Citation Nr: 21008282 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 18-04 171 DATE: February 16, 2021 ORDER Service connection for a meniscal tear of the left knee is granted. FINDING OF FACT The Veteran’s meniscal tear of the left knee was incurred during service or is otherwise related to service. CONCLUSION OF LAW The criteria for service connection for a meniscal tear of the left knee have been met. 38 U.S.C. §§ 101, 1110, 1112, 1113, 1521, 5103, 5103A, 5107; 38 C.F.R. §§ 3.3, 3.6, 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from September 2007 to January 2008. The Veteran also served on active duty for training from September 2007 to January 2008, March 2009 to May 2009, June 2009 to September 2009, February 9, 2010 to February 25, 2010, and has continuing reserve service. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2017 rating decision. The Veteran testified before the Board at a hearing in January 2020. A transcript of the hearing has been associated with the claims file. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show the existence of (1) a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases are subject to presumptive service connection if the disease manifests to a compensable degree within one year of separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Moreover, for such chronic diseases, an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2014). Additionally, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a). A Veteran meets the service requirements for disability benefits if he or she served in active military, naval, or air service (1) for 90 days or more during a period of war; (2) during a period of war and was discharged or released from service for a service-connected disability; (3) for a period of 90 consecutive days or more and such period began or ended during a period of war; or (4) for an aggregate of 90 days or more in two or more separate periods of service during more than one period of war. 38 U.S.C. § 1521(j); 38 C.F.R. § 3.3(a)(3). The term “active military, naval, or air service” includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled from an injury incurred or aggravated in line of duty. 38 U.S.C. §§ 101(21), (24); see also 38 C.F.R. § 3.6 (defining active duty, ACDUTRA, and INACDUTRA). The Board has reviewed the evidence of record and finds that service connection is warranted for the Veteran’s meniscal tear of the left knee. During the January 2020 hearing before the Board, the Veteran provided credible testimony regarding his meniscal tear of the left knee. The Veteran stated that during a period of ACDUTRA in September 2009 he injured he left knee during a run for physical training. The Veteran stated that after the run his knee started to swell and was painful. Further, he stated that he sought medical care, was diagnosed as having a meniscal tear of the left knee and was recommended to undergo knee surgery. The Veteran stated that due to difficulties in approving the cost of the surgery, he was unable to proceed with the surgery until December 2009. Next, the Veteran’s service treatment records (STRs) document a meniscal tear of the left knee. Specifically, the STRs indicate that on September 9, 2009, the Veteran experienced left knee pain and swelling after a run for physical training during a period of ACDUTRA. Further, the STRs document that following an MRI, the Veteran was diagnosed as having an acute meniscal tear of the left knee. Additionally, the Board notes that the service department records associated with the claims file in December 2016 and April 2017 indicate that the Veteran had a period of ACDUTRA from June 21, 2009 to September 16, 2009. Moreover, the private medical evidence indicates that following a period of awaiting insurance approval, the Veteran underwent meniscal repair surgery of the left knee in December 2009. The medical evidence also indicates that the Veteran underwent a second meniscal repair surgery of the left knee in 2016. In July 2017, the Veteran underwent an in-person VA examination with claims file review regarding his left knee. The examiner documented that the Veteran’s current left knee symptoms including pain and swelling. The examiner noted the Veteran’s September 2009 STRs demonstrate an in-service left knee injury causing a meniscal tear. The examiner documented that the Veteran underwent meniscal repair surgery of the left knee in May 2016. The examiner opined that it is at least as likely as not that that the Veteran meniscal tear of the left knee was incurred in or caused by service. In the rationale, the examiner stated that the Veteran injured his left knee during a period of service and developed swelling and chronic pain. The examiner further stated that a meniscal injury was diagnosed, and the Veteran underwent surgery. The examiner explained that chronic pain can persist after a meniscal injury, and that the examination found chronic symptoms and findings consistent with the Veteran’s knee injury and military history. Subsequently, the September 2017 rating decision, without discussion of the July 2017 VA examination regarding the Veteran’s left knee, denied service connection for the Veteran’s claim finding that the evidence demonstrates that the Veteran injured his left knee in September 2009, which was not during a period of eligible service. The Board notes that after the July 2017 VA examination and September 2017 rating decision, the private medical evidence demonstrating that the Veteran underwent meniscal repair surgery of the left knee in December 2009 was associated with the claims file in October 2017. The Board finds that service connection for the Veteran’s meniscal tear of the left knee is warranted. First, the Veteran’s service department records demonstrate that he had a period of service eligible for compensation with ACDUTRA from June 21, 2009, to September 16, 2009. Second, the evidence demonstrates that during the Veteran’s period of ACDUTRA he incurred an in-service left knee injury causing a meniscal tear on September 9, 2009. Third, the conclusions of the July 2017 VA examination establish a nexus relationship by demonstrating that the Veteran’s in-service left knee injury caused chronic symptoms resulting in his present left knee disability. Accordingly, the Board finds that the preponderance of the evidence demonstrates that the requirements for establishing service connection for a meniscal tear of the left knee have been met. Therefore, the appeal is granted. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Page-Nelson, 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.