Citation Nr: A21017906 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 200126-58892 DATE: November 4, 2021 ORDER Service connection for hernia condition is denied. Service connection for right knee condition, to include degenerative arthritis of the right knee, is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a hernia condition or any related disability at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence is against finding that the Veteran's right knee condition began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a hernia condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right knee condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Army from June 1964 to June 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in January 2020 by a Department of Veterans Affairs (VA) Regional Office (RO). The rating decision on appeal was issued in January 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the January 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). 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. §§ 1110, 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). 1. Entitlement to service connection for a hernia condition The Veteran seeks service connection for a hernia condition that he contends began during active service where he indicated that he began feeling pain during lifting. 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 the Veteran does not have a current diagnosis of a hernia condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran's service treatment records (STRs) are silent for pain or diagnosis of a hernia condition. In April 1965, the Veteran underwent an annual physical examination where all systems were found to be normal. On an April 1965 Report of Medical History, the Veteran did not report a hernia or pain with lifting. In March 1966, the Veteran's Report of Medical History at separation noted that he was in good health and indicated that he had cramps in his leg and had a history of whooping cough and mumps, but no indication of any hernia or related pain. The Veteran indicated that he had cramps in his legs with exercise. His separation examination was normal. The Veteran's separation examination occurred three months prior to his official separation. An undated document in the Veteran's STRs shows that the Veteran attested that there had been no changes since his March 1966 examination. VA treatment records show that the Veteran underwent a left inguinal hernia repair in 1998, 32 years after discharge from military service. In October 2017, during an abdominal CT scan, a small umbilical fat-containing hernia was seen. In June 2019, the Veteran reported pain in the left groin area which he indicated had been present for a couple of weeks. The Veteran rated pain level at level 3-4/10. The Board notes that the Veteran experienced left groin pain during the appeals period. There is only one complaint of pain in the medical records and the Veteran rated that pain as a 3-4 out of 10. While pain alone may constitute a disability even without a diagnosis, that pain must "reach[] the level of a functional impairment of earning capacity." See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Medical evidence of record does not indicate this left groin pain has impaired the Veteran's earning capacity in any way. The Veteran testified before the Board that he first experienced pain during military service when he was driving an armored personnel carrier (APC) and was trying to close the back door. He testified that he began to feel pain again in the 1990s and was subsequently operated on in 1998 for a left inguinal hernia. Of note, medical records of this procedure are not available for review. The Veteran testified that he can still feel his hernia today. In reference to his normal separation examination, the Veteran indicated that he just wanted to get home and did not mark anything wrong with him at separation. Of note, the Veteran's separation exam was three months prior to discharge and he re-certified closer to discharge that there had been no changes to his health. Currently, there is no medical evidence that the Veteran has been diagnosed with a hernia condition or residuals from his hernia surgery in 1998. While the Veteran believes he has a current diagnosis of a hernia condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical knowledge and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran is competent to report his symptoms of pain that persist until today, however, the Veteran is not able to opine on the etiology of this pain. Given that the Veteran does not have a diagnosis of a hernia condition, the claim for service connection is denied. 2. Service connection for a right knee condition The Veteran seeks service connection for a right knee condition that he asserts began during military service when he injured his knee in Germany. The Veteran testified at his Board hearing that he climbed up to the top of the APC he drove and jumped off the top, twisting his knee. He testified that he went to the ER the next day and was given medication and told that he twisted his knee. 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 arthritis of the right knee, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of right knee condition began during service or is otherwise related to an in-service injury, event, or disease. The Veteran's STRs are silent for knee problems throughout service, including at separation. Of note, the Veteran reported other conditions on his March 1966 Report of Medical History form at separation including cramps in his leg, whooping cough, and mumps. The Veteran was afforded a VA examination in August 2021 where he was diagnosed with degenerative arthritis of the right knee. The Veteran reported that this condition began in 1966 when he injured his knee when he slipped and twisted his knee while trying to get out of the back of the hatch in an APC. The Veteran indicated that he had surgery on his right knee in 1990. The examiner opined that the Veteran's right knee condition is less likely than not (less than 50 percent probability) related to his military service because the Veteran did not have any objective symptoms upon examination. An October 2002 VA treatment record shows that the Veteran presented to the emergency room because he popped his right knee two days prior and reported pain and swelling. The Veteran indicated that he was walking and felt his right kneecap move and then it became swollen and painful in the following days. A December 2002 physical therapy note shows a diagnosis of degenerative joint disease of his right knee post trauma from this October injury. In February 2017 the Veteran reported pain in the right knee. VA treatment records show the Veteran was not diagnosed with a right knee condition, to include DJD, until 2002, and first sought treatment for his right knee in the 1990s. Both of these instances were over 20 years after discharge from service. There is no evidence in the Veteran's STRs of a knee injury, treatment for right knee pain, or an ER visit in Germany as the Veteran reported. While the Veteran is competent to report having experienced symptoms of knee pain intermittently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his current right knee condition. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Additionally, while the Veteran believes his current knee pain is related to an in-service injury, event, or disease, he 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 Board gives more probative weight to the medical evidence of record. Taken together, the VA examiner's opinion and the lack of continuity of symptoms (since the knees were found normal at separation and the Veteran specifically denied any knee problems, while reporting other leg problems) establish that the Veteran's right knee condition is less likely than not to be related to any in-service injury, event, or disease, including twisting his knee from falling/slipping off an APC. Consequently, the Board finds that service connection for a right knee condition is not warranted and the claim is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jennifer M. Narvaez, 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.