails at the time of the examination and no pathology, diagnosis, or condition upon which to render an opinion. However, the VA examination itself does provide a diagnosis of ingrown toenails. Furthermore, the Veteran's VA treatment records state that the Veteran is diagnosed with dystrophic toenails (April 2016 VA treatment record) and that the Veteran has consistently complained of ingrown toenails in his treatment records. Therefore, the Board finds the October 2015 opinion to be inadequate and a remand is warranted to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of the Veteran's bilateral ingrown toenail and onychomycosis condition. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral ingrown toenail and/or onychomycosis condition is related to an in-service injury, event, or disease, including the removal of ingrown toenails during the Veteran's service. All opinions provided must be thoroughly explained and an adequate rationale for any conclusions reached must be provided. The examiner should not rely on the absence of evidence of in-service treatment or injury in the Veteran's service treatment records as a basis for any given opinion. If any requested opinion cannot be provided without resort to speculation, the medical professional should state and explain why an opinion cannot be provided without resort to speculation. 2. Following completion of the above, and a review of any additional evidence received, the RO should also undertake any other development it deems to be necessary, to include, if warranted, an addendum medical opinion which considers any newly received evidence. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mountford, 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.