Citation Nr: 21074544 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 17-36 806 DATE: December 15, 2021 ORDER Entitlement to service connection for left and right knee disabilities is granted. FINDING OF FACT The Veteran's left and right knee conditions are etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for left and right knee disabilities have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service with the U.S. Army from August 1997 to August 2000. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In October 2019, the Veteran had a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is of record. The Board remanded the issue, along with claims of service connection for foot and thoracolumbar disabilities, in December 2019, for provision of examinations. During the pendency of the remand, the AOJ granted service connection for the foot and back disabilities in an August 2020 decision, fully satisfying those appeals. In February 2021, the claim related to the knees was again remanded for provision of an adequate examination and nexus opinion. The matter is now back before the Board. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). For secondary service connection, it must be shown that the disability for which the claim is made is proximately due to or aggravated by a service-connected disability. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Service treatment records (STRs) showed no disabilities or conditions of the knees on entry into service. STRs documented that the Veteran complained of bilateral knee pain in February 1999. The Veteran reported aching pain in both knees with flexing and extending for prolonged periods. While he had some problems in high school sports, the current problems were aggravated by a recent jump. Patellar tendonitis was diagnosed. He bumped the left knee on a bed in May 1999, and acute bursitis was noted. Treatment was required for several weeks. A January 2000 dental treatment record noted the Veteran had a knee injury and had seen a physical therapist in the past nine months. Post service treatment records documented continued complaints and treatment for a bilateral knee condition. A November 2019 VA treatment record documented that he had chronic knee pain that was likely osteoarthritis. At a January 2020 examination, the Veteran reported his knees began hurting in service after parachute jumps. The examiner reviewed the claims file, but did not note all the reports of knee problems. Physical examination was normal, though complaints of pain with movement were noted. The examiner diagnosed current bilateral knee strain, but opined as to bilateral patellar tendonitis. She relied primarily on the absence of medical records. In March 2021, the Veteran was afforded a new VA examination. The VA examiner opined positively that the bilateral knee pain was at least as likely as not aggravated by service. However, the examiner for some reason found the condition clearly and unmistakably pre-existed service, and was then aggravated by parachute jumps. The Veteran was unable to walk or stand for long periods due to ongoing pain. She noted that he had a normal X-ray in January 2020, and the most likely reason was because it was a soft tissue injury and would not show on a conventional x-ray. In August 2021, an addendum opinion was obtained by the AOJ. However, the examiner again applied an incorrect standard, stating that a knee condition clearly and unmistakably pre-existed service and was clearly and unmistakably not aggravated by service. She then noted the entrance physical was normal, and there was only a speculative reference to high school in the STRs. Such is completely inconsistent with her statements regarding pre-existence. She then discussed studies regarding parachute jumping and the impact on injuries, stating that "late onset" problems were not supported by such. Contradictorily, she then stated the Veteran's problems were late onset despite the directive to consider his competent and credible reports of pain in and since service. The opinions from March 2021 and August 2021 have zero probative value. Accordingly, there is no adequate nexus opinion of record; the Board finds that further development and delay would be fruitless and counterproductive. The current record reflects the onset of chronic left and right knee problems in service, directly related to parachute jumps. The Veteran has competently and credibly reported continual symptoms since that time. He has a current disability of each knee manifesting in pain, consistent with his in-service and post-service complaints. Service connection for left and right knee disabilities is warranted. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Baxter 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.