Citation Nr: 21074263 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-51 727 DATE: December 14, 2021 ORDER Entitlement to service connection for right knee degenerative joint disease is granted. FINDING OF FACT The Veteran's right knee degenerative joint disease is etiologically related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for right knee degenerative joint disease have been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1977 to August 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Board previously remanded this claim in December 2019 for further development. 1. Entitlement to service connection for right knee degenerative joint disease is granted. Service connection will generally be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may 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). To establish service connection on a direct basis, the evidence must show (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link or nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 252 (1999). For Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the chronic diseases listed in 38 C.F.R. § 3.309(a), including arthritis, service connection may alternatively be established with evidence of chronicity of the disease during service or during a presumptive period following service separation, or by showing a continuity of symptoms after service. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015). When chronicity or continuity is established, subsequent manifestations of the same chronic disease at any later date, no matter how remote in time from the period of service, will be service connected unless clearly attributable to causes unrelated to service ("intercurrent" causes). 38 C.F.R. § 3.303(b). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1376-77. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran asserts that his right knee condition is etiologically related to his active service. Specifically, he asserts that he suffered trauma to his right knee in service, and that he required medical treatment on more than two occasions. See November 2020 Correspondence. The Veteran has a current diagnosis of right knee mild degenerative joint disease and tendonitis. See January 2014, September 2020 VA examinations. Thus, the Veteran has a current right knee disability, and the first element of service connection has been met. As discussed above, the Veteran states that he injured his knee several times in service. He recalled that he was playing football and fell forward, hitting his right knee on some rocks. See September 2020 VA Examination. He suffered an abrasion and was given sick call for his injury. He recalled that he hurt his knee several more times during service but could not recall the actual incidents or dates. See id. After separating from service, the Veteran stated that he treated his right knee with Tylenol, ibuprofen, bengay, and heat, and that he was unaware that he could receive medical treatment from the VA until 2009. See November 2020 Correspondence. The Board finds the Veteran competent to report on the onset and continuity of his current right knee condition. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Additionally, the Veteran's Service Treatment Records (STRs) show that he was treated several times for right knee injuries, including the football injury the Veteran reported. No knee issues were recorded on the Veteran's service entrance examination. See January 1977 STR. A December 1978 STR notes that the Veteran has pain in his right knee, that he has pain when sitting and rising, that he has a history of trauma, and that he has effusion and crepitus. An August 1979 STR shows that the Veteran suffered a right knee contusion while playing basketball. An October 1979 STR shows that the Veteran again injured his right knee playing football, that the reported a history of knee trouble, and that his right knee had crepitus and effusion. Finally, a May 1980 STR notes a right knee injury and that the Veteran needs a bandage change. In light of the multiple reports of right knee injuries documented in Veteran's STR's, as well as the Veteran's competent and credible testimony, the Board finds that the second element of service connection has been met - incurrence of a disease or injury in service. Finally, the Board finds that there is a nexus between the Veteran's right knee disability and his injury incurred in active service. The Board finds the Veteran's statements concerning his continuity of right knee symptoms following service to be credible. The finding that the Veteran has had right knee symptoms since service is supportive of the claim overall because it tends to show that the symptoms that began and were documented in service were the basis for the later diagnosed degenerative joint disease of the right knee. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (recognizing lay statements are competent on in-service and post-service symptoms - dizziness, loss of balance, hearing trouble, stumble and fall, and tinnitus - that were later diagnosed as Meniere's disease). The Board notes that negative nexus opinions exist in the form of the January 2014 and September 2020 VA medical opinions. As noted in the December 2019 remand, the January 2014 VA medical opinion was found to be inadequate as the examiner did not address the Veteran's apparent continuity of symptomatology as shown in his STR's to the present; additionally, the VA examiner did not have access the Veteran's VA medical treatment records which showed that he experienced right knee pain. The Board also finds the September 2020 VA medical opinion inadequate, as the examiner stated that there was no evidence of chronicity of care as the Veteran's symptoms were subjective only; the examiner also stated that the Veteran did not seek any medical care for his right knee for more than 35 years after separation. As the Board noted above, the Veteran is competent to report on the onset and continuity of his right knee symptoms since service. Additionally, the Veteran testified that he relied on self-care for his right knee symptoms as he did not have the financial means to seek medical attention after service, and that he was unaware that he could receive medical treatment at the VA until 2009. See November 2020 Correspondence. Finally, the Veteran's STR's show that he did not have any knee disability prior to entering service. In the absence of any competent and credible evidence supporting a contrary finding, the Board concludes that the Veteran's current right knee degenerative joint disease had its onset during service. Thus, service connection for right knee degenerative joint disease is granted. See 38 C.F.R. § 3.303. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Mohammad 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.