Citation Nr: 21072035 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 18-22 100 DATE: December 2, 2021 ORDER Service connection for a right knee disability is denied. Service connection for a left knee disability is denied. FINDINGS OF FACT 1. The Veteran's right knee status post total knee replacement is not due to or a result of any in-service injury or disease. 2. The Veteran's degenerative arthritis of the left knee is not due to or a result of any in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee status post knee replacement disability are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Air Force from July 1983 to April 1987. These matters come before the Board of Veterans Appeals (Board) on appeal from an August 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The Veteran timely filed a notice of disagreement (NOD) in November 2017 and a substantive appeal via a VA Form 9 in April 2018. In April 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is of record. In an October 2019 and June 2021, the Board remanded these claims for additional development of the record. In a September 2021 rating decision, the RO granted entitlement to individual unemployability effective September 19, 2016. This constitutes a full grant of that benefit sought on appeal, as the TDIU was granted for the entirety of the appeal period and there was no pending increased rating claim at the time of the filing of the service connection and TDIU claims on September 19, 2016. SERVICE CONNECTION Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected; if a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, such chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). Service connection for a right and left knee disability The Veteran contends that his bilateral knee disability is due to his military occupational specialty (MOS) as an aircraft mechanic. Specifically, he concedes that service treatment records (STRs) do not show a specific injury or disability; however, he argues that his bilateral knee disabilities developed due to his MOS that required him to kneel, squat, etc. for his entire active-duty service. Service treatment records do not reflect a diagnosis, treatment, or symptomatology of a bilateral knee disability as confirmed by the Veteran's statement. Additionally, the report of medical examinations, report of medical histories, and period medical questionnaires consistently fail to reflect that the Veteran had any bilateral knee complaints. Additionally, there are numerous certificates of medical examination that specifically note that the Veteran had no limitations preventing him from working as an aircraft specialist to include his period after active military service as a Reservist. Finally, the Veteran has filed for Federal Employee's Notice of Traumatic Injury claims while he was a Reservist and working as an aircraft mechanic for injuries to his right arm and right ankle. There were never any reports of a bilateral knee injury or complaints. Post-service, in June 2012, the Veteran was seen following his right knee popping when he twisted it while working on his knees. Additionally, private treatment records from October and December 2012 reflect that the Veteran was seen for right knee pain. He reported that he twisted his knee two months ago. Radiology imaging of the right knee revealed medial femoral condyle contusion. The Veteran had no prior problem in his right knee until he twisted it while at work in Georgia. In November 2012, the Veteran underwent an arthroscopic partial medial meniscectomy of the right knee. His postoperative diagnoses were OCD, medial meniscus tear, and synovitis. An April 2013 imaging report reflects that the Veteran had persistent right knee pain status post work-related injury. He had Grade II changes in the patellofemoral joint and Grade III changes in the area of the osteochondritis dissecans (OCD) medially. The physician noted that this is a U.S. Department of Labor case. In a January 2016 statement, the Veteran reported that the injuries claimed did not happen while on active duty service or reserve time. He reported that he is claiming injuries sustained after his military time, but caused by the wear and tear on his body for performing those duties for the time he was in. He reported that his right knee stems from aircraft mechanic duties for the 14 plus years he was in service. Radiology imaging from July 2016 of the left knee revealed a large tear of the posterior horn of the medial meniscus. Additionally, there was mild patellofemoral and medial femorotibial compartment osteoarthrosis. Private treatment records from May 2017 reflect that the Veteran was seen status post left knee unicompartmental arthroplasty. Imaging of the left knee revealed satisfactory position and alignment of the components. In an August 2017 statement, the Veteran reported that he was an aircraft mechanic and this has taken a toll on his body. He reported that all the ladders, climbing, kneeling, confined spaces, and more contributed to the toll. He reported that he is now dealing with knee issues where a knee replacement must be done which will limit his use and mobility. VA treatment records from July 2018 reflect that the Veteran complained of right knee pain for at least six months that has worsened. He was diagnosed with osteoarthritis of the right knee and evidence of medial meniscectomy. In December 2018, he underwent a total right knee replacement surgery. In an August 2018 statement, the Veteran reported that his left knee arthritis was caused from his service time as a mechanic from 1983 to 1987. During this time, all the knee bending, squatting, lifting heavy objects, working in confined spaces, stretching, and chemicals such as asbestos caused his knee disability. During April 2019 Board hearing, the Veteran testified that as a crew chief in service, his job duties including kneeling down, working in cold weather, and working in tight spaces. He reported that his arthritis is a result of his work when he was younger. The Veteran's wife testified that he would come home and have to ice his knees and take over the counter medication. A February 2020 Disability Benefits Questionnaire (DBQ) report reflects that the Veteran has a diagnosis of bilateral knee strain and shin splints. The clinician opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The Veteran reported that the condition began sometime around 1983 which he attributed to the physical demands of his job in service. Post-service, he was seen and had a scope done on his knees and knee replacements in April 2017 (left knee) and December 2018 (right knee). He had cortisone injections, physical therapy, and pain medications. The clinician opined that there is no objective finding in the STRs to support complaints, evaluation, and treatment of the right knee condition during service. He concluded that based on this fact finding, the claimed condition was not due to service. An August 2021 DBQ report reflects that the Veteran had a diagnosis of degenerative arthritis of the left knee and status post bilateral knee surgery bilaterally. Historically, the Veteran was diagnosed with arthritis and had arthroscopic surgery performed in 2010. In 2017 he had a partial knee replacement on the left and in 2018 a total knee replacement on the right. The clinician reported that the Veteran's medical records are silent for any bilateral knee condition, complaints, or treatment during service. The records reveal only post-service complaints and treatment. She reported that the Veteran's lay statements have been considered in this opinion. Therefore, the Veteran's claimed bilateral knee disability is less likely than not incurred in or caused by the right and/or left knee disability during service. In an August 2021 addendum opinion, the clinician reported that in 1982, the report of medical history was negative for knee problems. In 1985, the report of medical history for knee problems was negative. In 1991, the report of medical history was negative for knee problems. In 1996, the report of medical history was negative for knee problems. The clinician reported that a lack of reporting the knee condition is evident during active service; however, the condition could have begun in active service. She reported that she is unable to opine exactly when this occurred. The job which the Veteran continued to perform for many years after service, which he had during active service, was the cause of the knee conditions. She reported that in 2012, radiology imaging revealed that prepatellar bursitis and joint effusion of the right knee were caused by a reported twisting injury at work. He underwent a right knee arthroscopy in 2012 and the Carolina Sports Medicine and orthopedic specialist reported that there were no prior problems with his right knee until he twisted it at work in October 2012. Upon review of the evidence of record, service connection for a right and left knee disability are not warranted. Initially, the DBQ reports of record confirm that the Veteran has a right and left knee current disability. As the current disability requirement has been met, the question remains as to whether there is a nexus between the disabilities and the Veteran's active military service, to include his MOS. Based on a review of the available records and her particular expertise, the August 2021 VA clinician found that the Veteran's right and left knee disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Specifically, the clinician reported that she considered the Veteran's statements and provided an adequate rationale for her conclusion that the Veteran's disabilities are not due to service. She detailed how the STRs from the Veteran's active military service as well as from his period in Reserves failed to show any complaint of a bilateral knee disability. However, contrary to the Veteran's statements, the medical treatment records reflect that the Veteran's right knee was injured in 2012 following a work injury. This was 25 years following separation. She noted that the Veteran reported that he did not have right knee pain until this 2012 injury. As the clinician explained the reasons for her conclusions based on an accurate characterization of the evidence of record, his opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). To the extent that the Veteran, including through his representative, has opined that his bilateral knee disability is related to service, lay witnesses are competent to opine as to some matters of diagnosis and etiology, and the Board must determine on a case by case basis whether a veteran's particular disability is the type of disability for which lay evidence is competent. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In this case, the Veteran's contentions as to the etiology of his bilateral knee disability relate to an internal medical process which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Compare Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007) (witness capable of diagnosing dislocated shoulder). Moreover, the Veteran's statements contradict the medical evidence of record. Notably, there are numerous treatment records directly following the Veteran's active military service that continue to be silent of any complaints of a bilateral knee disability or any symptomatology indicating that a knee disability exists. The Veteran was routinely physically examined for his job as an aircraft mechanic and received a certificate of medical examination indicating that he was fit for employment. However, when the Veteran did injure his right knee in 2012 on the job, he filed a claim with the Department of Labor documenting this injury. The Veteran's statements are therefore not competent in this regard. To the extent that these lay statements are credible, the Board finds the specific, reasoned opinion of the VA clinician to be of greater probative weight than the Veteran's more general lay assertions. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim of service connection for a right and left knee disability. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laroche, N. 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.