Citation Nr: 21075673 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 12-14 502A DATE: December 21, 2021 ORDER Entitlement to service connection for a left knee disability is denied. FINDING OF FACT The evidence does not demonstrate that the Veteran's current left knee disability was caused by his military service. CONCLUSION OF LAW The criteria for service connection for a left knee disability have not been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1969 to March 1971. The matter is on appeal before the Board from a March 2010 rating decision. The Board previously remanded the issue for further development in January 2016, March 2018, May 2020, and May 2021. Entitlement to service connection for a left knee disability Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases, including arthritis, will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). At the outset, the Board finds that there is no evidence of record indicating that the Veteran had left knee arthritis that manifested within one year of service nor is there continuity of symptomatology. Therefore, service connection cannot be granted on a presumptive basis. The Veteran contends that his current left knee disability originated during his military service. Specifically, the Veteran asserts that his 2008 injury resulting in a left knee meniscus tear and arthroscopic surgery was caused by the left knee buckling due to a left knee disability that existed during service. Service treatment records (STRs) contain an August 1969 x-ray of the left knee noting no significant abnormalities and are otherwise silent for any complaints, treatment, or diagnosis of any knee disorder. However, the Veteran's March 1971 separation examination indicated a complaint of left knee pain secondary to "soft tissue injury." Post-service VA treatment records demonstrate that the Veteran reported left knee pain as early as 2002; however, October 2002 radiology reports indicate a normal left knee. Further VA records show complaints of knee pain beginning in June 2004. Radiology reports of May 2004 and August 2007 continue to show a normal left knee. In May 2008, the Veteran reported knee pain and swelling for five days with no specific injury and a radiology report indicated an essentially normal left knee. In September 2008, the Veteran reported left knee pain after stepping off of a semi-truck and twisting the knee; an MRI confirmed a left knee meniscus tear. He underwent a left knee arthroscopy with meniscectomy in October 2008. The Veteran submitted a single private treatment record from June 2004 that noted a history of arthritis. An August 2010 VA treatment note contained a bone scan showing bilateral knees basically unremarkable with mild degenerative changes. In determining that direct service connection is unwarranted in this case, the Board finds the negative opinion provided by the VA physician in July 2021 to be the most probative evidence of the record. The examiner opined that the Veteran's current left knee disability is less likely than not related to military service. After review of the evidence in its entirety, the examiner noted that there is a lack of medical evidence showing treatment for a left knee injury from the Veteran's separation examination and his meniscus surgery in 2008 secondary to a fall. In her opinion, the examiner acknowledged the Veteran's contention that his fall was due to buckling of the knee related to his in-service left knee condition; however, she stated that increase in age increases the incidence of buckling of the knees. She noted that the most common causes of knee buckling are arthritis, torn ligaments, bone fragments, dislocation of the kneecap, and inflammation, and that the Veteran's medical records are silent for the treatment of any of these causes during service or immediately post-service. Therefore, she concluded that the Veteran's soft tissue injury/trauma documented on discharge examination did not cause and is not related to the Veteran's current left knee disability and did not cause his fall in 2008 resulting in a meniscectomy. As the July 2021 VA opinion reflects consideration of all relevant facts and is supported by an adequate rationale, the Board finds it carries great weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding it is the factually accurate, fully-articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). The Board also notes that negative nexus opinions were provided by VA examiners in February 2010, July 2017, June 2019, and October 2020, finding that the Veteran's current left knee disability is less likely than not related to his military service. Although found to be inadequate in prior Board remands, the Board emphasizes that there is no competent medical opinion of record to the contrary. The Veteran's representative, in a September 2021 informal hearing presentation, asserted that the examiner did not provide an explanation for the opinion. Then the representative also notes that common causes of knee buckling were listed without explanation. The examiner noted the history of the disability, to include an intervening event (knee twisting as he stepped off a semi-truck). As for whether this was an isolated incident, also raised by the representative, the examiner considered the Veteran's lay statements as to history of the knee prior to giving the July 2021 opinion. The Board has also considered the Veteran's statements, to include his specific assertion that his left knee injury resulted from instability (buckling) due to a then already existing left knee disability, resulting in superimposed pathology. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., pain; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. (Continued on the next page) Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a left knee disability, and the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Sneeringer, Associate 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.