Citation Nr: 21010449 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 18-06 176 DATE: February 24, 2021 ORDER Service connection for left knee disability is granted. FINDING OF FACT The Veteran’s left knee disability, diagnosed as arthritis and total knee replacement, had its onset during active service and continued to the present. CONCLUSION OF LAW The criteria for service connection for left knee disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 1964 to August 1966. This matter comes before the Board of Veterans’ Appeals (Board) from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified at a hearing before the undersigned. A transcript of the hearing is associated with the record. In May 2020, the Board remanded the Veteran’s claim for additional development. The matter has been returned to the Board for review. Service connection for left knee disability Under the relevant laws and regulations, 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. Generally, the evidence 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. Shedden v. Principi, 391 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Arthritis is a listed chronic disease, with a presumptive period of one year following separation from service. The Veteran asserts that he injured his left knee during basic training in 1964. He testified that he fell into a hole in the ground and developed problems over time requiring multiple surgeries beginning in 1978. The medical evidence shows that the Veteran has a current disability and has been diagnosed with arthritis and total knee replacement of the left knee. The first Shedden element has been met. Concerning an in-service injury or disease, service medical treatment records show that the Veteran was treated for knee pain in 1964, without reference to the right or left knee. The second Shedden element has been met, resolving all doubt in favor of the Veteran. Thus, the remaining Shedden element required for service connection is a nexus relating the Veteran’s left knee disability to active service. Following separation from service, a May 2007 private treatment record shows that the Veteran reported that he had initially injured his left knee in 1964 during his active service. In addition, the Veteran reported that he had two prior surgical procedures for his left knee. The Veteran was assessed with arthritis. In May 2007, when the Veteran filed his initial claim for service connection for left knee disability, he reported that he injured his left knee during service in 1964. In October 2007, the Veteran was provided a VA examination. He reported that he injured his left knee while in the service. He stated that the stepped into a hole in the ground. The Veteran indicated that he was treated to repair torn cartilage at Beth Israel in 1978 and another repair at Duke Medical Center in 1990. The examiner provided a positive opinion, noting that there was evidence of posttraumatic osteoarthritis and two surgical procedures after service. However, the examiner did not review the Veteran’s claims file. In February 2008, a VA clinician reviewed the claims file and provided a negative nexus opinion. The clinician explained that there was only one note of pain in the service treatment records of knee pain treated with Darvon. There was no problem with the knee noted on separation and there was no documentation of left knee pain until the mention of the surgery completed in 1995. In April 2016, the Veteran submitted a release to obtain records from Beth Israel concerning his surgery in 1978. Beth Israel responded that no records could be found. Duke University Hospital records dated in 1995 show that the Veteran reported prior left knee cartilage surgery approximately 17 years ago at Beth Israel Hospital in New York. It was noted that the Veteran gradually began to experience pain and discomfort. He was evaluated with degenerative arthritis of a post-operative knee. VA treatment records show that the Veteran underwent surgery for a left total knee replacement in 2017. In April 2017, the Veteran’s VA physician provided a positive nexus opinion relating his left knee arthritis requiring a total knee replacement was related to his injury sustained in basic training. However, that physician did not provide any reasoning for that opinion. In September 2020, the VA examiner provided a negative nexus opinion. The examiner reviewed the Veteran’s claims file. The examiner explained that the Veteran’s record was silent relative to left knee pain during service and that he consulted for left knee pain in 1995, many years after service. The Board finds the opinion inadequate. Again, the examiner did not note that the Veteran reported surgery in 1978 when he was treated in 1995 and did not address the notation of knee pain during service. Here, the Board recognizes that there is no adequate medical opinion concerning the etiology of the Veteran’s left knee disability. However, the Veteran was treated in service in 1964 for knee pain, and has competently and credibly attested to his chronic symptoms since service that first required surgical intervention in approximately 1978. Though the Beth Israel medical records from 1978 are not available, the Veteran is competent and credible concerning his left knee surgery in 1978, as the Veteran reported a consistent history to VA examiners and private physicians in 1995 and 2007. Thus, the Board finds the Veteran competent and credible concerning his ongoing knee symptoms and pain since his 1964 in-service injury, as well as his treatment history. Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Accordingly, the Board finds that service connection is warranted based on continuity of symptomatology. The Board finds that the Veteran’s competent and credible statements coupled with the private treatment records dated over the years show continuity of the signs and symptoms of left knee problems associated with arthritis. Service connection for a left knee disability is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Seay, 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.