Citation Nr: 21072926 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 09-46 641A DATE: December 6, 2021 ORDER Entitlement to service connection for a right knee disability, to include patellofemoral pain syndrome and tendonitis, is granted. Entitlement to service connection for a left knee disability, to include chondromalacia and tendonitis, is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, a right knee condition, to include patellofemoral pain syndrome and tendonitis, is at least as likely as not related to an in-service injury. 2. Resolving reasonable doubt in the Veteran's favor, a left knee condition, to include chondromalacia and tendonitis, is at least as likely as not related to an in-service injury. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability, to include patellofemoral pain syndrome and tendonitis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a left knee disability, to include chondromalacia and tendonitis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from June 1987 to June 1991. In July 2014, the Veteran testified at a Travel Board hearing before Veterans Law Judge (VLJ) Mark Hindin. A transcript of that hearing is associated with the evidence of record. Subsequently, VA sent the Veteran a letter indicating that VLJ Hindin has since retired and that the Veteran had the opportunity to testify at an additional optional hearing before a VLJ who would make a decision on his claim. See 38 U.S.C. § 7107 (c); 38 C.F.R. § 20.707. The Veteran opted to have another hearing on the above issues and in July 2021, the Veteran appeared at a Board of Veterans' Appeals (Board) hearing via virtual videoconference before the undersigned. A transcript of that hearing is of record. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.306. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309 (a). Arthritis is a qualifying chronic disease and as such may be service-connected solely on the basis of evidence of continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). With regard to secondary service connection, a disability can be service-connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310 (a). Moreover, secondary service connection may also be established by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310 (b). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. Reasonable doubt concerning any matter material to the determination is resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Service connection for a right knee condition 2. Service connection for a left knee condition The Veteran contends that his bilateral knee conditions are due to his military service. The Veteran's service treatment records noted multiple complaints of right knee pain at the distal patella. He was diagnosed with right knee patellofemoral syndrome. The Veteran's April 1991 Report of Medical History noted trick knees. The Board concludes that the Veteran has current diagnoses of left knee chondromalacia, right knee patellofemoral pain syndrome, and bilateral knee tendonitis which was caused by his active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). In September 2015, the Veteran underwent a VA contract examination for knee and lower leg conditions. He was diagnosed with bilateral knee tendonitis. The Veteran reported injuring his right knee during active service and compensating with his left knee since. He was walking with a cane and used a left knee brace for ambulation. Image studies did not show degenerative changes. The examiner opined that the Veteran's left knee condition was likely secondary to his right knee condition as compensation is a known cause of a knee injury. The examiner did not offer an opinion on the Veteran's right knee condition. A March 2016 image study found left knee mild chondromalacia and small joint effusions. In September 2016, a VA examiner found that the Veteran's left knee disability was secondary to the Veteran's right knee tendonitis/tendinosis. However, the examiner opined that it is less likely as not that the Veteran's right knee disability was incurred in or caused by active service as there is insufficient evidence of record to show that the complaint of right knee pain resulted in real, permanent injury. In June 2017, a VA examiner opined that the Veteran's right knee condition is less likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationed that no right knee diagnosis was established in the claims file from 2000 to 2017. In May 2021, the Veteran's treating VA physician opined that it is at least as likely as not that his bilateral knee disabilities are related to military service. The physician explained that the Veteran injured his knees during active service while transporting heavy projectiles over uneven surfaces for long periods of time. The physician found that this task caused significant wear and tear on the Veteran's knees as the Veteran was treated at the Camp Lejeune Naval Hospital for his knees and given a knee brace. The Veteran sought treatment for his knees shortly after separating from active service and had been treated for his knee disabilities since. Notably, the Veteran had not injured his knees since active service and had worked in a totally administrative role. During his July 2021 Board hearing, the Veteran stated that his bilateral knee pain began during active service. In 1989, the Veteran fell off a truck and injured his right knee. He was diagnosed with tendonitis, placed on light duty, and given a knee brace. His right knee pain worsened as he was responsible for carrying heavy ordinance. The Veteran stated that his left knee pain became noticeable as he favored his left leg when carrying heavy ordinance due to his right knee injury. He did not complain of his bilateral knee pain as he was told if he did not perform his duties that he would not be granted leave. Months after separating from active service, the Veteran was diagnosed with patellofemoral syndrome. Bilateral knee pain was noted to cause an abnormal gait. He treated his bilateral knee pain with injections and other medications. Also, in a July 2021 statement, the Veteran's wife noted that he has had continual chronic bilateral knee pain since active service. In a separate letter, the Veteran noted that he injured his right knee when he fell off a truck during active service. He stated that both knees were painful during active service as he was required to carry heavy ordinance. He reported constant knee pain since active service. As noted above, the May 2021 VA physician found that the Veteran's bilateral knee disabilities were attributable to active service. This opinion addressed the STRs, lay reports, military occupational duties, and treatment/diagnoses since active service. The September 2016 and June 2017 negative etiology opinions hinged on a lack of evidence showing chronic knee pain since active service. However, the VA examiners did not address the Veteran's lay reports of bilateral knee pain since active service. The Board acknowledges that lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but are not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Based on the above, the Board finds that the May 2021 opinion is more probative than the September 2016 and June 2017 VA opinions as it is based on an accurate medical history, review of all relevant lay and medical evidence, and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In reviewing the medical evidence of record, reasonable doubt is resolved in the Veteran's favor to find that service connection for a right knee disability, to include patellofemoral pain syndrome and tendonitis, and service connection for a left knee disability, to include chondromalacia and tendonitis, is warranted. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Costello, 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.