Citation Nr: 21074758 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 18-43 043 DATE: December 16, 2021 ORDER Service connection for a left knee disability is denied. Service connection for a right knee disability is denied. FINDINGS OF FACT 1. The Veteran's left knee disability is not causally or etiologically related to any disease, injury, or incident in service. 2. The Veteran's right knee disability is not causally or etiologically related to any disease, injury, or incident in service. CONCLUSIONS OF LAW 1. The criteria for an award of service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for an award of service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1971 to October 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in July 2021, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denials and returned the case to the Board. Service Connection The Veteran seeks to establish service connection for bilateral knee disabilities. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). For chronic diseases listed in 38 C.F.R. § 3.309(a), including arthritis, an alternative to the nexus requirement exists: A Veteran may demonstrate a relationship to service through a showing of continuity of symptomatology since service. 38 C.F.R. § 3.303. Under the continuity of symptoms provision, "symptoms, not treatment, are the essence of any evidence of continuity of symptom[s]." Savage v. Gober, 10 Vet. App. 488, 496 (1997). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board finds that service connection for a left knee disability or right knee disability is not warranted. With regard to a current disability, the Veteran has current diagnoses of bilateral knee pain and degenerative joint disease (DJD). See October 2021 VA Opinion. Thus, the first element of service connection is met. See Davidson, 581 F.3d 1313. With regard to an in-service injury, the Veteran attributes her current conditions to injuries sustained in service. Specifically, she stated that her knee disabilities are due to a motorcycle accident during her service in 1975. See December 2016 VA Examination. The Veteran's service treatment records reflect she was treated for multiple small superficial lacerations on both knees in April 1975. With regard to nexus, however, the Board finds that the probative evidence of record does not support a link between the Veteran's current disabilities and service. There is no medical evidence linking a current disability of the left or right knee to service and no evidence of arthritis of the knees becoming manifest to a degree of 10 percent or more within one year of service. In December 2016, a VA examiner provided negative nexus opinions because the Veteran did not have diagnosed knee disabilities at the time. In October 2021, a VA examiner opined that the Veteran's bilateral knee disabilities were less likely than not due to or incurred in during the Veteran's service, including her military occupational specialty (MOS), training, and knee lacerations occurring1975. The examiner found that although the Veteran was noted to have been involved in a motorcycle accident, in which she sustained 3 right knee lacerations in April 1975, the records also specifically noted "joint not involved." The examiner found that the Veteran did not have a knee joint injury but rather a skin injury which occurred at the knee. The examiner noted that the March 1976 Report of Medical History reflected resolution of any knee complaints, as "trick knee" was specifically negative. Furthermore, periodic medical examinations afterwards were negative for any knee conditions in both knees. The examiner found the Veteran's bilateral DJD was part of the natural aging process and age-appropriate. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran's claims. While the evidence of record shows that the Veteran has current knee disabilities diagnoses, the probative evidence demonstrates that they are not related to service. In this regard, the Board places great probative weight on the October 2021 VA examiner's opinion as it sets out clear conclusions and supporting data, as well as a reasoned medical explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), Stefl v. Nicholson, 21 Vet. App. 120 (2007). The Board acknowledges the Veteran's contentions to the effect that her knee current disabilities are related to her knee injuries sustained during service. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts that they have observed and are within the realm of their personal knowledge but are not competent to establish that which would require specialized knowledge or training, such as medical expertise. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). In the instant case, the Board finds that questions regarding the potential relationship between the Veteran's bilateral knee pain and DJD and any instance of service to be complex in nature. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Thus, while the Veteran is competent to describe the manifestations of her bilateral knee pain and DJD, the Board must accord her statements regarding the etiology of her disabilities little probative value. Although the Board is appreciative of the Veteran's faithful and honorable service, given the record before it, the Board must find that her current bilateral knee disabilities are not shown to be causally or etiologically related to any disease, injury, or incident during service. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claims. As such, that doctrine is not applicable, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. L. BARSTOW Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Gandhi, 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.