Citation Nr: 21009875 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 16-19 650A DATE: February 23, 2021 ORDER Service connection for a left knee disability is denied. FINDING OF FACT The weight of the evidence is insufficient to show that the Veteran’s left knee disability occurred during or was otherwise etiologically related to his active service. CONCLUSION OF LAW The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1972 to September 1974. His military specialty was lineman/field wireman. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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 (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran is seeking service connection for his left knee disability. He testified at his October 2018 Board hearing that he worked on telegram poles for long hours while serving as a pole lineman in the military, and he believes that as a result, he developed left knee problems. In his notice of disagreement, the Veteran stated that his left knee was injured while climbing a telephone pole at Ft. Huachuka in 1971. Service treatment records (STRs) did not show any complaints of or treatment for any knee problems. Separation physical in August 1974 did not show any knee conditions. Reserve medical examination in June 1977 showed normal lower extremities. In June 1977, the Veteran reported occasional right knee problems, but did not report any left knee problems. Likewise, the Veteran was placed on a profile based on a finger injury, but there was no such limitation on account of any finger injury. In a December 2018 statement, the Veteran’s wife wrote that his left knee had been fractured and had healed in a malformed position. However, there is no other allegation of a knee fracture and as such, this statement is taken to be in error. Of note, the statement does not address the onset of the knee problem, but rather focuses on the fact that the Veteran currently has knee problems which is not in question. The Veteran provided a private pinion from Dr. T. dated January 9, 2019 stating that veterans who held positions in service requiring climbing and extensive physical activity would have physical effects later in their health, and that the Veteran’s knee conditions (such as buckling and problems with maintaining the balance of walking without a cane) were likely occurred during service. However, Dr. T. did not indicate any diagnosis of Veteran’s left knee and did not seem to have reviewed the Veteran’s medical records, including his service treatment records (STRs). Additionally, the doctor acknowledged that the Veteran had to wrestle with inmates in a juvenile lock-down facility which he indicated would be equally debilitating and would aggravate any underlying problem. In May 2019, the Board remanded the issue for further development to conduct a VA examination to diagnose any left knee condition, and to obtain a medical opinion regarding the etiology thereof. The Board superficially asked the examiner to address Dr. T.’s opinion. The Veteran was afforded a VA examination in November 2019, at which he was diagnosed with degenerative arthritis of the left knee. The examiner opined that the left knee condition was less likely than not (less than 50 percent probability) incurred in or caused by the Veteran’s service. However, the examiner provided inconsistent rationale and did not address Dr. T.’s opinion. In October 2020, the Board remanded the issue again for a VA medical opinion to further address the etiology of the Veteran’s left knee condition. In November 2020, a VA examiner reviewed the Veteran’s claim file, and opined that his left knee condition was less likely than not (less than 50 percent probability) incurred in or caused by his service. The examiner provided the following rationale: No chronic diagnosis is made for a left knee condition to include left knee DJD while on active duty. Symptoms are subjective only. … The separation exam dated 08/21/1974 did not note a chronic left knee condition. The Veteran is deemed competent to provide a history of his symptoms. The lay/buddy statements regarding the Veteran’s symptoms were also considered. However, the Veteran is not capable of diagnosing the medical condition related to those symptoms. The available medical records are silent for medical evaluations, treatment, or a diagnosis for a left knee condition to include left knee DJD while on active duty. Symptoms are per self-report only and are not confirmed in the claims file. There is no objective medical evidence linking the current diagnosis of left knee DJD to his military service. … Per the available documentation, Dr. T. noted “the Veteran’s knee conditions (such as buckling and problems with maintaining the balance of walking without a cane) were likely occurred during service”. This examiner is not in agreeance with this opinion presented by Dr. T. as the available medical records are silent for medical evaluations, treatment, or a diagnosis for a left knee condition while on active duty. The November 2020 VA opinion is consistent with STRs as well as the VA treatment records. For example, VA treatment records show that during the May 2005 initial primary care evaluation, the Veteran reported that he had neck pain and occasional headaches, without reporting any knee problems. Physical examination that that time showed normal lower extremities. In March 2015, the Veteran reported chronic knee pain. In July 2015, x-rays showed left knee degenerative joint disease (DJD). These are the earliest post-service records showing left knee complaints and diagnosis, which are approximately 41 years after he separated from active service. The Board finds that the November 2020 VA opinion is based on well-reasoned rationale, supported by evidence of record, and therefore, is found to be more probative than Dr. T.’s opinion, which seemed to rely primarily on the Veteran’s statement, without reviewing his medical records, to include STRs and VA treatment records, which neither show any knee problems in service or for many years thereafter. As such, evidence is insufficient to show that the Veteran’s left knee condition occurred during or was otherwise etiologically related to his active service. Service connection for a left knee disability is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Wang, 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.