Citation Nr: 21007147 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 14-16 588 DATE: February 8, 2021 ORDER Entitlement to service connection for a back disability is denied. Entitlement to service connection for a left knee disability is denied. FINDINGS OF FACT 1. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 2. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 CONCLUSIONS OF LAW 1. The most probative evidence of record does not support the finding that the Veteran’s back disability had its onset in service or first manifested within a year of separation from service or is otherwise related to an in-service injury or disease. 2. The most probative evidence of record does not support the finding that the Veteran’s left knee disability had its onset in service or first manifested within a year of separation from service or is otherwise related to an in-service injury or disease. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1958 to December 1980. These matters come before the Board of Veteran’s Appeals (Board) from a September 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in August 2020 when the claims were remanded for addendum medical opinions. The Board finds the August 2020 remand directives have been substantially complied with, and the matters are again before the Board. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Generally, service connection may be established for a disability resulting from disease or injury in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). To establish service connection for a disability, there must be (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). 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). Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, to include arthritis, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Although degenerative changes are not specifically referenced as a chronic disease in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a), the Court has long recognized that degenerative joint disease (DJD) and degenerative changes denote the presence of arthritis. See Giglio v. Derwinski, 2 Vet. App. 560, 561 (1992). Moreover, while there may be a distinction between DJD and degenerative disc disease (DDD), it is more favorable to the Veteran to treat DDD as a chronic disease and the Board will therefore do so. See Brown v. Gardner, 513 U.S. 115, 118 (1994); see also Bierman v. Brown, 6 Vet. App. 125, 126 (1994). Alternatively, service connection may be established under 38 C.F.R. § 3.303 (b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. The use of continuity of symptomatology to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) as noted above. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Lay evidence is competent to establish the presence of observable symptomatology and “may provide sufficient support for a claim of service connection.” Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition is capable of lay observation and may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination “medical in nature.” Lay evidence can be competent and sufficient to establish a diagnosis when a layperson (1) is competent to identify the medical condition; or, (2) is reporting a contemporaneous medical diagnosis; or, (3) describes symptoms at the time which supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a back disability The Veteran seeks service connection for a back disability. In favor of his claim, the Veteran asserts that while in service in Korea he fell off a tank and hurt his back. He asserts that his back has never been the same since the fall. See statement of December 2009. He also asserted that throughout service he sometimes felt pain in his back. See statement of December 2009. At the hearing held in April 2018, the Veteran testified that his military occupational specialty was an infantryman at first and then as a tanker. He explained he served in many roles; including as a drill instructor for a period of time. See hearing transcript page 3. He further testified, regarding his in-service injury, that in Korea he was a platoon sergeant in charge of a few tanks, and that while he was inspecting one of the armored tanks, he fell about 13 feet down to the ground. He says he got up as best he could and went to his vehicle but that the next morning, he went to sick call for his back. See hearing transcript page 7. The Veteran’s service treatment records (STRs) and post-service medical records have been associated with the claims file. While in service, the Veteran was treated for a backache in August 1972. See STRs for August 1972. The Board notes, the Veteran also asserted that in service he went to the clinic with back pain and was diagnosed with rectal issues instead. See statement of December 2009. The Veteran’s STRs do show that in November 1963, the Veteran was diagnosed with constipation and the notation begins with the word “back” however; no diagnosis relating to the Veteran’s back is noted in this November 1963 entry. See STRs for November 1963. Additionally, the Veteran’s periodic physical examinations did not note any back pain or any back abnormalities. See Reports of Medical Examination dated December 1961, March 1962, February 1966, February 1975, November 1977, and November 1979. The Veteran’s post-service medical records reveal that in January 1989, the Veteran complained of urinary frequency that started with back pain radiating to the groin and scrotum. The doctor’s impression was to rule out a stone and a possible uretal obstruction. See medical records for January 1989. In February 1996, the Veteran complained of low back pain radiating to his hip. The Veteran reported the pain had been present for about 3 weeks prior to his visit. The doctor diagnosed the Veteran with low sacral dysfunction. See medical records for February 1996. In March 1996, the Veteran visited his medical providers for other reasons, and noted that the low back pain of February 1996 had resolved. See medical records for March 1996. In September 1996, the Veteran again reported back pain. See medical records for September 1996. In a November 1999 VA General Examination, the Veteran complained of back pain. The Veteran explained that his back pain started in Fort Lewis in 1961- he described the pain as back spasms from getting up from a bed. The Veteran explained that his back soreness is recurrent and radiates to his left leg. As part of this examination, the Veteran was administered a lumbosacral spine X-ray and diagnosed with moderate degenerative disc disease (DDD), at L4-5, and L5-S1. See November 1999 VA General Examination. In April 2003, the Veteran complained of back pain that had been present for 2 weeks prior to his visit but had worsened in the last 3 days prior to the visit. See medical records for April 2003. In May 2003, the Veteran complained of back pain that had been present since 1962, but that had recent exacerbation lasting about 2 weeks with left leg pain. See medical records for May 2003. An MRI was ordered that revealed pinched nerves. See medical records for June 2003. In July 2003, the Veteran was noted to have a history of chronic low back pain. He also reported back pain that had begun approximately 4 months prior to his visit. See medical records for July 2003. In September 2003, the Veteran complained of back pain. See medical records for September 2003. In October 2003, the Veteran was seen for back pain. A provisional diagnosis of lumbosacral neuritis (nos) was noted in the Veteran’s medical records. See medical records for October 2003. In February 2004, the Veteran reported he had chronic low back pain since 1962-while on active duty. He reported continued low back pain. See medical records for February 2004. In December 2004, the Veteran reported continued low back pain. See medical records for December 2004. In March 2005, the Veteran fell off a tree limb and re-injured his low back. See medical records for March 2005. In June 2005, the Veteran continued to report lumbar pain and left leg pain. See medical records for June 2005. In January 2006, the Veteran reported severe back pain and left leg pain. See medical records for January 2006. In October 2006, the Veteran reported lumbar pain radiating down to left leg. See medical records for October 2006. In February 2007 and August 2007, October 2007, the Veteran continued to report lumbar pain. See medical records for February 2007. In a December 2007 MRI, the Veteran’s spine DDD was noted to have progressed. See medical records for December 2007. In May 2008, the Veteran denied persistent low back pain. See medical records for May 2008. In December 2008, one of the Veteran’s private physicians subscribed a medical opinion where he noted that the Veteran fell off a tank in August 1972 while serving in Korea injuring his back. The physician opined that the Veteran’s lumbar pain due to spinal stenosis was more likely than not related to his fall in 1972. See medical opinion of December 2008. The physician did not provide a complete rationale for the opinion expressed. Thus, the Board finds this medical opinion inadequate and assigns it low probative value. In May 2009, the Veteran was noted to have severe lumbar back pain. See medical records for May 2009. In March 2010, the Veteran complained of back pain. See medical records for March 2010. In October 2010, the Veteran was evaluated by VA for his back condition. The examiner noted the Veteran reported back pain since 1972. He also noted the Veteran reported falling off his armored tank, landing on his back and that he had gradually increasing low back pain since. The examiner also noted the Veteran’s description of his pain and physical limitations associated with his back condition. The examiner noted a diagnosis of lumbosacral spine degenerative joint disease and disc disease with left sciatic intervertebral disc syndrome. Following the examination, the examiner opined that the Veteran’s back condition was less likely as not caused by any back injury while on active duty. In support of his opinion the examiner noted that there was no evidence in the military medical records reviewed regarding a significant low back injury and that the next mention of a back condition was in 1996 (after the Veteran’s separation from service). See VA examination of October 2010. The Board finds this medical opinion inadequate for adjudication purposes as it relied on absence of contemporaneous evidence to provide a negative nexus opinion and did not address the Veteran’s lay statements regarding his in-service injury. Accordingly, the Board assigns this medical opinion low probative value. In June 2011, the Veteran complained of back pain and knee pain. See medical records for June 2011. In September 2011, the Veteran complained of back pain following a fall. See medical records for September 2011. In November 2011, the Veteran reported falling in September 2011 and aggravating his back pain. See medical records for November 2011. In December 2011, an MRI revealed progressive DDD changes and slightly increasing spinal canal narrowing throughout most of the lumbar spine. See medical records for December 2011. In February 2012, the Veteran underwent a sacral epidurogram and an epidural injection. This procedure was intended to help with the Veteran’s back pain however, the Veteran reported continued pain with no improvement in July 2013. See medical records for February 2012 and July 2013; associated with the claims file in December 2020. In April 2012, the Veteran reported back pain but also reported that he was doing ok and that he wanted to “hold on” on back surgery. See medical records for April 2012. In November 2013, the Veteran reported back pain. See medical records for November 2013. In November 2015 the Veteran reported no back pain and his back was noted to have full range of motion with no tenderness, palpable spasms or pain on motion. See medical records for November 2015. In April 2016, the Veteran reported back pain. See medical records for April 2016. However, in September 2016, the Veteran reported no back pain and his back was noted to have full range of motion with no tenderness, palpable spasms or pain on motion. See medical records for September 2016. In October 2017, the Veteran reported low back pain with motion while standing. See medical records for October 2017. In October 2019, the Veteran was administered a Back (Thoracolumbar spine) Conditions Disability Benefits Questionnaire (Back BDQ). The examiner noted the Veteran’s diagnosis of degenerative joint and disc disease of the lumbosacral spine. Following the examination the examiner, a board-certified neurologist, opined that it is less likely as not that the Veteran’s back condition diagnosed as degenerative joint and disc disease of the lumbosacral spine was incurred in or caused by exposures or conditions, including any injury, event or disease during active duty to include the Veteran’s documented in-service low back pain. The examiner noted that he could not find in the claims record the December 2008 positive nexus opinion; but that based on the review of the available records, he found that any conclusion drawn by the author of the noted December 2008 nexus opinion was based solely upon the Veteran’s subjective complaints unsupported by the objective evidence of record and therefore was based upon mere speculation. The examiner further noted that although he believed the Veteran and the experiences the Veteran reported; that the Veteran was not qualified to make a medical diagnosis of a back condition. The examiner also opined that although the Veteran’s medical record notes he complained of backache in August 1972, his subjective complaint represented an acute and transitory symptom of acute prostatitis, and did not represent a separate and distinct chronic and disabling back condition as supported by the evidence of record and weight of medical literature. See medical opinion of October 2019. The Board found this medical opinion did not comply with the August 2018 remand instructions; as the examiner did not revise the December 2008 private nexus opinion. In September 2020, another medical opinion was associated with the claims file. The same examiner that conducted the Veteran’s October 2019 examination provided an addendum opinion where he opined that it was less likely as not that the Veteran’s low back condition was incurred in or caused by any in-service exposure or condition to include the Veteran’s documented in-service low back pain. In favor of his opinion, the examiner noted having reviewed the medical opinion dated December 2008 and indicated that the opinion was not supported by objective evidence of record and was therefore based on speculation as the Veteran never complained of, nor was ever treated for, any back conditions due to a fall from a tank in 1972 and subsequent records note the Veteran denied any chronic back conditions. The examiner also addressed other instances where the Veteran’s back was mentioned in his STRs noting that in September 1968 the Veteran was diagnosed with a low back strain despite no objectively abnormal clinical musculoskeletal findings. The examiner further noted that this September 1968 diagnosis represented an acute and transitory condition of the back muscles that resolved without residuals and does not represent a chronic and disabling back degenerative joint condition as supported by the evidence of record and medical literature. The examiner also noted the November 1963 entry in the Veteran’s STRs that begins with the word back and noted that the Veteran’s subjectively reported back complaints in the milieu of constipation with secondary traumatic injury to the anus represented an acute and transitory symptom that resolved without residuals and does not represent a chronic and disabling thoracolumbar spine condition. The examiner further noted that the Veteran’s diagnosis of degenerative disc disease was 19 years after the Veteran’s release from active duty and is at least as likely as not due to age related changes that were not caused, secondary to, or aggravated beyond their natural progression by any in service exposure or claimed in service event or any service connected condition. The examiner also noted having reviewed the hearing transcript of record in its entirety and noted he believed the Veteran regarding his in-service events. See medical opinion of September 2020. The Board finds this medical opinion adequate and assigns it high probative value. Based on all of the above, the Board finds that the preponderance of the evidence weighs heavily against the claim. In the present case, the Veteran’s claim surpasses the first and second prong of the Shedden service connection test, as the Veteran has a current diagnosis of DDD and the Veteran reported in-service incurrences of back pain and falls while in service. However, the Veteran’s claim fails to surpass the third prong of the Shedden service connection test, the nexus requirement, as the most probative evidence of record does not support the finding that the Veteran’s current back condition is etiologically related to his service. The Board notes that although the Veteran submitted a positive nexus opinion- the December 2008 opinion, the opinion was found inadequate because it lacked a complete rationale (i.e. explanation) for the opinion expressed by the Veteran’s private physician. The Board also notes the Veteran’s assertions regarding how he has experienced continued pain in his back since his service. However, the Veteran’s available medical records do not show that he was continuously treated for back pain or back issues following his service. The records do demonstrate that since the 1990s the Veteran has experienced at times back pain and has sought treatment for it. Furthermore, these medical records show the Veteran has reported different onset dates for his back pain. Thus, although the Board finds the Veteran competent to describe his continuous symptomatology of back pain, the Board finds these statements not credible in light of the medical evidence of record and the Veteran’s conflicting reports regarding the onset of his back pain. Thus, the Board finds that the preponderance of the evidence weighs heavily against the claim of entitlement to service connection for a back condition and must be denied. The Board has also considered whether a continuity of symptomatology has been demonstrated by the most probative evidence of record. 38 C.F.R. §§ 3.303 (b), 3.307, 3.309. However, although the Veteran attributes his current back disability to an in-service fall injury and while the Veteran is competent to describe the in-service fall and his history of back pain; his reports must be weighed with the additional evidence of record. Caluza v. Brown, 7 Vet. App. 498, 506 (1995) (VA adjudicators may properly consider internal inconsistency, facial plausibility and consistency with other evidence submitted on behalf of the Veteran in weighing evidence). In the instant case, the Veteran’s lay statements regarding his back pain onset are not wholly consistent throughout his medical records and these inconsistencies, along with a lack of evidence regarding the severity of the Veteran’s back condition following service; as well as the fact that he was diagnosed with DDD 19 years following his separation from service, weigh against the finding of a continuity of symptomatology since service. Thus, the Board finds that a continuity of symptomatology has not been demonstrated regarding a chronic disability in the back beginning in service or first manifesting within a year of separation from service. 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, this doctrine is not applicable in the instant appeal, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 2. Entitlement to service connection for a left knee disability The Veteran asserts that while in service he injured his left knee. In a December 2009 statement, the Veteran stated that during physical training (PT) in 1976, he fell and hit a pole with his knee. He bled and needed help getting up. He was taken to the aid station where his wound was cleaned. He noted he asked about getting an x-ray and was told it was not necessary. He was given bandages, medicine and was sent to his quarters for 24 hours. The Veteran notes that his knee has never been the same since the incident. See statement of December 2009. At the hearing, the Veteran testified that while in basic training he fell and hit his knee, but that he got up and continued. He also stated that he had other instances where he hurt his knee. See hearing transcript. As previously noted, the Veteran’s STRs and post-service medical records have been associated with the claims file. The Veteran’s STRs show he was treated for a left kneecap abrasion in January 1976. It was noted the Veteran tripped while doing PT. The Veteran’s periodic physical examinations did not note any knee pain or knee abnormalities. See Reports of Medical Examination dated December 1961, March 1962, February 1966, February 1975, November 1977, and November 1979. The Veteran’s post-service medical records show that he complained of left posterior knee pain in April 1999. The Veteran reported the pain had been present for 3 weeks. See medical records for April 1999. In November 1999, the Veteran was administered a VA examination for his left knee condition. The Veteran reported that he had injured his knee while running in Germany in 1961. He reported as current symptoms that his knee popped, and pain that radiated from his back. The Veteran also reported swelling in the knee and that he had one instance of a varum deformity where the knee became lax. The examiner diagnosed the Veteran with degenerative disease of the left knee. See VA examination of November 1999. In May 2002, the Veteran reported left knee pain that had been present for months with no injury. The physician noted the Veteran had a history of arthritis. See medical records for May 2002. In February 2008, the Veteran complained of left knee pain. The physician noted that an x-ray revealed tricompartmental osteoarthritis with moderate narrowing of the medial compartment in the left knee. The physician recommended an injection if other medication did not help pain symptoms. See medical records for February 2008. In May 2008, the Veteran reported chronic pain in the left knee. See medical records for May 2008. In December 2008, the Veteran’s private physician subscribed a medical opinion where he noted the Veteran’s in-service injury of January 1976 and opined that the Veteran’s osteoarthritis of the left knee and left knee pain were more likely than not related to the injury of January 1976. See private medical opinion dated December 2008. The physician did not offer any rationale or explanation for the opinion expressed. Accordingly, the Board finds this medical opinion inadequate for adjudication purposes and assigns it low probative value. In January 2009, the Veteran’s left knee pain was treated with an injection to help the pain. See medical records for January 2009. In May 2009, the Veteran reported continued knee pain. See medical records for May 2009. In October 2010, the Veteran was evaluated by VA for his left knee condition. The Veteran reported left knee pain since 1976. The Veteran described running into a pole on a PT run, sustaining a laceration and knee swelling. The examiner noted the Veteran’s current symptomatology related to his left knee of stiffness, weakness, occasional instability, frequent swelling and constant medial knee pain. Following the examination, the examiner noted a diagnosis of left knee degenerative joint disease (DJD) and opined that the claimed condition was less likely as not related to service as there was no evidence in the Veteran’s military medical records regarding a significant left knee injury and that the next mention of left knee condition was in November 1999. See VA examination of October 2010. In December 2010, June 2011 and November 2012, the Veteran’s medical records show he continued to complain of left knee pain. See medical records for December 2010, June 2011 and November 2012. In November 2015, the Veteran reported no knee pain. See medical records for November 2015. In March 2018, the Veteran reported left knee pain. See medical records for March 2018. In October 2019, the Veteran was administered a Knee and Lower Leg Conditions Disability Benefits Questionnaire (Knee DBQ). In this examination, the examiner noted the Veteran’s diagnosis of degenerative joint disease of the left knee and opined that the claimed condition was less likely as not related to the Veteran’s service. In favor of this opinion, the examiner noted that the Veteran’s STRs were silent for objective clinical diagnosis of a chronic disabling left knee condition during service. The examiner also noted that although the Veteran was diagnosed with degenerative disease of the left knee, the diagnosis was based on an x-ray administered to the Veteran 19 years after his separation from service. The examiner opined that the Veteran’s condition is at least as likely as not age related and was not caused by or aggravated by the Veteran’s service as supported by the evidence of record and medical literature. Additionally, the examiner noted that although the Veteran was treated in service for a left knee injury, the injury consisted of a scrape to the skin of the left kneecap that did not involve the left knee joint at all. Thus, the examiner opined that this injury was an acute and transient condition that resolved without residuals. See Knee DBQ of October 2019. In August 2020, the Board found this opinion did not comply with the previous Board remand instructions that instructed the examiner to revise a December 2008 positive nexus opinion. In September 2020, another VA medical opinion was associated with the claims file. The same examiner that subscribed the October 2019 medical opinion, noted that he had reviewed the hearing transcript as well as the December 2008 positive nexus opinion. He also noted the Veteran’s medical history regarding his left knee and opined that it is less likely as not that the Veteran’s claimed condition was incurred in or caused by any in-service exposure or claimed /service connected condition to include the Veteran’s documented in-service left knee pain and abrasion. In support of this opinion the examiner noted that available STRs were silent for objective clinical diagnosis of a chronic and disabling left knee condition during active service. The examiner further noted that the Veteran’s diagnosis of degenerative disease of the left knee was rendered 19 years after the Veteran’s separation from service and that the Veteran’s in-service left knee injury of 1976 consisted on a scrape to the skin over the left kneecap that did not involve the joint at all. The examiner thus noted that the Veteran’s abrasion on the left kneecap in-service represented an acute and transient condition that resolved without residuals and does not represent a chronic and disabling left knee joint condition as supported by the evidence of record and medical literature. The examiner further noted that the medical literature does not support that a chronic degenerative joint condition is caused by an isolated, acute and transitory condition to include the fall of 1976 with no subsequent reported left knee condition or subjective complaints during active duty service. Additionally, the examiner noted that the medical literature does not support that scrape to the kneecap caused degenerative joint disease of the knee joint. See medical opinion of September 2020. Based on all of the above, the Board finds that the preponderance of the evidence is against the claim of service connection for a left knee condition, to include DJD, as the most probative evidence of record does not support the finding that the Veteran’s left knee condition is etiologically related to his service. While the Veteran’s claim surpasses the first and second prongs of the Shedden service connection test, as the Veteran has a current diagnosed disability and there is an in-service event, the claim fails to surpass the third prong of the Shedden service connection test; the nexus requirement. The Board notes the Veteran submitted a private medical opinion, dated December 2008, that related his current left knee disability to his service, however this opinion was found inadequate by the Board for adjudication purposes as it lacks a complete rationale (i.e. explanation) for the opinion expressed. Finally, the Board has considered the application of 38 C.F.R. §§ 3.303 (b), 3.307, 3.309. However, the evidence of record fails to support the finding that a chronic disease was shown in service or manifested to a compensable degree within the presumptive period. Additionally, a continuity of symptomatology has not been established, as the most probative evidence of record shows the Veteran reported different onset dates regarding his left knee disability. Furthermore, the most probative evidence of record does not support the finding that the Veteran has continually suffered from the same symptomatology since service. Based on the foregoing, the Board finds that the preponderance of evidence is against the claim of service connection for a left knee condition as the condition has not been shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest to a compensable degree within one year from service discharge. Consequently, service connection for a left knee condition not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, this doctrine is not applicable in the instant appeal, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Gonzalez-Maldonado 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.