Citation Nr: A21020291 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 190920-32056 DATE: December 21, 2021 ORDER Entitlement to service connection for a right knee disability, other than bipartite patella, is granted. FINDING OF FACT The evidence is in at least relative equipoise regarding whether the Veteran's right knee disability is related to his service. CONCLUSION OF LAW The criteria for service connection for a right knee disability, other than bipartite patella, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1963 to October 1966. This appeal to the Board of Veteran's Appeals (Board) arose from a June 2019 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). The modernized review system, more commonly known as AMA, applies in this matter. In September 2019, the Veteran appealed the rating decision, requesting a hearing before the Board. The requested hearing was conducted in November 2020. A transcript of the hearing is associated with the file. The Veteran was provided the opportunity to submit new evidence within 90 days after the hearing. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C.§ 7107(a)(2). The Veteran contends that he developed a right knee disability due to his service. The AOJ favorably found that he has a current diagnosis of a right knee disability and that he sustained a right knee injury during his service. 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). In February 2012, a VA examiner opined that it was less likely than not that the Veteran's right knee condition, which was diagnosed as severe degenerative joint disease (DJD), was related to his in-service injury. The examiner opined that it was more likely than not that the Veteran's years as a truck driver was related to his current right knee condition. [The Veteran's military occupational specialty (MOS) was that of a motor vehicle operator, which involved driving trucks.] In August 2016, a VA examiner provided a negative etiological opinion of the Veteran's diagnosed mild right knee joint osteoarthritis. The examiner stated that, if significant trauma to this joint had occurred in service, his current right knee condition would be more severe. In February 2017, a VA examiner also provided a negative nexus opinion, as the Veteran had not related any in-service motor vehicle operator incident. In April 2019, the VA examiner clarified that, the during the appeal period, the Veteran had the following right knee diagnoses: strain, DJD, osteoarthritis (OA), and bipartite patella. The examiner explained that the bipartite patella is a congenital condition (present at birth) that occurs when the patella (kneecap) is made of two bones instead of a single bone. Bipartite patella is quite common and usually asymptomatic and is found on X rays in 2 percent of the population. It is usually an incidental finding on imaging and rarely requires treatment. Pertaining to the bipartite patella, the examiner opined that it was less likely as not that there was a superimposed disease or injury that occurred during the Veteran's service that resulted in additional disease or disability or that the bipartite patella was aggravated by his service. Regarding the diagnosis of internal derangement of the right knee, the examiner opined that there is no indication of an internal derangement (instability or derangement of any stabilizing structures) of this joint. Regarding the diagnosis of DJD, the examiner opined that it was less likely than not that this condition was manifested during the Veteran's service or was otherwise related to his service. The examiner explained that the mild severity of degenerative arthritic changes noted in 2011 (as opposed to moderate or severe) indicated that the condition was a normal disease of life that is genetically determined as opposed to a degenerative state secondary to trauma or other injury. Regarding the diagnosis of OA, it was opined that this condition was less likely than not manifested during the Veteran's service or otherwise related to an in service event, injury, or disease. In the absence of significant trauma (as here), the most common cause of OA is genetic. The main basis for the negative nexus opinions regarding the Veteran right knee disability (specifically his DJD) is the severity of the condition being described as mild. However, at the February 2012 VA examination, the examiner indicated that the Veteran had "severe" DJD in his right knee. Also, the March 2011 VA magnetic imaging (MRI) scan noted that the Veteran had severe cartilage defect. See February 2012 VA Examination Report. While the February 2011 MRI scan results were discussed by the April 2019 VA Examiner, the March 2011 MRI scan results indicating a severe right knee condition were not discussed by the examiners. The Veteran has repeatedly asserted that he has experienced right knee pain since twisting this joint in service. He admitted that he did not seek right knee treatment at a medical facility for a while after separating from active service. Indeed, according to post-service medical records, when he did seek treatment for his right knee, he reported that he had twisted his knee again. He denied any specific trauma or injury to his right knee, which was also noted in the VA examination reports. The Board also acknowledges that the February 2012 VA examiner proffered that the Veteran's right knee condition was more likely related to his years of truck driving. As previously stated, however, the Veteran was a motor vehicle operator during his active service. After a thorough consideration of the evidence, the Board finds that the evidence is at least in relative equipoise regarding whether the Veteran's right knee condition was incurred during his service. The Board acknowledges that the evidence in this case is not explicitly clear in resolving the issue regarding the specific onset of the Veteran's right knee condition. Significant time has been used to develop the evidentiary record in this matter to resolve the uncertainties specific to his right knee condition. However, those uncertainties have not been resolved. Significantly, however, there is evidence that tends to support the finding that the Veteran's current right knee condition is related to his service, to include his in service duties as a motor vehicle operator. Considering what has been proffered in the opinions and examinations, taken with the available evidence of the record, including the Veteran's assertions, there is sufficient competent evidence to raise a reasonable doubt regarding the onset of his right knee condition. Resolving all reasonable doubt in favor of the Veteran, the Board finds that a nexus has been established between his current right knee disability and his active duty. The criteria for service connection for a right knee condition, other than bipartite patella, have been met, and entitlement to service connection for this disability is warranted. In reaching this decision, the Board acknowledges that the diagnosis of bipartite patella has been deemed to be a congenital condition, which is not subject to service connection based on the regulations. Herein, the Board's grant of service connection for a right knee disability excludes the diagnosed bipartite patella. 38 C.F.R. §§ 3.303(c), 4.9; Winn v. Brown, 8 Vet. App. 510 (1996). THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Middleton, 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.