Citation Nr: 21007668 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-17 038 DATE: February 10, 2021 ORDER Entitlement to service connection for bilateral knee arthritis is denied. FINDING OF FACT The Veteran’s bilateral knee arthritis was not shown as chronic in service, did not manifest to a compensable degree within one year of service, and is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for bilateral knee arthritis have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1977 to August 1983. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript is associated with the claims folder. The Board remanded the issues on appeal for development in December 2017 and June 2020. In January 2021, the Veteran and his representative were sent letters informing him that the appeal had been re-certified and docketed with the Board. To date, the Board has not received any such argument, or a request for more time to make a submission. The Veteran and his representative have been afforded an opportunity to provide additional argument and adjudication may proceed. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. §20.900(c). Entitlement to service connection for bilateral knee arthritis is denied. The Veteran seeks service connection for bilateral knee arthritis. During the November 2017 Board hearing, the Veteran testified that his knee condition is the result of the physical rigors of service, to include running long distances in military boots, carrying 60 to 80 pounds of equipment, laying prone on rough terrain, and carrying heavy machinery such as base plates for cannons. The Veteran further testified that he did not notice the condition until 1985 and used over the counter medication to treat his knee pain prior to seeking out professional care. 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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (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). Certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of bilateral knee degenerative arthritis as evidenced by the November 2020 VA examination. However, the preponderance of the competent and probative evidence does not show that the Veteran’s disability was chronic in service, manifested to a compensable degree within a presumptive period, or was attributable to service. Service treatment records are silent for complaints, diagnoses or symptoms related to the knees. An August 1983 discharge examination showed no lower extremity abnormalities; the Veteran indicated good health in the related August 1983 report of medical history. The post-service treatment records show the Veteran complained of knee pain many decades after service. See November 2005 VA treatment record. The Veteran was shown to have degenerative changes in his bilateral knees by April 2011. In a May 2013 VA treatment records, the Veteran reported that he was diagnosed with early joint narrowing two years prior (in 2011). Pursuant to the Board’s remand, the Veteran was afforded a VA examination in November 2020. The examiner noted a diagnosis of bilateral knee degenerative arthritis. The examiner noted review of the evidence, including service and post service clinical records, and the BVA Remand. At the examination, the Veteran reported that he developed bilateral knee pain in the 1990s, which continued thereafter. In a November 2020 opinion, the examiner negatively opined as to the etiology of the Veteran’s knee condition. The examiner explained that medial joint space narrowing can be caused by injury or wear and tear, but the examiner also noted that there are no records of injury in service and there is no injury requiring treatment in the Veteran’s service. Further, the evidence does not show development of pain in service from wear and tear, or due to the physical rigors of service including long runs in boots, carrying heavy equipment and gear, and laying prone in rocky terrain. The examiner concluded that the chronology of the disease presentation means it is more likely a result of wear and tear due to aging. As such, there is no etiological relationship between the Veteran’s current condition to service. Upon review of the evidence, service connection is not warranted. Initially, the Board finds the November 2020 opinion to be highly probative on this matter. The examiner has the appropriate training, expertise and knowledge to evaluate the claimed disability. The examiner provided a thorough and cogent rationale to support the report’s findings and opinions, which included consideration of the Veteran’s reported symptoms both during and after service, and the post-service clinical history. Furthermore, the examiner also reviewed the entire claims file. There are no competent opinions to the contrary. While the Veteran is competent to give testimony about the recurrent knee pain he experienced in service and thereafter, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of bilateral knee degenerative arthritis. The progression of increasingly narrowed joint spaces is an internal process that requires knowledge of the musculoskeletal system and interpretation of complicated diagnostic medical testing. The Veteran has not demonstrated the necessary medical expertise and thus, he is not competent to provide an opinion on the matter. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In addition, the Veteran has also offered conflicting statements as to onset of his knee. The Veteran’s service records are also silent for knee problems until many years after his service and imaging noted only moderate narrowing of the medial compartment. The Board notes further that the Veteran answered in the negative when asked by the undersigned if he had ever gone to sick call or had any injuries in service. See November 2017 Board Hearing at page 3-4. At the November 2020 examination, the Veteran reported knee pain began in the 1990s, but during the 2017 Board hearing, the Veteran indicated that he noticed arthritis symptoms in 1985. The conflicting nature of the Veteran’s statements as to onset of symptoms lessens the probative value of his testimony and lay statement regarding onset and recurrent of knee pain. Even considering the lay statements, the evidence does not show that the Veteran’s arthritis had onset for years after separation from service, outside of the applicable presumptive period. The Board notes that either report of onset, in either 1985 or the 1990s, is outside the presumptive one year period. The evidence does not otherwise show manifestation of the Veteran’s bilateral knee condition to a compensable degree within one year of separation from service. Accordingly, presumptive service connection is not warranted. Service connection may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s bilateral knee arthritis and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. Here, the Board gives more probative weight to competent November 2020 VA opinion which was based on file review, consideration of the Veteran’s lay statements, and clinical examination. As noted above, the rationale was thorough and sufficient to support the opinion provided. The opinion establishes that these symptoms were attributable to wear and tear from aging, and are unrelated to the Veteran’s active service. There is no equally probative and competent medical opinion to the contrary. (Continued on the next page)   Accordingly, the competent evidence weighs against a nexus between the current disability and active service; the evidence does not support presumptive service connection. As such, there is no reasonable doubt to be resolved in this instance. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Service connection for a bilateral knee arthritis is not warranted. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Vuong, 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.