Citation Nr: 21070804 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 17-21 906 DATE: November 26, 2021 ORDER The claim for service connection for a right knee disability is granted. The claim for service connection for a left knee disability is granted. FINDINGS OF FACT 1. The Veteran's right knee disability had its onset in service or is otherwise related to his active military service. 2. The Veteran's left knee disability had its onset in service or is otherwise related to his active military service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 2006 until his honorable discharge in March 2013. He then served in the Army Reserve. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 decision by the Lincoln, Nebraska, Regional Office of the United States Department of Veterans Affairs (VA). In April 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. Evidentiary Standards In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 12829 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. Service Connection VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to be entitled to service connection there must be competent, credible evidence of (1) a current disability, (2) an 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). When these elements are satisfied, service connection may be granted on a direct basis. Analysis 1. Service connection for a right knee disability 2. Service connection for a left knee disability Due to the similar disposition of each of these claims, the Board addresses them together. First element: A current disability The Veteran received a March 2017 VA-contracted examination addressing his bilateral knee disabilities. The examiner diagnosed the Veteran with right and left knee strain. The Board finds this evidence credible and probative. Therefore, the first element is satisfied. Second element: An in-service event, injury, or illness, or aggravation thereof The Veteran testified at his April 2021 Board hearing that he suffered several knee issues in service. On review of his in-service medical records, the Board finds his testimony to be accurate. On June 22, 2006, the Veteran reported left knee pain. On June 28, 2006, he reported left knee pain after he felt a "pop" during physical training, and it had bothered him since the injury. On November 11, 2006, he reported left knee pain shooting into his lower back. On November 14, 2006, he reported left knee pain while running. He was diagnosed with patellofemoral dysfunction. On January 31, 2007, he experienced sharp left knee pain and received injections to alleviate his pain. He was diagnosed with bursitis and tendonitis. A January 2, 2008, pre-deployment physical documented patellofemoral dysfunction. On August 4, 2010, he experienced bilateral knee pain. His August 16, 2011, physical profile documented bilateral knee pain. The Board finds this evidence of bilateral knee pain credible and probative. Therefore, the Board finds the second element, and in-service onset or injury of bilateral knee pain, is satisfied. Third element: A causal link The VA Regional Office obtained a VA-contracted opinion from the March 2017 examiner who opined that the Veteran's bilateral knee disabilities were less likely than not incurred in or caused by his active service. The only rationale offered by the examiner was that the Veteran only reported knee issues in 2006 and 2010. The examiner found no additional medical documentation for persistent knee-related issues. The Board finds this opinion inadequate because the Veteran's in-service medical records document additional knee treatment and reports of symptoms, and the examiner failed to address the Veteran's lay statements about the continuity of his bilateral knee issues since service. Thus, the Board affords the opinion no probative value. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (noting that an examiner's opinion relying on the absence of contemporaneous medical evidence, "failed to consider whether the lay statements presented sufficient evidence of the etiology of [the veteran's] disability such that his claim of service connection could be proven"); Dalton v. Peake, 21 Vet. App. 23, 3940 (2007) (a medical opinion is inadequate if it does not take into account a veteran's reports of symptoms and history, even if recorded in the course of the examination); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("It is the fully articulated, sound reasoning for the conclusion . . . that contributes probative value to a medical opinion."). The Board finds the Veteran's lay statements about the continuity of his bilateral knee pain and other symptoms are highly credible. First, the Board acknowledge' s the Veteran's bilateral knee issues in service, which primarily consisted of knee pain. The Board finds that the Veteran's bilateral knee pain was mostly present during physical exertion, such as physical training, exercise, and sporting activities. Second, his bilateral knee issues did not end at the time of separation from service, rather they persisted. His U.S. Army Reserve medical records continued to document bilateral knee issues. After his separation from the Reserve, the Veteran's private medical records continued to document bilateral knee issues. The Board finds that since his active military service, the Veteran has continuously experienced bilateral knee pain resulting in disability. Based on his credible and probative statements addressing his bilateral knee pain, to include onset and continuity, the Board finds that the facts of record reasonably establish that his current bilateral knee strain is a continuation of the bilateral knee issues that he experienced in service. Jandreau v. Nicholson, 493 F.3d 1372, 1377 (Fed. Cir. 2007) (noting general competence of laypersons to testify as to symptoms); Savage v. Gober, 10 Vet. App. 488, 497 (1997) (holding that lay evidence of continuing symptoms of a disability following service can be sufficient to demonstrate a medical nexus between a current disability and an in-service event or injury, even where there is no medical opinion establishing that nexus). Importantly, the Board finds no intervening event related to his knees that would call into doubt his continuity of symptoms. Therefore, the Board finds the third element, a causal link, is satisfied. Accordingly, service connection for a right and left knee disability is granted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. F. Sawka, 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.