Citation Nr: 21008957 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 17-38 150 DATE: February 18, 2021 ORDER Entitlement to service connection for a bilateral knee condition is denied. FINDING OF FACT The Veteran’s bilateral degenerative knee arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a bilateral knee condition are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1973 to February 1976. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in October 2019. A transcript is of record. In a July 2020 decision, the Board reopened entitlement to service connection for the knees based on the submission of new and material evidence and remanded the matter so the RO could adjudicate this matter on the merits in the first instance. See Hickson v. Shinseki, 23 Vet. App.394(2010). 1. Entitlement to service connection for a bilateral knee condition The Veteran contends that his bilateral knee condition is related to a fall injury that he sustained during active service. He states that he has experienced ongoing knee pain since this fall injury. 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 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 record reflects current diagnoses of moderate arthritis in the right knee with a complex tear of the medial meniscus and moderate degenerative arthropathy of the left knee. The Veteran’s arthritis is an enumerated condition under 38 C.F.R. § 3.309 (a); Walker, 708 F.3d 1331. However, the Board finds the Veteran’s degenerative arthritis were not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and were not noted in service with attributable continuity of symptomatology. Service treatment records are silent for complaints, diagnosis, or treatment of knee pain. The Veteran’s November 1973 enlistment examination reflects a normal clinical evaluation, including of the knees and other musculoskeletal system. In May 1973, the Veteran sought treatment for a swollen right ankle and possible fracture. However, treatment notes are silent with respect to any complaints or evaluation of the Veteran’s knee joints. The Veteran’s January 1976 discharge examination reflected normal clinical findings of the knees and other musculoskeletal system. His January 1976 report of medical examination showed the Veteran denied having a trick or locked knee, or swollen or painful joints. There are no other records near in time to the Veteran’s active service. The first apparent report of knee pain is at an November 2003 annual checkup, where the Veteran reported he sometimes experienced right knee arthralgia. During the October 2019 hearing, the Veteran reported that he injured his knees in a fall during active service. He indicated that it was in the same incident when he fell and hurt his ankle. He stated that his pain has continued since active duty, and that he self-treated his knee pain using Goody powders. An October 2020 statement indicated that the Veteran incurred a knee injury after he fell off a ladder during active service. While the Veteran is competent to report experiencing symptoms of bilateral knee pain after an injury in service and consistently since service, the Board finds the reports of continuity of symptomatology not credible. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records. Service treatment records do reflect that the Veteran injured his right ankle, but do not reflect any positive complaints of knee pain or assessment of the right knee associated with this injury. The January 1976 separation examination and report of medical history show that he denied experiencing painful joints or trick or locked knee symptoms. Post service treatment records reflect that he reported occasional right knee pain in November 2003, outside of the presumptive period and many years after service discharge. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Service connection for a bilateral knee disability 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. While the Veteran asserts that his fall and right ankle injury during active service also resulted in his right knee disability, he is not competent to determine that these symptoms were manifestations of a knee disability as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran has not been afforded a VA examination to aid in substantiating this claim; however, given the lack of an in-service incurrence or evidence indicating that there may be a nexus between the current knee disability and service, the Board finds that one is not warranted. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The preponderance of the evidence weighs against a finding that the Veteran’s current bilateral knee conditions were incurred in or are otherwise related to his active service, including his reported in-service fall and/or ankle injury. There is no doubt to be resolved; service connection for a knee condition is not warranted. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Lauritzen, 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.