Citation Nr: 21008554 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 19-18 276 DATE: February 17, 2021 ORDER Service connection for a right knee disorder is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s current right knee disorder is etiologically related to her active duty service. CONCLUSION OF LAW The criteria for service connection for a right knee disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1995 to January 2002, September 2007 to August 2008, January 2009 to May 2009, July 2009 to June 2010, August 2010 to December 2012, and July 2015 to July 2016. In February 2021, a Board hearing was held before the undersigned Veterans Law Judge. Entitlement to service connection for a right knee disorder. 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; 38 C.F.R. § 3.303(a). To establish service connection, a Veteran must show: (1) the existence of 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, the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Although the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran asserts that her right knee disorder began during active duty service. The record establishes that she has a current diagnosis for right knee patellofemoral pain syndrome. See December 2017 VA Examination report. Such is sufficient to meet the first element for establishing service connection, i.e., a current disability. Moreover, the Veteran’s service treatment records (STRs) reflect that she had persistent right knee problems and diagnoses for right knee patellofemoral syndrome and patellar chondromalacia during her active duty service. Therefore, the second element for establishing service connection, service incurrence, is established. The crucial question in this case is whether the evidence suggests that a relationship exists between the Veteran’s current diagnoses for a right knee disorder and her active duty service. To that end, the Board finds that it does. As noted above, the Veteran was diagnosed with right knee patellofemoral syndrome and patellar chondromalacia in October 2009 and February 2010, during her active duty service. Her STRs show that her right knee problems persisted through separation from service and, in November 2016, within a few months after separation, she continued to report right knee pain. See September 2017 STRs. Consistent with these records, she testified at the February 2021 Board hearing that she continued to have right knee pain and it has only gotten worse. The Board finds the Veteran’s reports of right knee pain to be competent and credible. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Significantly, during her December 2017 VA examination, the examiner diagnosed her with patellofemoral pain syndrome. This is the same diagnosis for the right knee that was made during her active duty service. Likewise, this evidence tends to show that the Veteran’s right knee disorder, which initially manifested during active duty service, has continued since. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a), (d). The Board acknowledges the negative nexus opinion provided by the December 2017 VA examiner. However, the VA examiner’s opinion was inadequate because it was based solely on the fact that the Veteran did not have a diagnosis for right knee arthritis. The examiner did not otherwise consider whether the Veteran’s current right knee diagnosis (patellofemoral pain syndrome) was related to her active duty service. Consequently, the Board finds that the VA examiner’s negative nexus opinion cannot serve as a basis for a denial of service connection. In sum, in resolving reasonable doubt in the Veteran’s favor, the Board finds that the competent and credible evidence of record establishes that the criteria for service connection for a right knee disorder have been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection for a right knee disorder is granted. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Metzner, Paul 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.