Citation Nr: 21070749 Decision Date: 11/25/21 Archive Date: 11/25/21 DOCKET NO. 18-18 323 DATE: November 25, 2021 ORDER Entitlement to service connection for a left knee disability is denied. FINDING OF FACT The probative evidence of record does not show that the Veteran's diagnosed left knee strain had its onset during service or is otherwise etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1996 to August 1999. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a March 2020 videoconference hearing. A transcript of that hearing is associated with the claims file. This case was most recently before the Board in July 2021 when it was remanded for additional development. It has returned for adjudication. Entitlement to service connection for a left knee disability Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). During a December 2020 VA examination, the Veteran was diagnosed with a left knee strain. Accordingly, the requirements of Shedden element (1) have been satisfied. The Veteran's service treatment records are absent of complaint or treatment for a left knee disability. However, during the March 2020 Board hearing, the Veteran competently and credibly reported that his left knee used to swell during service after running with a heavy backpack. He stated that there was no specific injury to his knee but reported wear and tear from the physical demands of service. Accordingly, in affording the Veteran the benefit of the doubt, and finding his reports consistent with the circumstances of his service, the Board finds that the requirements of Shedden element (2) have been satisfied. The question before the Board is whether the Veteran's current left knee strain began during or is otherwise related to his period of active service. After a review of the evidence, the Board finds that a preponderance of the evidence is against finding service connection for a left knee disability is warranted. The Veteran's post-service treatment records indicate that he first sought treatment for left knee pain in October 2013. At that time, the Veteran stated that after running on the treadmill for the previous 3 weeks, his left knee was hurting and swollen. An x-ray was obtained and was unremarkable. The physician assessed the Veteran with "most likely" tendonitis. A VA opinion was obtained in August 2021 regarding the etiology of the Veteran's left knee strain. After a review of the claims file, the examiner opined that it was less likely than not that the Veteran's left knee strain was incurred in or caused by his period of service. The rationale was that the first mention of a left knee disability was in 2013, 14 years after his discharge. The examiner stated that it was highly unlikely that the Veteran's in-service strain would have gone unnoted or unreported for 14 years. Rather, the examiner would expect that an in-service strain would likely have progressed to a point requiring treatment within 14 years and noted that the diagnosis in 2013 is the same disability diagnosed presently. The examiner further indicated that any current reports of continuity of symptoms since service are not supported by the medical evidence and are inconsistent with the medical records showing the onset around 2013. After a review of the above, the Board finds that the preponderance of the evidence weighs against finding that the Veteran's left knee disability was caused by or incurred in service. The Board notes that the Veteran is competent to report the onset and continuity of knee pain. However, the question of whether the Veteran's current left knee strain is related to his active service falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Opining on the etiology of a musculoskeletal disorder requires the expertise of a medical professional, particularly when there has been a significant passage of time without any documentation of symptomatology. While the Veteran can report symptoms that he experiences, he does not have the necessary training to offer medical opinions. The Board further finds that the Veteran's more recent statements are in conflict with the medical evidence of record, which indicates that the onset of his current left knee pain was in October 2013, over a decade after his discharge from service. At that time, the Veteran reported that his knee disability was related to running on a treadmill. The Board finds that statements made to clinicians for the purposes of treatment are highly probative and, accordingly, affords them more weight than those made for the purposes of establishing entitlement to compensation. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (it is presumed that a person will be as honest with their treatment providers as possible in an effort to obtain relief from their symptoms). The August 2021 VA opinion is the most probative evidence of record on the question of a nexus to service. The opinion was based on an extensive review of all of the evidence, including statements from the Veteran and the Veteran's treatment records, and provided a clear and reasoned analysis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA opinion is also consistent with the evidence of record. There is no competent, credible evidence to refute the VA examiner's opinion. After a review of the above, the Board finds that the weight of the probative evidence of record is against a finding that the Veteran's left knee strain is causally or etiologically related to his period of active service, to include his reports of in-service knee pain and swelling. Accordingly, the claim for entitlement to service connection for a left knee disability must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.