Citation Nr: 21008921 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 16-39 556 DATE: February 18, 2021 ORDER Entitlement to service connection for a left knee disorder is denied. FINDING OF FACT A left knee disorder did not initially manifest during service or within one year of discharge therefrom and is related to the aging process and overuse, not service or a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a left knee disorder is denied. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1962 to March 1964. His claim comes before the Board of Veterans' Appeals (Board) on appeal of a November 2014 Department of Veterans Affairs (VA) rating decision. The Board remanded this claim to the Agency of Original Jurisdiction (AOJ) in April 2018, December 2019 and September 2020. Entitlement to service connection for a left knee disorder The Veteran seeks service connection for a left knee disorder, to include a fracture and nerve damage, on either a direct basis, as related to in-service injuries, or secondary basis, as related to back and/or neck disabilities he believes should also be service connected. In describing the in-service injuries, he has testified that, in 1963, on training in Alaska, he fell several times while skiing. One time, he ended up in a hole, requiring extraction by multiple soldiers and a transfer to a hospital by ambulance. There, a provider put a cast on his leg (later indicating it was his ankle), gave him pain medication, and ordered x-rays but did not render any diagnosis, sending him back to his company the next day. He asserts that, thereafter, he continued to experience pain, and in March 2015, he underwent corrective left knee surgery, resulting in nerve damage. 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). Service connection may also be granted on a secondary basis, for disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. For chronic arthritis, service connection may be presumed when the condition is shown to a degree of 10 percent or more within one year of discharge from active duty. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The questions for the Board are therefore whether the Veteran has a left knee disability that began during or within a year of service, and, if not, whether such disability is at least as likely as not related to an in-service injury, event, or disease or service-connected disability. For the reasons that follow, the Board concludes that, while the Veteran currently has a left knee disability characterized as degenerative arthritis, the preponderance of the evidence weighs against finding that that disability initially manifested during or within a year of service or is otherwise related to service or a service-connected disability. According to service treatment records, the Veteran injured and received treatment for his left knee in service. Specifically, in December 1962, he sprained his left knee and left ankle skiing, an injury that necessitated splinting, but to immobilize his foot, not his knee. A week later during follow-up visits, providers noted a fairly stiff knee, tenderness over the medial malleolus and pain on full flexion. By separation examination conducted in February 1964, he was no longer complaining of left knee symptoms, and the examiner noted a normal clinical evaluation of the Veteran’s lower extremities. The Veteran also received in-service treatment for complaints involving other parts of his left lower extremity. In December 1963, again while skiing, he injured his left ankle, x-rays of which showed no fracture. The same month, the Veteran presented with a mass on his anterior tibia, which reportedly developed after a pre-service bike accident that occurred ten years prior to the visit. An examiner characterized it as a cystic-like mass, and x-rays revealed no bony defect. For five decades after discharge from service, the Veteran did not seek treatment for his left knee disability. Rather, during the course of this appeal, examiners diagnosed degenerative joint disease. Multiple VA examiners have discussed whether this disability or any other left knee disability is related to his service, including any incidents or abnormalities noted above, and none has provided a favorable opinion. In an August 2014 VA examination report, one examiner ruled out a relationship between the Veteran’s reported left knee fracture (the only left knee disability the Veteran initially claimed) and service on the basis that there was no evidence of such a fracture. As this examiner did not address whether the Veteran had any other left knee disability that might be due to the December 1962 left knee injury, the Board remanded the claim for another VA examination. The report of that April 2019 examination, which acknowledges the Veteran’s in-service knee sprain but notes an absence of evidence of continuity of left knee symptoms following the sprain, relates the Veteran’s left knee degenerative arthritis to the normal progression of the aging rather than any in-service incident. Unfortunately, it too is inadequate as it ignores the Veteran’s reports of continuous, lay-observable left knee pain following the sprain. Based on this inadequacy and because the Veteran continued to assert that he had nerve damage in his left knee, which surgery reportedly corrected in 2015, the Board twice remanded this claim to the AOJ for additional opinions. The purpose was to consider the Veteran’s reports of lay-observable left knee symptoms and the significance of other possibly pertinent medical information of record, including a pre-service report of leg cramps and numbness, post-service diagnoses of a popliteal aneurysm in the left lower extremity, removed in 2015, and a vascular condition affecting that extremity. In February and October 2020, VA examiners considered the Veteran’s statements, pre-service reported history of leg cramping and numbness, confirmed all post-service diagnoses, related the left knee degenerative joint disease to aging and overuse, ruled out a relationship between the Veteran’s popliteal artery aneurysm and vascular condition to service, finding the latter the cause of some of the Veteran’s complaints, and distinguished these other left lower extremity diagnoses from the Veteran’s left knee degenerative arthritis. The October 2020 VA examiner based his opinion on a thorough review of the record and well-reasoned rationale. The Veteran has not submitted a medical opinion, favorable or otherwise, in support of his claim, and not being trained in medicine, his assertions may not be considered competent evidence of a nexus in this case. The facts are complex, involving the interaction between multiple systems of the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4. As the Veteran’s left knee disorder did not initially manifest during service or within one year of discharge therefrom, and there is no competent evidence of record otherwise relating it to service or a service-connected disability, the criteria for entitlement to service connection for a left knee disorder are not met 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. N. 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.