Citation Nr: 21010427 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 18-23 372 DATE: February 24, 2021 ORDER Service connection for a right knee condition, to include arthritis and internal derangement, is granted. Service connection for a left knee condition, to include arthritis and internal derangement, is granted. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for ischemic heart disease is remanded. Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT The evidence is at least in equal balance that the Veteran’s right and left knee conditions, diagnosed as arthritis and internal derangement, are related to his service. CONCLUSION OF LAW The criteria for service connection for right and left knee conditions are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Marine Corps from January 1978 to January 1982. These matters are before the Board of Veterans’ Appeals (Board) on appeal from November 2014 (ischemic heart disease, hypertension, and bilateral hearing loss) and October 2015 (right knee arthritis and left knee arthritis) rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified at a videoconference hearing before the undersigned; a transcript of that hearing is of record. Service Connection Entitlement to service connection for right knee arthritis and left knee arthritis The Veteran has contended that his arthritis of the bilateral knees had its onset during active duty service, and alternately that it was caused or aggravated by his service-connected lumbar spine strain and / or radiculopathy of the left lower extremity. As the Board is granting service connection below based on bilateral knee arthritis being directly related to service, the Board will not further discuss the theory of entitlement that it is secondarily related to a service-connected disability. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease 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). Establishing entitlement to direct service connection generally requires: (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 - which is the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases (such as arthritis) may be presumptively service connected if they become manifest to a degree of 10 percent or more within one year of leaving qualifying military service. 38 C.F.R. §§ 3.307, 3.309. If a condition listed as a chronic disease in § 3.309(a) is noted during service but is either shown not to be chronic or the diagnosis could be legitimately questioned, then a showing of continuity of related symptomatology after discharge is required to support the claim. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Turning to the evidence, the Veteran’s service treatment records are silent for complaints, diagnosis, or treatment of any knee conditions in service. The Veteran’s lower extremities were marked “normal” in September 1977, and December 1981 medical examinations. The Veteran denied arthritis, rheumatism, bursitis, and bone or joint deformities in September 1977, June 1979, and June 1983 medical histories. In a September 2013 VA treatment record, the Veteran reported bilateral knee pain for “a couple of months – getting worse.” The September 2013 provider noted crepitus in both knees and pain on pressure to the patella. November 2013 X-rays showed no abnormalities to the knees, but in December 2013 the Veteran reported continued pain, now with swelling in the left leg. In a March 2014 private treatment record from the Travis Clinic, the Veteran reported popping in both of his knees. The doctor found the Veteran had bilateral degenerative changes in the knees with pain and decreased range of motion. In a June 2015 VA treatment record, the Veteran reported bilateral knee pain for the past 3 to 5 years, and described a throbbing, aching pain. The Veteran testified before the Board in December 2019. He stated that he was required to do a great deal of running for his physical training while he was stationed in Okinawa, as well as standing as a rifleman guard. The Veteran said that his bilateral knee pain onset during service and he treated himself with Tylenol and heating pads. He said that he did not report the pain because he did not like doctors. The Veteran testified that after service, he worked as a security guard and spent most of his time seated. Later, he worked for a pipeline which required kneeling and he needed to use kneepads due to his knee pain. The Veteran stated that his knee pain worsened as he got older and that he had been diagnosed with bilateral arthritis of the knees. He said he gets treatment for his knees from a private doctor at the Travis Clinic who told him that the knee disability was caused by his back pain. In November 2019, the Veteran’s treating provider at the Travis Clinic provided a review of the Veteran’s records as provided by the Veteran’s attorney. The provider diagnosed internal derangement of the right and left knees and stated that she reviewed the Veteran’s medical history and concluded that within a reasonable medical certainty the Veteran “has damage to his knees during service due to running 3 miles a days with heavy packs and later walking off balance due to his sciatica which is already service-connected.” A December 2019 letter from private Dr. F. opined that it is at least as likely as not that the bilateral knee condition began in service. The rationale for this conclusion was that the Veteran testified that his knee pain began in service due to long hours standing, marching, and running with a heavy pack, and that he treated his pain with heating pads and ice. Dr. F. noted that the Veteran was also having continual back pain with sciatica that affected his gait and caused him to walk in an unbalanced fashion, putting undue pressure on his knees. Dr. F. commented that the Veteran’s knee pain has continued and worsened since leaving service with the development of bilateral degenerative arthritis. The Veteran’s treatment records reflect that he has a current diagnosis of bilateral knee arthritis and internal derangement of the knees, and the first element of service connection has been met. Additionally, the Veteran has testified that he was required to do a great deal of running for his physical training and did a lot of standing as a rifleman guard during service. He has also testified that he started having bilateral knee pain during service and he treated himself with Tylenol and heating pads. The Veteran is competent to testify regarding observable symptoms, including experiencing pain, and the circumstances of his service. The Board also finds his statements to be credible as they have been consistent. Therefore, the Board finds that the second element of service connection, an in-service event or injury, has been met. Regarding whether there is a nexus between the Veteran’s current right knee arthritis and his service, the Board finds the November and December 2019 opinions that the Veteran’s bilateral knee conditions are at least as likely as not related to physical activity in service are entitled to great weight of probative value as they reflect that the Veteran’s medical and service records were reviewed and that the Veteran’s medical history was considered. The opinions are also accompanied by clear rationales for the conclusions reached. The evidence does not contain any contrary medical opinions. Therefore, the Board finds that the third element of service connection has been met. In summary, the Board finds the evidence is at least in equipoise that the Veteran’s bilateral knee conditions, diagnosed as arthritis and internal derangement, are related to his service. Thus, the Board resolves any reasonable doubt in his favor and finds that service connection is warranted. 38 U.S.C. § 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS FOR REMAND Entitlement to service connection for hypertension, ischemic heart disease, and bilateral hearing loss is remanded. A November 2014 rating decision denied service connection for hypertension, ischemic heart disease, and bilateral hearing loss. The Veteran filed a timely VA Form 21-0958, Notice of Disagreement, in response to that decision in July 2015. The record does not reflect that the Agency of Original Jurisdiction has issued a statement of the case in these matters. As such, the Board must remand the claims for such issuance. 38 C.F.R. § 20.904(c); see Manlincon v. West, 12 Vet. App. 238 (1999). The matters are REMANDED for the following action: Issue a SOC for the matters of service connection for hypertension, ischemic heart disease, and bilateral hearing loss. Advise the Veteran and his attorney of their appeal rights. If an appeal is perfected in these matters, the claims should be returned to the Board, if otherwise in order. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Dean 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.