Citation Nr: 21076726 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 20-04 350 DATE: December 27, 2021 ORDER Entitlement to service connection for right knee strain is granted. FINDING OF FACT Resolving all doubt in the Veteran's favor, the Veteran's right knee disability is etiologically related to his service. CONCLUSION OF LAW The criteria for entitlement to service connection for right knee disability have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from August 1963 to August 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In a December 2019 rating decision, service connection for obstructive sleep apnea and hypertension was granted. This represents a full grant of the benefits sought, and the issued are no longer in appellate status. Service Connection 1. Entitlement to service connection for right knee strain is granted. Service connection may be granted for 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). To establish a right to compensation for a present disability, 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. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2017). In addition, service connection for certain chronic diseases, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran alleges that his right knee condition is due to an injury in-service. First, the Board finds that there is a current disability. The Veteran was diagnosed with right knee strain in an October 2018 VA examination. In February 2020 the Veteran's representative also submitted an MRI of the Veteran's right knee. The MRI revealed a complex tear at the medial meniscal body and posterior horn. Second, the Board finds that there was an in-service event, injury, or disease. The Veteran provided testimony at the August 2021 hearing that he injured his right knee in service when his knee was caught in a doorway. He stated that he wrenched his knee causing a twisting injury. A December 1965 STR documented the Veteran's complaints of right knee pain on movement. It was noted that the Veteran suffered a twisting injury that resulted in some swelling. Third, the Board finds that the evidence of record does support a finding that the right knee condition is related to active service. In an October 2018 opinion, the VA examiner determined that the Veteran's right knee strain was less likely than not related to service. The examiner noted that there was a lack of medical records that showed complaint of or treatment for a chronic knee problem after his military service. The examiner also emphasized that the Veteran's 1967 report of medical history did not include any complaints regarding the knee. The examiner then noted that the Veteran only complained of knee pain for six months in November 2013 and that x-rays from that time showed degenerative joint disease which is related to age. In October 2020, the Veteran submitted a private opinion. The physician reiterated the Veteran's lay statements regarding his in-service injury. He then noted that the January 2020 imaging studies indicated that the Veteran had several knee conditions to include mild tricompartmental knee arthrosis and Baker's cyst. The physician determined that the Veteran experienced significant trauma to the knee in-service and that the Veteran had simply chosen to bear the pain until he could no longer handle it. He stated that it was significant that the Veteran was diagnosed with five degenerative conditions of the right knee following the January 2020 imaging study rather than just one. The physician found that the Veteran was severely arthritic and that degenerative conditions, when induced by trauma, could develop years following said trauma. He stated that there was no doubt that when the Veteran sought treatment for his right knee, his degeneration had existed for a long time, given the progression. The physician also noted that the Veteran did not have any significant degeneration is his left knee. He also stated that twisting injuries to the knee, like the one suffered by the Veteran in service, were particularly traumatic to knee joints. As such, the physician opined that the Veteran's right knee conditions were at least as likely as not due to the in-service injury. (Continued on the next page) There are both positive and negative opinions of record as to the etiology of the right knee disability. Both opinion providers are competent and credible, and their opinions are given equal probative weight. Given that his right knee condition has been deemed related to service and there is a positive medical opinion, the Board finds that the evidence is at least in equipoise to support the establishment of service connection for a right knee condition. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AK 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.