Citation Nr: 21077225 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 15-23 107 DATE: December 29, 2021 ORDER Service connection for a bilateral knee disability is granted. Service connection for a bilateral ankle disability is granted. FINDINGS OF FACT 1. The Veteran began experiencing symptoms of his current bilateral knee disability during service, and he has continued to experience those symptoms since separation from service. 2. The Veteran began experiencing symptoms of his current bilateral ankle disability during service, and he has continued to experience those symptoms since separation from service. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral knee disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a bilateral ankle disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1989 to August 1993, from April 1994 to April 1997, and from July 1997 to October 2011, to include service in Southwest Asia during the Persian Gulf War. In August 2018, January 2020, February 2021, and June 2021, the Board of Veterans Appeals (Board) remanded this appeal for further evidentiary development. 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; 38 C.F.R. § 3.303(a). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection can also be established through application of a statutory presumption for chronic diseases when manifested to a compensable degree within a year of separation from service. 38 C.F.R. §§ 3.307, 3.309. If a chronic disease is not manifested to a compensable degree within a year of separation of service, then, generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Further, a layperson is competent to report on the onset and continuity of his or her current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). The Veteran contends that his current bilateral knee and bilateral ankle disabilities onset during his active duty. Service treatment records reflect treatment for left ankle and left knee pain in March 1993 but make no references to the Veteran's right knee or right ankle. VA treatment records reflect diagnoses of bilateral patellofemoral pain syndrome and bilateral ankle tendonitis. In multiple written statements, the Veteran reports that both his bilateral knee pain and bilateral ankle pain began during service and has continued since his separation. See June 2013 NOD and May 2017 Form 9. He also reported that, throughout his 21 years of service, he participated in numerous physical activities, such as physical training, long road marches, Airborne School and Air Assault School, which he feels contributed to his current chronic bilateral knee and bilateral ankle pain. During the course of this appeal, the Veteran has been afforded VA examinations in March 2013, November 2013, June 2019. However, for reasons discussed in the previous Board decisions, there were deficiencies with each of these examinations, and the Board found these examinations to be inadequate. Therefore, they will not be discussed at length in this decision. In April 2021, the Veteran was afforded another VA examination. He reported that he began experiencing bilateral knee and bilateral ankle pain while in service and that such symptoms have continued since. He described that pain as constant aching and soreness and explained that the pain in these joints has progressively worsened since his separation from service. He denied any specific event or injury which caused the pain, explaining that the onset was gradual during physical training and high-impact activities. The examiner diagnosed bilateral patellofemoral pain syndrome and bilateral ankle tendonitis but opined that it was less likely than not that these conditions were incurred in, or caused by, his service. The examiner explained that there was no medical evidence that the Veteran had sought treatment for a bilateral knee condition or a bilateral ankle condition during service or soon after separation therefrom. Thus, the examiner explained that a nexus between his current disabilities and his service could not be established. In the June 2021 remand, the Board remanded this matter to obtain an addendum opinion, as the April 2021 examiner failed to address medical evidence of record which shows the Veteran sought treatment for his left knee and left ankle during service, and since service has sought treatment for chronic bilateral knee and ankle pain. In a September 2021 addendum opinion, the examiner opined that it was less likely than not that the Veteran's bilateral knee and bilateral ankle disabilities were incurred in, or caused by, service. The examiner noted that the Veteran has reported experiencing bilateral knee and bilateral ankle pain since service, but, because he was not diagnosed with any knee or ankle disabilities until 10 years after service, a nexus to service could not be established. The Board cannot ignore or disregard the VA examiner's medical conclusions but is free to assess medical evidence and is not compelled to accept a medical opinion. Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992). The September 2021 opinion did not give due consideration to the Veteran's competent report of his onset of symptoms during service and their continuity thereafter. Rather, the examiner placed more weight on the date of diagnosis of the bilateral knee and bilateral ankle disabilities. The Veteran has consistently reported that he began experiencing bilateral knee and bilateral ankle pain in service and has continued to experience this pain since separation from service. As noted above, as a lay person, he is competent to give evidence about observable symptoms such as pain and onset of symptoms. Layno, 6 Vet. App. at 465. Moreover, his recent diagnosis of bilateral patellofemoral pain syndrome and bilateral ankle tendonitis is predicated on his reports of pain since service. As such, the Board finds his competent lay statements are credible and affords them more probative value than the September 2021 opinion. Here, the Board finds that the evidence of record supports a finding that the Veteran began experiencing symptoms of his current bilateral patellofemoral pain syndrome and bilateral ankle tendonitis during service and has continued to experience those symptoms since then. Accordingly, service connection for a bilateral knee disability and a bilateral ankle disability is granted. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Benson, 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.