Citation Nr: 21007761 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 16-47 199 DATE: February 10, 2021 ORDER Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for prostate cancer is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s left knee disability began during active service, that arthritis was manifest to a compensable degree within one year of separation from service, or that the current left knee disability is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran’s right knee disability began during active service, that arthritis was manifest to a compensable degree within one year of separation from service, or that the current right knee disability is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence of record is against finding that the Veteran has had prostate cancer at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for prostate cancer are not 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 in the United States Navy from November 1972 to November 1980 and from June 1981 to July 1984. He also served on active duty in the United States Coast Guard from July 1984 to August 1995 and from August 1999 to July 2001. These matters come before the Board of Veterans’ Appeals (Board) from a June 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran provided testimony at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. In November 2019, the Board remanded these matters for additional development, which has been substantially completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection 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, including arthritis and malignant tumors, 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). 1. Entitlement to service connection for a left knee disability is denied. 2. Entitlement to service connection for a right knee disability is denied. The Veteran contends that his knees began to hurt during service and continued to remain symptomatic since service. Appellate Brief, January 2021. He testified that his current symptoms are due to his duties as a helicopter pilot, to include sitting in cramped cockpits and having to get in and out of tight spaces, which led to frequently striking his knees against hard surfaces. Board Hearing Transcript, June 2019, page 10. He also contends that his knee disabilities are due to constant training for annual physical fitness tests during service. Id. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that while the Veteran has a diagnosis of bilateral knee degenerative arthritis, the preponderance of the evidence is against finding that it began during active service, was manifest to a compensable degree within one year of active duty, or is otherwise related to an in-service injury or disease. In this case, the Veteran’s service treatment records fail to show he reported or was treated for symptoms related to either knee during service. Rather, the service treatment records reflect that his lower extremities were repeatedly examined and determined to be normal and on reports of medical history, he repeatedly denied having or ever having had a trick or locked knee and arthritis. Further, treatment records fail to show that he was diagnosed with arthritis of either knee in service or within one year of separation from service. The first mention of bilateral knee pain is documented on his April 2014 claim for service connection. Treatment records show the Veteran was not diagnosed with degenerative arthritis of the knees until October 2020, more than 19 years after his separation from active duty. See VA examination, October 2020. The October 2020 VA examiner opined that the Veteran’s right and left knee degenerative arthritis is not at least as likely as not related to an in-service injury, event, or disease, to include sitting in cockpits of aircraft or training for fitness tests. The Veteran told the examiner his knees started hurting in 1995 after his first retirement from service, and that his symptoms had progressively worsened over the years. The examiner noted that the Veteran participated in personal fitness tests throughout his career but did not report to sick call for any specific injury to either knee. The examiner found that the service treatment records, including periodic examinations, were silent for any reports to sick call for knee pain and that treatment records dated subsequent to service fail to show reports or treatment for bilateral knee pain until the October 2020 examination. The examiner stated that based on the silent service treatment records and the absence of documentation of recurrent or persistent knee pain since service, it is less likely than not that the Veteran’s degenerative arthritis is related to service. The examiner also explained that a sitting position without weight bearing, whether or not in a cockpit, would not result in degenerative arthritis. The examiner stated that the Veteran’s disability is more likely than not due to a combination of aging and a history of years playing racquetball. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board has considered the Veteran’s lay assertions of experiencing bilateral knee pain during and since service. The Veteran is competent to report his knee symptoms, but the Board finds that his statements are not credible as they are inconsistent with the contemporaneous evidence. Notably, the Veteran did not report symptoms related to either knee during any period of active service, and while he was treated for multiple conditions after service, he did not report knee symptoms until he filed his claim for benefits in April 2014. The first medical contemporaneous report of bilateral knee symptoms and diagnosis is located in the October 2020 VA examination report. As such, the Board finds the Veteran’s lay statements asserting that his bilateral knee disabilities manifested during and continued since service not credible. Moreover, while the Veteran is competent to report having experienced symptoms of bilateral knee pain since service, he is not competent to provide a diagnosis or determine that these symptoms were manifestations of degenerative arthritis. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Based on the evidence, the Board finds that the Veteran’s bilateral knee arthritis did not manifest during service, within one year of separation from service, and is not otherwise related to service. The preponderance of the evidence is against the claims and the benefit of the doubt rule is inapplicable. The appeals are denied. 3. Entitlement to service connection for prostate cancer is denied. The Veteran seeks service connection for prostate cancer. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of prostate cancer and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The March 2020 VA examiner evaluated the Veteran and determined he had bladder cancer that invaded directly into the prostate. As a result, the Veteran had a cystoprostatectomy, or removal of the bladder and prostate. The examiner stated that the Veteran never had adenocarcinoma of the prostate. Thus, while the Veteran had cancer in his prostate necessitating its removal, the underlying pathology was bladder cancer. While the Veteran believes he has had a diagnosis of prostate cancer, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. (Continued on the next page)   Significantly, the Veteran has been awarded service connection for radical cystoprostatectomy, ileal conduit with urinary diversion for T4 transitional cell carcinoma of the bladder (claimed as bladder and prostate cancer). The disability has been rated under 38 C.F.R. § 4.115b, Diagnostic Code 7528, as malignant neoplasms of the genitourinary system, and compensates the Veteran for his residuals of bladder cancer, to include removal of his prostate. Based on the foregoing, service connection for prostate cancer is not warranted as the Veteran has not had a diagnosis of prostate cancer. The underlying pathology resulting in his prostatectomy was bladder cancer as opposed to prostate cancer, and has already been service-connected. As such, without evidence of a diagnosis of a separate disability for which service connection has not already been established, service connection for prostate cancer must be denied. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda G. Alderman 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.