Citation Nr: 21070642 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 19-17 004 DATE: November 24, 2021 ORDER Entitlement to service connection for degenerative arthritis of the lumbar spine is denied. Entitlement to service connection for right knee disability is denied. Entitlement to service connection for left knee degenerative joint disease, lateral meniscus tear and chondromalacia of the patella is granted. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran's degenerative arthritis of the lumbar spine had its onset during active service or within a year of separation, or that it is otherwise related to service. 2. The Veteran's right knee disability has not been linked by competent evidence to an in-service disease or injury. 3. There is a balance of evidence on whether the Veteran's left knee degenerative joint disease, lateral meniscus tear and chondromalacia of the patella is related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for degenerative arthritis of the lumbar spine have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303. 3.307, 3.309. 2. The criteria for service connection for right knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for left knee degenerative joint disease, lateral meniscus tear and chondromalacia of the patella have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from December 1988 to May 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 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). Certain chronic diseases (including arthritis) will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Entitlement to service connection for degenerative arthritis of the lumbar spine The Veteran contends that he injured his back in service, and that the injury has resulted in his current degenerative arthritis of the lumbar spine. The Board concludes that while the Veteran has a current disability of degenerative arthritis of the lumbar spine the preponderance of the evidence weighs against finding that the Veteran's disability began during service or is otherwise related to an in-service injury or disease. The Veteran has a current diagnosis of degenerative arthritis of the lumbar spine as evidenced by a VA examiner's notation in November 2011. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. The Veteran reported low back pain in service in January 1990, but when examined in connection with service discharge in March 1992, there were no abnormalities. In addition, an October 2000 medical examination conducted for the purpose of enlistment into the Reserves indicated that the Veteran's back was normal, and the Veteran reported he did not have back trouble. VA records dated in 2007 reference low back pain of only one week duration, and back pain complaints noted in 2010, reflect it began that afternoon. Clearly, the Veteran was not diagnosed to have arthritis during active service, nor within one year of separation from active service, nor does this support a finding of chronic back complaints since service. The disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA treatment records show the Veteran was not diagnosed to have arthritis until 2011, 20 years after his separation from service, which was many years outside of the applicable presumptive period. As the Veteran's arthritis did not manifest until 20 years after his separation from service, presumptive service connection is not applicable in this case. 38 C.F.R. § 3.309(a). In an October 2016 VA examination, the examiner indicated that records were not available that indicated continuity of care for the Veteran's injury since release from service, noting that the Veteran did not receive care for his back following release from service until January 2012. Thus, the examiner concluded that it was less likely than not that his current back condition was related to his in-service injury. Another VA opinion was provided in April 2018. The examiner concluded that the Veteran's in-service diagnosis of a back strain implied that the Veteran's back condition was an acute, transitory condition. The examiner noted that generally a condition like degenerative spine disease most commonly results from "wear and tear," which occurs over time, while a strain is self-limiting and resolves over time. Further, the examiner stated that there was one acute episode of low back pain following service, diagnosed as a strain in 2007, with lumbar spine arthritis noted in 2012. As such, the examiner concluded that the Veteran's current lumbar spine condition was less likely than not related to the single remote episode of muscle strain noted in 1990 during service. Taken together, the two VA opinions of record establish that the Veteran's degenerative arthritis of the lumbar spine is not at least as likely as not related to an in-service injury or disease, including the in-service complaint. The October 2016 VA examiner opined that the Veteran's back condition was not at least as likely as not related to the in-service complaints of back strain, while the April 2018 VA examiner also opined that the Veteran's degenerative arthritis of the lumbar spine was less likely than not related to service. The combined rationale was that the Veteran's in-service reports were an acute condition, and degenerative arthritis is a condition that occurs over time. The examiners' combined opinion is probative, because it is based on a sufficiently accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Consequently, the Board gives more probative weight to the VA opinions of record. In reaching this decision, the Board notes that the Veteran testified at the Board hearing that as an infantry soldier he was required to participate in marches while carrying a heavy ruck sack, and that following those marches he would have back pain. While the Veteran is competent to report having experienced symptoms of back pain, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of the back disability currently shown. The Veteran believes his back condition is related to service, but the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. 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 Veteran's medical opinion is accorded no evidentiary weight. Here, the most probative evidence is against the claim of entitlement to service connection for degenerative arthritis of the lumbar spine. The Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for right knee disability The Veteran contends that he injured his right knee in service and that the injury has resulted in his current right knee condition. The Board concludes that while the Veteran is diagnosed with right knee strain, the preponderance of the evidence weighs against finding that the Veteran's right knee disability began during service or is otherwise related to an in-service injury or disease. June 2013 VA treatment records indicate that the Veteran was diagnosed with a right knee strain. During service, the Veteran was seen for right knee complaints that was initially thought to be a tear of the meniscus and a ligament. However, the equipment necessary to establish this was unavailable because of the Veteran's deployment at the time. Subsequently, the complaints were characterized as patellofemoral syndrome, and when examined in connection with his service discharge no right knee abnormalities were noted. The Veteran was afforded a VA examination in October 2016. The examiner diagnosed the Veteran with a right knee strain and concluded that the Veteran's condition was less likely than not related to service because there was no continuity of care. The examiner noted that the Veteran was not seen for right knee pain following service until April 2011. The Veteran was afforded another VA examination in October 2017, but the examiner did not provide an opinion as to whether the Veteran's condition was related to his service. The Veteran was afforded another VA examination in April 2018. The examiner noted that although the Veteran had a diagnosis in service of a possible meniscal tear, there was no imaging conducted at that time. The examiner concluded that because the records did not note care for the right knee until 2011, there was no clinical evidence to suggest that the Veteran's right knee complaints were causally related to service. Further, the Veteran's separation examination in 1992 and reserve enlistment examination in 2000 noted no issues with the right knee. As such, the examiner concluded that there was no evidence to suggest the Veteran's current right knee condition was causally related to the Veteran's in-service complaints. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran testified that his right knee pain has continued since service. This assertion is accorded little weight since it is contradicted by the examination at service separation, as well as the 2000 examination report, and the other post service medical records that fail to show any complaints until 2011. While the Veteran is competent to report having experienced symptoms of knee pain, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a knee disability. He also is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. 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 Veteran's medical opinion is accorded no evidentiary weight. Here, the most probative evidence addressing whether the Veteran's right knee disability is related to service is contained in the April 2018 VA examination report. That medical opinion is against the claim. Accordingly, entitlement to service connection for a right knee disability is denied. 3. Entitlement to service connection for left knee disability The Veteran contends that his left knee disability began during service. The Board concludes that the Veteran has a current disability that is related to an in-service left knee injury. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). August 2017 VA treatment records show the Veteran has a current diagnosis of left knee degenerative joint disease, and a July 2017 MRI showed a lateral meniscus tear and chondromalacia of the patella. During service, the Veteran was seen for complaints of left knee pain following an injury. Thus, the question becomes whether the current disability is related to service. The evidence against the claim includes an October 2016 VA examination. The examiner diagnosed the Veteran with left knee degenerative arthritis and concluded that the Veteran's disability was less likely than not related to service because there was no continuity of care. However, the examiner did not comment on the Veteran's statements that his knee pain had continued since service, particularly the 2001 treatment notes that indicated that the Veteran had continued to receive care since service. The Veteran was afforded another VA examination in April 2018. The examiner noted that the Veteran had a diagnosis in service of a patellofemoral syndrome, but did not link current disability with service, in large measure based on the absence of clinical evidence reflecting a link with service. However, it did not account for the Veteran's report of ongoing symptoms since service, bolstered by the history taken in 2001 that included the Veteran's report of pain since service. The evidence in favor of the claim includes the in-service October 1991 left knee injury, the March 1992 in-service diagnosis of patellofemoral syndrome, and the Veteran's testimony regarding continued complaints, which is supported by the August 2001 treatment note that indicated the Veteran had experienced knee pain during and after service. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current degenerative joint disease, lateral meniscus tear and chondromalacia of the patella is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for left knee degenerative joint disease, lateral meniscus tear and chondromalacia of the patella is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Geer, Vanessa V. 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.