Citation Nr: 21075126 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 16-48 921 DATE: December 17, 2021 ORDER Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right hip disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding the Veteran's cervical strain began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence reflects the Veteran's right knee strain, meniscal tear and osteoarthritis were not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 3. The preponderance of the evidence is against finding the Veteran's left knee strain began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding the Veteran's right hip strain began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.. 2. The criteria for service connection for right knee disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. 3. The criteria for service connection for left knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training (ACDUTRA) from August 1982 to September 1982 and also served in the Army Reserve and Army National Guard. The Veteran has already been granted service connection for disability during this period of ACDUTRA, establishing that he has been disabled due to a disease incurred in the line of duty during this period of ACDUTRA. Therefore, Veteran status has been established for this period of ACDUTRA service. See Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998). Service Connection Generally, service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Under VA regulations, in addition to a disability incurred in or aggravated by active duty, service connection may be granted when the individual concerned was disabled or died from a disease or injury, incurred or aggravated in the line of duty during a period of ACDUTRA. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6. A claimant may also be service connected for an injury or, and/or a disease, incurred while proceeding directly to or returning directly from ACDUTRA. 38 C.F.R. § 3.6(e). To establish service connection on a direct incurrence basis, 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. Shedden v. Principi, 381 F.3d 1163, 1167 Fed. Cir. (2004). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. 1. Entitlement to service connection for a cervical spine disability is denied. The Veteran contends that service connection is warranted for a cervical spine disability. The Veteran reports that his current neck pain, limited movement, and radiating pain, are related to an in-service injury. The Veteran reports during boot camp, he fell while running in formation and sustained a back injury during the fall. The Veteran reports that his neck was also injured in this fall and he has experienced ongoing symptomology since service. The Veteran reports ongoing neck pain and decreased range of motion, and increased flare ups of pain with lifting objects and turning his head while driving. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a cervical spine disability that began during service or is at least as likely as not caused by an in-service injury or disease. The Board concludes that the Veteran has a current cervical spine disability, best characterized as a cervical strain. Specifically, a September 2021 VA examiner endorsed a diagnosis of a cervical strain. Thus, the question becomes whether the Veteran's current disability of a cervical strain is related to service. The Veteran's service treatment records (STRs) and service personnel records have been associated with the claims file. The STRs do not refer to a cervical spine disability. An August 12, 1982 STR noted the Veteran was seen for low back pain secondary to a fall but the corresponding examination noted no neuropathy, sciatic or problems with gait, and a straight leg test was negative. On August 16, 1982, the Veteran was seen for ongoing low back pain lasting for 4 days with tenderness and an inability to perform full range of motion. A possible fracture of the coccyx was noted, and x-ray imaging was recommended with no running, lifting, or sit-ups, for 24 hours. An August 17, 1982 STR noted the Veteran reported tenderness over both SI joints and range of motion was within normal limits. A diagnosis of a muscle strain was endorsed. Based on the Veteran's statements and STRs, the Board finds an in-service a fall occurred, but without a clear diagnosis of a cervical spine disability or associated symptomology. The Veteran was afforded a VA spine examination in October 2000. The October 2000 examiner noted reports of pain, weakness and stiffness in the neck. X-ray imaging of the cervical spine was negative, and a cervical strain was noted. The Veteran was afforded a VA neck examination in September 2021 and the examiner noted a cervical strain. Reduced range of motion was noted with guarding and less movement than normal. Physical examination noted normal reflexes, normal muscle strength, a normal sensory exam and no evidence of radicular symptomology in the upper extremities. The September 2021 VA examiner noted the Veteran's cervical strain impacted his ability to perform occupational tasks in that the Veteran reported he was unable to lift objects, and has difficulty driving due to neck pain when turning his head. The September 2021 VA examiner found that it was less likely than not that the Veteran's cervical strain was incurred in or caused by the claimed in-service injury, event or illness. The September 2021 VA examiner noted the Veteran's in-service fall during bootcamp in August 1982. Specifically, the September 2021 VA examiner noted that the Veteran was seen in August 1982 reporting low back pain after a fall but physical examination noted there was no abnormal gait, neuropathy or sciatica, a straight leg test was negative, and x-ray imaging in August 1982 of the sacroiliac joint was negative. The September 2021 VA examiner also noted the Veteran was placed on a profile for 1 week with no running, jumping, marching or lifting weight greater than 10 pounds. The September 2021 VA examiner noted there was no mention of neck pain during the medical visits pertaining to the Veteran's August 1982 in-service fall. The September 2021 VA examiner noted the Veteran's reports of injuring his upper neck during the in-service fall were inconsistent with the evidence of record, specifically medical records first noted complaints of neck pain in 2000. The September 2021 VA examiner further explained x-ray imaging in 2000 was negative and the Veteran was diagnosed with a cervical strain. As such, the September 2021 VA examiner found that the Veteran's cervical strain was less likely than not incurred in or caused by the claimed in-service injury, event or illness. VA and private treatment records have been associated with the claims file. A review of these records notes the earliest self-reports of cervical spine pain and upper extremity numbness are dated in October 2000. The October 2000 VA examination report first noted pain and stiffness in the neck, x-ray imaging was negative, and a diagnosis of a cervical strain was endorsed. Treatment records also note reports of neck pain, stiffness and weakness. These treatment records do not contradict the VA examination reports and are absent of any link between the Veteran's current cervical spine disability and an in-service disease or injury. After consideration of all the evidence of record, the Board finds that the weight of the evidence is against finding that service connection for a cervical spine disability is warranted. The Board concludes that service connection for a cervical spine disability on a direct incurrence basis is not warranted as the Veteran's current cervical spine disability was not caused by service. The Veteran's lay statements regarding his current symptoms, in-service events and ongoing symptomology are afforded low probative weight. While the Veteran reports that his current cervical spine disability is related an in-service injury, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service, and as such, the Veteran is not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377. The Board finds that the medical evidence is more probative and credible than the lay opinions of record. In this regard, the competent medical evidence, including the VA September 2021 VA examiner's opinion, is entitled to significant probative weight. Specifically, the September 2021 VA examiner's opinion is probative, because the examiner considered the Veteran's contentions and provided an explanation that contained clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As such the Board finds that the Veteran's cervical spine disability is less likely than not caused by active service. In conclusion, the Board finds that the weight of competent and credible evidence is against the Veteran's claim for service connection for a cervical spine disability. The benefit of the doubt rule is not applicable. 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 2. Entitlement to service connection for a right knee disability is denied. 3. Entitlement to service connection for a left knee disability is denied. The Veteran contends that service connection is warranted for a left knee disability and a right knee disability. For the sake of brevity, the Board will discuss the Veteran's claims for a left knee disability and right knee disability together. The Veteran reports that his ongoing left and right knee pain is related an in-service fall during bootcamp in August 1982. The Veteran reports during boot camp, he fell while running in formation, injured his left and right knees, and he has experienced ongoing symptomology since service. The Veteran reports pain and decreased mobility in his knees. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms. Jandreau, 492 F.3d at 1377. The question for the Board is whether the Veteran has a left knee disability and/or right knee disability that began during service, manifested during the applicable presumptive period, or are at least as likely as not caused by an in-service injury or disease. The Board concludes that the Veteran has a current left knee disability, best characterized as a knee strain, and a right knee disability, best characterized as a knee strain, meniscal tear and osteoarthritis. Specifically, a September 2021 VA examiner endorsed these bilateral knee diagnoses. Thus, the question becomes whether the Veteran's current disabilities of each knee are related to service, The Veteran's STRs, as discussed above, document an in-service fall; however, the STRs do not refer to any left and right knee pain or related symptomology. Based on the Veteran's statements and STRs, the Board finds an in-service a fall occurred, but without a clear diagnosis of a left or right knee disability or associated symptomology. The Veteran was afforded a VA knee and lower leg examination in September 2021. The September 2021 VA examiner noted a left knee strain and right knee strain, meniscal tear and osteoarthritis and documented the Veteran reported flare-ups of pain, with difficulty walking or standing for extended periods of time, and daily swelling of the knees. The September 2021 VA examiner noted review of a December 2020 right knee MRI, which noted multidirectional tearing of the posterior horn of the body of the medial meniscus and osteoarthritis of the medial patellofemoral compartments with large joint effusion. The September 2021 VA examiner also noted the Veteran's left and right knee conditions impacted his ability to perform occupational tasks in that he was unable to walk or stand for extended periods of time, and was unable to complete household chores such as sweeping. However, the September 2021 VA examiner found that the Veteran's left and right knee disabilities were less likely than not incurred in or caused by the claimed in-service injury, event or illness. The September 2021 VA examiner noted review of the Veteran's in-service treatment records and reports of a fall during bootcamp. Specifically, the September 2021 VA examiner noted that the Veteran was seen in August 1982 reporting low back pain after a fall and physical examination noted there was not any abnormal gait, neuropathy or sciatica, and he was placed on a profile for 1 week with no running, jumping, marching or lifting weight greater than 10 pounds. The September 2021 VA examiner noted there was no mention of a bilateral knee injury or pain during the medical visits pertaining to the Veteran's in-service August 1982 fall. The September 2021 VA examiner explained there were numerous medical notations, starting in 2014, noting a diagnosis of obesity. The September 2021 VA examiner noted an article by the American Academy of Orthopaedic Surgeons from March 2015, found "that obesity frequently contributes to soft tissue damage and osteoarthritis, which is a progressive wear and tear of the joints." Further, the September 2021 VA examiner explained the article also noted that the impact of obesity was especially felt in osteoarthritis of the hip and knee joints. As such the September 2021 VA examiner found that the Veteran's bilateral knee pain and decreased mobility were likely due to his history of obesity. Thus, after review of the medical and lay evidence of record, and current medical literature, the September 2021 VA examiner found that the Veteran's left knee strain, and his right knee strain, meniscal tear and osteoarthritis, were less likely than not incurred in or caused by the claimed in service injury. VA and private treatment records have been associated with the claims file. A review of these records shows that the earliest self-reports of left and right knee symptomology began in September 2002. Social Security Administration records in October 2013 note reports of arthritis pain and swelling in the knees. These treatment records do not contradict the VA examination and are absent indication between the Veteran's current left and right knee disabilities and an in-service disease or injury. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for a left and right knee disability is warranted. The Board concludes that service connection for a left and right knee disability on a direct incurrence basis is not warranted as the Veteran's current left and right knee disabilities were not caused by service. The Veteran's lay statements regarding his current symptoms, in-service events and ongoing symptomology are afforded low probative weight. While the Veteran reports that his current left and right knee disabilities are related to an in-service injury, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service, and as such, the Veteran is not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377. The Board finds that the medical evidence is more probative and credible than the lay opinions of record. In this regard, the competent medical evidence, including the VA September 2021 VA examiner's opinion, is entitled to significant probative weight. Specifically, the September 2021 VA examiner's opinion is probative, because the examiner considered the Veteran's contentions and provided an explanation that contained clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. As such the Board finds that the Veteran's current left and right knee disabilities are less likely than not caused by active service. As to presumptive service connection, the Veteran's osteoarthritis of the right knee did not manifest until many years post-service. The Board concludes that while the Veteran has osteoarthritis of the right knee, which falls within a chronic disease under 38 U.S.C. § 1101 (3) and/or 38 C.F.R. § 3.309(a), however such was not chronic in service nor did such manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. The Veteran's osteoarthritis of the right knee was not noted during service or within one year of separation. Walker, 708 F.3d 1331. Service records do not support an onset of the Veteran's osteoarthritis of the right knee in active service. Based on the probative evidence of record, the Board finds that the Veteran's osteoarthritis of the right knee did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. In addition, in weighing the evidence of record, the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection for osteoarthritis of the right knee based on continuity of symptomology is not warranted. In conclusion, the Board finds that the weight of competent and credible evidence is against the Veteran's claims for service connection for a left knee disability and a right knee disability. The benefit of the doubt rule is not applicable. 38 U.S.C. § 5107 (b); Ortiz, 274 F.3d at 1364; Gilbert, 1 Vet. App. at 55-57; 38 C.F.R. § 3.102. For these reasons, the claims are denied. 4. Entitlement to service connection for a right hip disability is denied. The Veteran contends that service connection is warranted for a right hip disability. The Veteran reports that his ongoing right hip pain and symptomology is related to his in-service August 1982 injury and fall in bootcamp. Further, the Veteran reports ongoing right hip pain and symptomology since service. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms. Jandreau, 492 F.3d at 1377. The question for the Board is whether the Veteran has a right hip disability that began during service or is at least as likely as not caused by an in-service injury or disease. The Board concludes that the Veteran has a current right hip disability, best characterized as a hip strain. Specifically, a September 2021 VA examiner endorsed a diagnosis of a right hip strain. Thus, the question becomes whether the Veteran's current right hip strain is related to service. The Veteran's STRs, as discussed above, document an in-service fall; however, the STRs do not refer to any right hip pain or related symptomology. Based on the Veteran's statements and STRs, the Board finds an in-service a fall occurred, but without a clear diagnosis of a right hip disability or associated symptomology. The Veteran was afforded a VA hip and thigh conditions examination in September 2021. The September 2021 VA examiner noted a right hip strain and the corresponding examination noted pain, localized tenderness, interference with standing and disturbance of locomotion. The September 2021 VA examiner noted that the Veteran's right hip disability impacted his ability to perform occupational tasks in that he has difficulty walking or standing for extended periods and completing repetitive movements due to hip pain. However, the September 2021 VA examiner found that the Veteran's right hip condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The September 2021 VA examiner noted the Veteran's injury in August 1982 during bootcamp. However, the September 2021 VA examiner noted there was no mention of right hip pain during his August 1982 medical visits pertaining to his in-service fall. The September 2021 VA examiner noted numerous medical notations in 2014 noting a diagnosis of obesity. The September 2021 VA examiner further explained an article by the American Academy of Orthopaedic Surgeons from March 2015, noted "that obesity frequently contributes to soft tissue damage and osteoarthritis, which is a progressive wear and tear of the joints." Further, the September 2021 VA examiner explained the article noted that the impact of obesity was especially felt in osteoarthritis of the hip and knee joints. As such, the September 2021 VA examiner found that the Veteran's right hip pain and decreased mobility were likely due to his history of obesity. After a review of the medical and lay evidence of record, and current medical literature, the September 2021 VA examiner found that the Veteran's right hip strain was less likely than not incurred in or caused by the claimed in service injury. VA and private treatment records have been associated with the claims file. A review of these records shows the earliest self-reports of right hip symptomology began in 2015. These treatment records do not contradict the VA examination and are absent indications between the Veteran's current right hip disability and an in-service disease or injury. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for a right hip disability is warranted. The Board concludes that service connection for a right hip disability on a direct basis is not warranted as the Veteran's current right hip disability was not caused by service. The Veteran's lay statements regarding his current symptoms, in-service events and ongoing symptomology are afforded low probative weight. While the Veteran reports that his current right hip disability is related an in-service injury, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service, and as such, the Veteran is not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377. The Board finds that the medical evidence is more probative and credible than the lay opinions of record. In this regard, the competent medical evidence, including the VA September 2021 VA examiner's opinion, is entitled to significant probative weight. Specifically, the September 2021 VA examiner's opinion is probative, because the examiner considered the Veteran's contentions and provided an explanation that contained clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. As such the Board finds that the Veteran's current right hip disability is less likely than not caused by active service. In conclusion, the Board finds that the weight of competent and credible evidence is against the Veteran's claim for service connection for a right hip disability. The benefit of the doubt rule is not applicable. 38 U.S.C. § 5107 (b); Ortiz, 274 F.3d at 1364; Gilbert, 1 Vet. App. at 55-57; 38 C.F.R. § 3.102. For these reasons, the claim is denied. M. ESPINOZA Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.R. Kardian, 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.