Citation Nr: A21019641 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 200206-60294 DATE: December 9, 2021 ORDER Entitlement to service connection for left knee strain with patellofemoral pain syndrome is denied. Entitlement to service connection for lumbosacral strain is denied. FINDINGS OF FACT 1. The preponderance of the evidence fails to establish that the Veteran's left knee strain with patellofemoral pain syndrome is etiologically related to service. 2. The preponderance of the evidence fails to establish that the Veteran's lumbosacral strain is etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left knee strain with patellofemoral pain syndrome have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for entitlement to service connection lumbosacral strain have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1986 to April 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2020 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Board of Veterans' Appeals (Board) issued a decision that denied entitlement to a left knee strain and entitlement to lumbosacral strain. The Veteran appealed the denial to the Court of Appeals for Veterans Claims (CAVC). In a June 2021 Order, pursuant to a Joint Motion for Remand (JMR) filed by the parties, the Court vacated and remanded the December 2020 decision for compliance with the instructions in the JMR. 1. Entitlement to service connection for left knee strain with patellofemoral pain syndrome is denied 2. Entitlement to service connection for lumbosacral strain is denied Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (2018). 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). The Veteran seeks service connection for a left knee and back disabilities. He contends that during a three-week training in the summer of 1987, he stepped in a hole carrying a 100-lb projectile from a truck injuring his back and left knee. Initially, the Board notes that the Veteran was diagnosed with left knee strain with patellofemoral pain syndrome and lumbosacral strain on his December 2019 VA examination. Thus, the question is whether his current left knee strain with patellofemoral pain syndrome and/or lumbosacral strain are related to service. On this question, the preponderance of the evidence is against the claim. In this regard, in a December 2019 VA examination, the VA examiner determined that the Veteran's left knee disability and low back disability were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reviewed the Veteran's entire claims file and found that when he visited the clinic, he complained about his toe pain, foot pain, neck pain, a pneumothorax and even jock itch. The VA examiner added that if the Veteran's injury happened as stated it would be expected that there would be one piece of documentation regarding this complaint. The VA examiner noted that there was a lapse in treatment or procedures for his low back and left knee between discharge in 1988 until 2012. The Board finds the medical opinion to be highly probative, as it was based on a thorough review of the Veteran's claim file, lay statements and an adequate rationale was provided to support the conclusions. See Bloom v. West, 12Vet.App.185, 187 (1999). The medical opinion is afforded substantial probative weight. See Nieves-Rodriquez v. Peake, 22Vet. App.295, 304 (2008). The Board notes that in June 2021 Order, pursuant to the JMR filed by the parties, the Court vacated and remanded the December 2020 decision for the Board to discuss favorable evidence in support of Veteran's claims in the form of a February 2019 statement from a soldier with whom he served. In this regard, the Board notes the February 2019 buddy statement by M. F. reflecting that he served with the Veteran; that he recalled that "[o]n or about June or July 1987" he observed the Veteran laying on the ground, "bent over and holding his lower back and limping"; that "[a]fter the fire mission had ended, [the] gun crew leader sent the him to see the medic"; that, "[l]ater, [Veteran] returned to the gun location [and] said the medic had wrapped his left knee, given him some Motrin [ and the Veteran] mentioned that his lower back was killing him and the Motrin was supposed to reduce inflammation"; and that he "remember[ed] seeing [the Veteran] sitting on his cot for the next day [and]... limping for a few days after." Here, the issue is not whether the Veteran sustained an injury in service, but rather whether the diagnosed left knee disability and low back disability are due to the claimed inservice injury. The December 2019 VA examiner determined that the Veteran's left knee disability and low back disability were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. To the extent the Veteran and his buddy contends that he has suffered from left knee disability and low back disability since the alleged in-service injury, the Board finds such assertion less probative than the medical evidence of record. The Veteran was seen for many other ailments while in service, it seems more than reasonable that he would have sought out care for injuries to his knee and back. The lapse of time between service separation and the earliest documentation of the current disabilities may also service as a factor for consideration in deciding a service connection claim. The time lapse of at least 20 years between the Veteran's discharge and diagnosis is of significant probative value. The Board finds it unlikely that the Veteran would not have reported back and/ or knee complaints had he been experiencing them. See AZ v. Shinseki, 731 F.3d 1303, 1315 (Fed. Cir. 2013). Moreover, while the Veteran believes that his knee disability and low back disability are related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. In this regard, the diagnosis and etiology of knee disability and low back disability are matters that require medical training and expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his current back and knee disabilities are not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Further, whether the symptoms the Veteran reportedly experienced in service or following service are in any way related to his back and knee disability are matter that requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999). Although medical records from the October 2012 note the Veteran providing a history of the lumbar and knee disabilities beginning during active service, a bare transcription of lay history unenhanced by any additional medical comment by the examiner, is not competent medical evidence. LeShore, 8 Vet. App. 406. The Board finds the contemporaneous medical evidence, the diagnosis of back and knee disabilities decades after separation and the VA examiner's opinion to be significantly more probative than the lay assertions of record. Hence, the Board attaches significant weight to them. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In sum, there is no competent evidence of his knee disability and/or low back disability in service or during the year following service, and the most probative medical evidence of record indicates the Veteran's current knee disability and/or low back disability are not related to service. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a lumbar strain and entitlement to service connection for left knee strain with patellofemoral pain syndrome are not warranted. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claims, the doctrine is not for application. See Gilbert, 1 Vet. App. at 56. MARGARET M. LUNGER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Asare, 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.