Citation Nr: 21074215 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 14-00 522 DATE: December 14, 2021 ORDER Entitlement to service connection for left knee arthritis is granted. FINDING OF FACT The Veteran's left knee arthritis had its onset during active service. CONCLUSION OF LAW The criteria for service connection for left knee arthritis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from August 1966 to May 1970 and was awarded the Vietnam Service Medal by virtue of service in waters contiguous to the Vietnam war zone and the Combat Action Ribbon after his ship was attacked by enemy forces in February 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2012 rating decision by the Houston, Texas Department of Veterans Affairs (VA) Regional Office (RO). In November 2016, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing. In May 2020, the Board denied entitlement to service connection for a left knee disorder. The Veteran appealed the Board's May 2020 decision to the United States Court of Appeals for Veterans Claims (Court). In a January 2021 Order, the Court granted the parties' Joint Motion for Partial Remand vacating the denial and remanding the Veteran's service connection claim for a left knee disorder. Specifically, the parties agreed that the Board erred when it failed to consider whether service connection for a left knee disorder could be granted on a presumptive basis under § 3.303(b) as the Board acknowledged the Veteran's contentions that left knee pain has been continuous since discharge from service and he has a current diagnosis of degenerative arthritis. Service Connection Entitlement to service connection for a left knee disorder. 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. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Service connection may also be established on a presumptive basis for specific chronic diseases listed in 38 C.F.R. § 3.309(a), such as arthritis, established during active service with subsequent manifestations of the same chronic disease at any later date, however remote, unless clearly attributable to incurrent causes. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). If the evidence is not sufficient to show that the disease was chronic at the time of service, the claim may be established with evidence of continuity of symptoms after service, which is a distinct and lesser evidentiary burden than the nexus element under Shedden. Walker, 708 F.3d at 1338; 38 C.F.R. § 3.303(b). The Veteran contends his left knee disorder was caused by active service. Specifically, the Veteran stated that while carrying 85-pound projectile ammunition down a ladder well, he slipped and fell off the ladder, landing on his left knee and severely injuring it. He further stated that since the in-service fall, he has had recurrent left knee pain, to include the tibial tubercle area, stiffness, and difficulty bending, climbing stairs, running and squatting. See November 2016, Hearing transcript; January 2013, Notice of disagreement (NOD); April 2010, VA Form 21-4138. A January 1968 service treatment record (STR) indicates the Veteran sought treatment for ongoing left knee pain two months after he fell down a ladder well onto his knee. At the time of treatment, the Veteran's knee pain had moved from the site of injury (i.e., lateral patella) to the tibial tubercle area and was tender. See January 1967, STR. Post-service treatment records include a diagnosis of left knee degenerative arthritis. See VA examinations dated July 2019 and September 2021. A 1970 medical record indicates the Veteran was given a shot for pain and in 1976, he complained of left knee pain for two weeks. See VA treatment records dated September 1970 and March 1976. In April 2000, the Veteran's private orthopedist examined the Veteran and noted the Veteran's ongoing problems with his left knee since he fell during service. Dr. G.G. further stated the Veteran's left knee was sore from the date of injury until 1999 when left knee symptoms caused him to have two additional falls, thus reinjuring his knee. At the time of the examination, the Veteran complained of left knee pain, limited range of motion, and limited use of his knee. See April 2000, Private treatment record. At the Board hearing, the Veteran testified to experiencing recurrent left knee pain since his in-service injury. He further stated that left knee symptoms continued to worsen after discharge to include increased pain, stiffness, swelling, and occasional locking. He reported that several years after discharge from service, left knee locking caused him to fall and reinjure his knee on two occasionsonce when he was walking and a second time during a chase. The Veteran stated he is unable to take steroids or cortisone because it negatively impacts his glucose readings, and topical painkillers are ineffective. See November 2016, Hearing transcript. Lay statements submitted by the Veteran's wife of over 50 years and children indicate that the Veteran has had knee problems ever since he fell during service while carrying 85-pound ammunition rounds. The Veteran's wife recalled receiving a letter from the Veteran while he was on active duty concerning the injury and his reports of intense left knee pain. After service, the Veteran's wife and children stated the Veteran's left knee symptoms continued to worsen to include increased pain, swelling, locking, and difficulty walking and climbing. See November 2016, VA Forms 21-4138. In light of the above, the Board finds service connection for a left knee disorder is warranted. The Board notes the Veteran, his wife, and children's competent and credible lay statements that left knee pain began during active service after a fall and has been recurrent since discharge, to include worsening symptoms of locking. See Charles v. Principi, 16 Vet. App. 370, 374 (2002); see also Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Additionally, the Board finds the 1999 falls which reinjured the Veteran's left knee were the result of worsening symptoms of locking and increased pain from the in-service fall; therefore, the left knee reinjury was not clearly attributable to incurrent causes. The Board acknowledges the May 1993, January 2012, November 2013, July 2019, and September 2021 VA examiners' negative nexus opinions but assigns little probative weight to same as they all failed to consider the 1970 and 1976 private treatment records indicating continuing left knee pain, lay statements by the Veteran's family members indicating continuity and worsening of left knee symptoms, and because the evidence of record establishes the Veteran's left knee disorder became manifest while he was on active duty. Resolving all reasonable doubt in the Veteran's favor, service connection for a left knee disorder is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Straughn, Shavonne 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.