Citation Nr: 21012837 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-46 851 DATE: March 5, 2021 ORDER Service connection for a gastrointestinal disability is denied. Service connection for a right knee disability is denied. FINDINGS OF FACT 1. The Veteran’s malrotation of the gut is a congenital defect which was not subject to a superimposed disease or injury during service that resulted in an additional disability, and the preponderance of the evidence is against finding that any gastrointestinal disability began during active service, or is otherwise related to an in-service injury or disease. 2. A right knee disability, to include osteoarthritis and meniscal tears, was not present during active duty, did not manifest to a compensable degree within one year of separation from active duty, continuity of symptomatology is not established, and the Veteran’s current right knee disability is not otherwise causally related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a gastrointestinal disability are not met. 38 U.S.C. §§ 1110, 1111, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right knee disability 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 FINDINGS AND CONCLUSIONS The Veteran had active service from April 1972 to October 1972. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, denied service connection for a right ankle disability, reconsidered a previously denied claim of entitlement to service connection for a stomach condition but denied that claim on the merits, and determined that new and material evidence had not been received to warrant reopening a previously denied claim of entitlement to service connection for right knee osteoarthritis. The Veteran filed a timely notice of disagreement received by VA in September 2014. In December 2015, the RO issued a statement of the case. The Veteran’s substantive appeal was received by VA in December 2015. In a November 2018 decision, the Board denied entitlement to service connection for a right ankle disability and determined that new and material evidence had been received to warrant reopening previously denied claims of entitlement to service connection for stomach and right knee disabilities, and remanded the issues of entitlement to service connection for stomach and right knee disabilities. The RO issued a supplemental statement of the case in August 2020 and the matter was returned to the Board. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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 specifically enumerated chronic diseases, including arthritis, 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 (a year following separation for arthritis); 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). A veteran is presumed to have been in sound condition when entering service, except as to defects, infirmities, or disorders noted at the time of the examination or where clear and unmistakable evidence demonstrates that the injury or disease existed prior to service and was not aggravated by such service. 38 U.S.C. §§ 1111, 1137. In order to rebut the presumption of soundness, the government must show by clear and unmistakable evidence that (1) a veteran’s disability existed prior to service and (2) that the pre-existing disability was not aggravated during service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). The Federal Circuit has made clear that the Secretary may rebut the second prong of the presumption of soundness by demonstrating with clear and unmistakable evidence, either that (1) there was no increase in disability during service, or (2) any increase in disability was due to the natural progression of the condition. Wagner, 370 F.3d at 1096; see also Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009). Congenital or developmental defects are not “diseases or injuries” within the meaning of applicable statutes and regulations. 38 C.F.R. § 3.303(c). Rather, a defect of congenital, familial, or hereditary origin by its very nature pre-exists military service. Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993). If the defect is congenital, therefore, the presumption of sound condition at service entrance does not attach. See Quirin, 22 Vet. App. at 397; Terry v. Principi, 340 F.3d 1378, 1385–86 (Fed. Cir. 2003) (holding that the presumption of soundness does not apply to congenital defects). Service connection is only possible if there is evidence of additional disability due to aggravation during service of the congenital defect by superimposed disease or injury. See Monroe, 4 Vet. App. 513, 514-15; Carpenter, 8 Vet. App. 240, 245. On the other hand, “congenital diseases, but not defects, may be service connected.” Quirin, 22 Vet. App. at 394; see also Winn v. Brown, 8 Vet. App. 510, 516 (1996) (holding that “non-disease or non-injury entities such as congenital defects” are not “disabilities” within the meaning of 38 U.S.C. § 1110 ); 38 C.F.R. § 3.303(c) (providing that congenital or developmental defects “are not diseases or injuries” for VA disability compensation purposes). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39–40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). “When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter,” the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. Gilbert, 1 Vet. App. at 54. Gastrointestinal Disability The Veteran asserted that his current H. Pylori was incurred in service. See, e.g., October 2020 Correspondence. Of record is an April 1972 letter from a private physician stating that when the Veteran was five years old, he operated on the Veteran to correct a congenital malrotation of the gut. The physician stated that the Veteran had an uneventful convalescence with no trouble and that the condition should never cause the Veteran trouble in the future. At the Veteran’s April 1972 entrance examination, clinical evaluation showed that his abdomen was normal. However, the examining physician noted that that the Veteran had congenital malrotation of the gut, which was repaired in 1965. The physician indicated that the congenital malrotation of the gut was okay. The Veteran was found qualified for duty. In a concurrent report of medical history completed by the Veteran, he noted that when he was five years old he had a stomach operation. In-service treatment records show, in pertinent part, that in May 1972 the Veteran complained of stomach pains for one day in his entire abdomen. The Veteran denied any previous history of stomach pain. June 1972 service treatment records note that the Veteran complained of gas indigestion. July 1972 service treatment records show that the Veteran complained of stomach pain in the lower left quadrant. On examination, the Veteran had an extremely tender and enlarged prostate. The impression was prostatitis. The Veteran complained of abdominal pain again later in July 1972. Service treatment records from September 1972 show the Veteran complained of stomach pain again and a consult was pending. The following day, the Veteran had his eighteenth sick call entry for abdominal pain during his short period of active duty. He reported he had constant abdominal pain since his operation for congenital malrotation at the age of five. The Veteran stated that the pain was unrelenting for the prior 16 years and that diets, analgesics, antacids, anti-cholinergics, and various nostrums had not provided even transient relief. The Veteran said that because of this pain, he had never participated in sports while in school and he did not feel like doing work. After examination, the physician recommended administrative separation from service. At the Veteran’s October 1972 separation examination, clinical evaluation revealed that his abdomen and viscera were abnormal. The examining physician noted that the Veteran had a history of abdominal pain for 17 years after an operation for congenital malrotation of the gut. Post-service private treatment records from April 1982 show the Veteran complained of constipation left upper quadrant pressure or gas-like sensation suggestive of a splenic flexure syndrome for about a month. The Veteran reported that he had a similar spell of constipation and left upper quadrant pain three years prior. The diagnostic impression was that the Veteran may have had gastritis or another colonic disorder. An imaging study later in April 1982 revealed minimal diverticulosis in the sigmoid. There was non-rotation of the colon with the cecum lying in the midline and no hepatic flexure present. Sonography of the gallbladder and pancreas were normal. Further imaging tests showed incomplete colon rotation. The impression was distal antral erosive disease. Private treatment records show that in October 1982 the Veteran was diagnosed as having an umbilical hernia repair. X-ray examinations were negative. The hernia was repaired in February 1983. Private treatment records from August 2013 show the Veteran visited an emergency room complaining of crampy abdominal pain followed by dark red stool. The Veteran reported that he had gut problems ever since his childhood surgery with occasional abdominal pain. The impression was a suspected lower gastrointestinal bleed, most likely diverticular versus a bout of ischemic colitis. The Veteran may have had a component of malrotation as well. A CT scan suggested that most of the Veteran’s colon was on the left side of his body. A colonoscopy revealed diffuse diverticular disease and recent lower gastrointestinal bleeding that was a suspected diverticular bleed. In May 2014 the Veteran was afforded a VA examination in connection with this claim. The examiner diagnosed the Veteran as having antral erosions of the stomach. The Veteran stated that during basic training he developed mild and vague abdominal pain on the right side that intensified and worsened during service. The examiner noted the Veteran’s history of antral erosions of the distal stomach and scattered diverticula. The examiner also noted discrepancies between the Veteran’s statements to the examiner that he had no pain from the age of five until his service, and the Veteran’s in-service reports that he had constant, unrelenting abdominal pain for 16 years. The examiner stated that although the Veteran vaguely recalled having gastritis during service, there was no in-service documentation of gastritis. The examiner opined that the Veteran’s current stomach condition was less likely than not incurred in or caused by an in-service injury, event, or illness because there were no in-service notations of gastritis. The examiner stated, however, that some of the symptoms that the Veteran had during service may have been unrecognized gastritis. Pursuant to the Board’s November 2018 remand, the Veteran was afforded another VA examination in connection with this claim in July 2020. The examiner diagnosed the Veteran as having correction of congenital malrotation of the gut, diverticulitis, diverticulosis, gastritis with antral erosions, and Helicobacter pylori (H. pylori). The examiner explained that “diverticulosis is the anatomical change where the colon forms ‘out-pouches’ over time, typically after the age of 40, and is considered an active disease when these pouches become infected, which is then defined as diverticulitis.” The examiner opined that it was less likely than not that the Veteran’s “gastritis with H. pylori & diverticulitis were originally incurred in active service, and . . . his congenital malrotation of the gut was present at birth.” The examiner noted that the Veteran’s “diagnosis of gastritis was not confirmed until 1982, when he was seen following spells of increased abdominal pain of the left upper quadrant.” The examiner acknowledged that the Veteran was: seen for abdominal pain multiple times while in his brief active service period, but none of the above diagnoses were associated with his symptoms. One medical visit concluded that his abdominal pain was due to prostatitis, which would be unrelated to the GI system, and another on September 29, 1972, stated that the veteran reported ongoing abdominal pain throughout the 16-17 years following his childhood abdominal surgery. The descriptions of his pain appears to be diffuse, nonspecific, and resembling his chronic pain since his surgery. This is not unheard of as a portion of patients who undergo malrotation correction are expected to have chronic & diffuse abdominal pain (Husberg, et al. 2016). Furthermore, there is no accepted medical evidence that the presence, or exacerbation/aggravation, of congenital malrotation of the gut would cause his currently claimed gastritis & diverticulosis. There has been at least one case study that found a ruptured appendix & diverticulitis in an adult patient with untreated congenital malrotation of the gut (Chen. 2018). However, this would not suggest that the veteran, who had successful repair of his gut malrotation as a child, should attribute his diverticular disease diagnosed later in life to his brief active service period, nor could his diverticular disease be considered a progression of his congenital malrotation. The VA clinician also opined that it was less likely than not that the Veteran’s congenital malrotation of the gut was aggravated by an in-service event, illness, or injury. The clinician explained that there did “not appear to be any quantifiable change in the Veteran’s abdominal symptoms due to his 6 months in active service.” The clinician noted that service treatment records showed the Veteran had: recurrent abdominal discomfort for 16 to 17 years following his childhood surgery. Multiple sick bay visits are documented, but no new confirmed diagnoses are provided until about 10 years after his active service period when his abdominal pain apparently took on a new pattern with focal left upper quadrant pain & constipation in 1982. At that time, the veteran stated that this pain was similar to “a spell about 3 years ago” which would place his earliest objective change in his lifelong abdominal symptoms around 1979. There does not appear to be any objectively diagnosed gastrointestinal disorders during the veteran’s 6 months in active service. Around the time of his administrative separation from active service for his “post-operative stomach pains[,]”[] it was noted that the veteran suffered from “16 years of constant abdomen pain following surgery for his cong. malrotation of the bowel” that apparently prevented the veteran from playing sports prior to his active service period. It would appear that his symptoms were at least as limiting prior to service, continued through his 6 months of service, and were not found to be due to any new or superimposed gastrointestinal disorders while in active service or in the year following this period. In addition, the July 2020 VA clinician stated that the Veteran’s malrotation of the gut was a congenital defect of embryonic development. Although the Veteran had the condition surgically corrected, “the orientation of the intestines is rarely restored exactly to where it should be anatomically and can produce lifelong symptoms in some patients who continue to suffer from chronic & diffuse abdominal pain (Husberg, et al. 2016). This seems to be the case for the Veteran, as per his STRs & documentation of separation from active service.” The clinician opined that it was thus less likely than not that the Veteran had any additional disability due to aggravation of the congenital malrotation of the gut defect because of a superimposed disease or injury. The examiner supported this opinion with much of the same reasoning as set forth above and stated that “[t]here is no additional disability apparent during the veteran’s active service beyond the continuation of his chronic abdominal pain from childhood.” In October 2020, VA received a letter from one of the Veteran’s gastroenterology providers, an advanced registered nurse practitioner (ARNP), dated August 2020. The ARNP stated that the Veteran was diagnosed as having malrotation of the intestines at the age of five and underwent surgery at that time. The ARNP asserted that the Veteran had done well following his surgery, but “after he enlisted into the military at the age of 19, he began having recurrence of his gastrointestinal issues during his basic training. He has had multiple GI issues since that time.” In October 2020 VA received a letter from the Veteran asserting that the July 2020 VA examiner told the Veteran that he did not have gastrointestinal problems but had H. pylori. The Veteran also listed private providers he was seeing for his stomach problems. The Veteran stated: “I was active while in school playing baseball and basketball from age 7 until I went into the service in which I went at age 19. I passed my physical and entrance exam. I was sent to Orlando, FL for basic training. Due to the basic training exercises, I went to medical about my stomach was hurting. I played basketball with the basic training team.” Applying the facts in this case to the legal criteria set forth above, the Board finds that the preponderance of the evidence is against granting service connection for a gastrointestinal disability, to include H. pylori, diverticulitis, diverticulosis with antral erosions, and congenital malrotation of the gut. First, the Board finds that the Veteran’s malrotation of the gut is a congenital defect not subject to additional disability due to any superimposed injury or disease because there were no superimposed injuries or diseases during service. Second, the Board finds that the Veteran’s current H. pylori, diverticulitis, and diverticulosis with antral erosions disabilities were not incurred in or otherwise related to the Veteran’s period of active service. The presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service. Gilbert v. Shinseki, 26 Vet. App. 48, 55 (2012), aff’d 749 F.3d 1370 (Fed. Cir. 2014). In this case, there is a question as to whether the Veteran’s claimed stomach problems or gastrointestinal disability preexisted his military service. As set forth above, the Veteran’s history of malrotation of the gut was noted at his entrance examination. And although the evidence at the time of the Veteran’s entrance examination indicated that the malrotation was successfully repaired and the Veteran was cleared for duty, in-service treatment records show that the Veteran reported constant, unrelenting abdominal pain in the 16 to 17 years between his surgical repair and his administrative separation. The most competent and credible evidence of record shows that the Veteran’s malrotation of the gut disability is congenital in nature. The July 2020 VA clinician explained that the Veteran’s malrotation of the gut was present at the Veteran’s birth. In addition, an April 1972 letter from a physician upon the Veteran’s entrance into service notes that the Veteran had congenital malrotation of the gut. There is no evidence of record to suggest that the Veteran’s malrotation of the gut was not congenital. Nor has the Veteran asserted otherwise. As set forth above, service-connection may be granted for diseases, but not defects, of congenital, developmental or familial origin. The most competent and credible evidence of record shows that the Veteran’s malrotation of the gut is a congenital defect. In this regard, the Board finds the opinion of the July 2020 VA clinician highly probative. The clinician explained that malrotation of the gut is a congenital defect that, although subject to surgical repair, is generally never cured, and lifelong chronic and diffuse abdominal pain is to be expected, as the Veteran has experienced. Review of the record reveals no evidence to suggest that the Veteran’s malrotation of the gut is instead a congenital disease. Service connection for congenital or developmental defects is precluded by VA regulation. 38 C.F.R. §§ 3.303(c), 4.9. Service connection for a congenital defect can be established only if the congenital defect was subject to a superimposed disease or injury during military service that resulted in disability apart from the congenital or developmental defect. The probative evidence of record does not show a superimposed disease or injury in this case. In this regard, the Board finds the opinion of the July 2020 VA examiner highly probative. As set forth above, the examiner opined that the Veteran’s malrotation of the gut was a congenital defect and that there was no evidence of additional disability due to superimposed disease or injury during service. The examiner’s rationale shows that this opinion was based on a thorough review of the record and current medical literature. The examiner explained that, as shown by the service treatment records set forth above, the Veteran reported that his diffuse abdominal pain during service was the same constant, unrelenting abdominal pain that he had experienced since the surgical repair of his congenital malrotation of the gut when he was five years old. Further, during service, the Veteran told military physicians that the constant pain had prevented him from participating in sports prior to service. No new gastrointestinal conditions or symptoms were noted in any medical records until April 1982, when the Veteran reported constipation and focal left upper quadrant abdominal pain similar to an episode three years prior. Further, there were no separately diagnosed gastrointestinal conditions during service. In addition, there was no medical evidence or literature to support the contention that the Veteran’s current diverticular disease is a progression of the Veteran’s malrotation of the gut. As the July 2020 examiner reasoned, this evidence combines to show that the Veteran’s symptoms and gastrointestinal problems were the same during service as they were prior to service, and there was no separate injury or disease incurred during or related to service; therefore there was no additional disability from a superimposed injury or disease during service. In this regard, the Board has considered the Veteran’s assertions that he was active during school prior to service and had played sports, and that his stomach problems began during service. The Board finds that these statements are not credible as they are contradicted directly by the Veteran’s in-service reports that his abdominal pain had persisted and was “unrelenting” since the time he underwent surgical repair of malrotation of the gut. Because the Veteran’s in-service statements were made for the purpose of medical diagnosis and treatment, and they were closer in time to the relevant period, the Board finds that they are more credible than the statements later provided by the Veteran for purposes of obtaining VA disability compensation. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). In addition, the Board finds that the Veteran’s in-service statements of constant abdominal pain since his childhood surgery are supported by the highly probative July 2020 opinion of the VA clinician, who explained that even after surgical repair of malrotation of the gut, medical literature shows that patients are expected to continue to have chronic and diffuse abdominal pain. The Board has also considered the October 2020 letter from the Veteran’s treating APRN stating that the Veteran’s symptoms began in service. However, this letter was based on the Veteran’s statements about the onset of his symptoms, which, as explained, the Board finds to be not credible. The mere transcription of lay history as reported by a veteran, unenhanced by any additional comment by that examiner, does not become competent medical evidence merely because the transcriber is a medical professional. See LeShore v. Brown, Vet. App. 406, 409 (1995). The Board also finds that the Veteran’s current H. pylori, diverticulitis, and diverticulosis with antral erosions disabilities were not incurred in or otherwise related to the Veteran’s active service. As explained above, the Board finds that the Veteran’s in-service complaints of abdominal symptoms were no different than the pain he had already experienced in the years since the surgical repair of malrotation of the gut, and the preponderance of the evidence shows that the Veteran’s symptoms of left upper quadrant abdominal pain associated with gastritis, antral erosions, and diverticulosis arose in 1979 at the earliest. The Board has reviewed the entire record and finds no indication that the Veteran’s gastrointestinal disability, to include malrotation of the gut, H. pylori, diverticulitis, and diverticulosis with antral erosions, were at least as likely as not incurred in or aggravated by the service. The Board has considered the Veteran’s contentions to the effect that his gastrointestinal disability was incurred in service. As a layperson, however, the Veteran is not competent to provide an opinion on the etiology of the current hypothyroid endocrine dysfunction because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have had medical training or skills. See Jandreau v. Nicholson, 492 F.3d 1372, 1376–77 (Fed. Cir. 2007). Questions of competency notwithstanding, the Board assigns more probative weight to the findings of the VA clinician given the clinical expertise and the rationale supporting that opinion. For the foregoing reasons and bases, the Board concludes that the preponderance of the evidence is against the claim of service connection for a gastrointestinal disability, to include malrotation of the gut, H. pylori, diverticulitis, and diverticulosis with antral erosions. Under these circumstances, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53–56. Right Knee Disability The Veteran asserted that his current right knee osteoarthritis was caused by exercises on asphalt during basic training, and a right leg sprain during service. See, e.g., September 2014 Notice of Disagreement. At the Veteran’s April 1972 entrance examination, clinical evaluation revealed that his musculoskeletal system was normal. In a report of medical history completed by the Veteran at the time of the examination, he denied having or ever having had swollen or painful joints or a trick or locked knee. In-service treatment records are negative for any complaints or treatment of right knee pain or osteoarthritis. It is unclear whether the Veteran’s musculoskeletal system was evaluated at his October 1972 separation examination. No knee problems were noted. Post-service private treatment records from March 2012 show that in his post-service work for a county sheriff’s department, he was trying to restrain somebody and hit his right knee and twisted it. The Veteran complained of diffuse pain around the right knee, which persisted. The Veteran reported that he had a patellar dislocation in 1986 and underwent a subsequent lateral release through an open incision. The Veteran stated that his right knee had done relatively well over the years. A magnetic resonance imaging (MRI) report revealing a medial meniscal tear, lateral meniscal tear, osteoarthritis with full-thickness cartilage loss noted along the weightbearing surfaces of the medial femoral condyle and medial tibial plateau and thinning and irregularity of the articular cartilage overlying the patella, small Baker’s cyst, distal quadriceps tendinopathy, and nonspecific soft tissue edema. Private treatment records from July 2012 show the Veteran underwent diagnostic arthroscopy, partial medial meniscectomy, and chondroplasty of the right knee. The preoperative diagnosis was a medial meniscal tear, lateral meniscal tear, and osteoarthritis. The postoperative diagnosis was medial meniscal tear and osteoarthritis. October 2012 private treatment records show the Veteran complained of right knee pain. An October 2012 private MRI revealed suspected recurrent medial meniscal tear, lateral meniscal tear, tricompartmental osteoarthritis most advanced in the medial compartment where there was generalized full-thickness to near full-thickness cartilage loss along the weightbearing surfaces of the medial femoral condyle and medial tibial plateau, moderate-sized joint effusion, small Baker’s cyst, and nonspecific soft tissue edema. December 2012 private treatment records show that the Veteran underwent diagnostic arthroscopy, partial medial meniscectomy, and chondroplasty of the right knee. The preoperative diagnosis was osteoarthritis and a possible meniscal tear of the right knee. The postoperative diagnosis was osteoarthritis and medial meniscal tear of the right knee. Private treatment notes from December 2012 indicate that there was a question as to whether the Veteran incurred a new right knee injury when shooting a firearm in a kneeling position. The private physician opined that it was more likely than not this was not a separate new injury, but rather an aggravation of the Veteran’s previous condition. In his September 2014 notice of disagreement, the Veteran asserted that exercises on asphalt and running during his service caused his current right knee disability. The Veteran also asserted that he sprained his leg during service. In October 2020 VA received a letter from the Veteran asserted that “during basic training, with the cheap shoes that I was issued, I had to participate in running, exercising, obstacle courses on asphalt that I had problems with my knee, but I had to do the exercises in order to pass basic training.” As a preliminary matter, the Board finds that a right knee osteoarthritis disability was not present during active service nor was it manifest to a compensable degree within one year of separation. As detailed above, the Veteran’s service treatment records are negative for any complaints of right knee pain or osteoarthritis, and upon examination at the Veteran’s separation in October 1972, no musculoskeletal system abnormalities were noted. Although the separation examination report did not affirmatively find the Veteran’s musculoskeletal system to be normal, because the report indicated other abnormalities, the Board finds that if arthritis had been present, it would have been noted at that time. The post-service clinical evidence is also silent for any findings, treatment, or diagnosis of osteoarthritis in the first year following service. For these reasons, the preponderance of the evidence is against finding that the Veteran’s current right knee osteoarthritis disability had its inception during active duty, was manifest to a compensable degree within one year of separation, or was present on a continuous basis since service. The Board also finds that the preponderance of the evidence shows that the Veteran’s current right knee disability, to include osteoarthritis and meniscal tear, is not otherwise causally related to active service. As to the first element of a service-connection claim, a current disability, as set forth above the medical records establish that the Veteran is currently diagnosed as having osteoarthritis and that he has also been diagnosed as having meniscal tears. Regarding the second element necessary to establish service connection, and in-service injury, the Veteran has asserted that he was required to exercise on asphalt and also that he had a leg sprain in service. The Board notes that in-service treatment records are negative for any complaints or treatment of a leg sprain, and that as a layperson, the Veteran is not competent to diagnosis a leg sprain. See Jandreau, 492 F.3d at 1376–77. Nonetheless, the Board finds that the Veteran’s descriptions of exercise requirements in-service are consistent with the circumstances of the Veteran’s service. However, the Board finds that the preponderance of the evidence of record is against finding the third element required for service connection, a causal relationship between the Veteran’s current right knee disability, and his exercise in service. In this regard, the Board has considered the Veteran’s contentions to the effect that his right knee disability resulted from exercise and injury during service. As a layperson, however, the Veteran is not competent to provide an opinion on the etiology of the current right knee disability because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have had medical training or skills. See Jandreau, 492 F.3d at 1376–77. As set forth above, the earliest indication of a knee disability in the evidence of record are the March 2012 private treatment records set forth above. In March 2012, the Veteran reported that he previously had a patellar dislocation in 1986. Then in March 2012 the Veteran twisted his right knee at work. An MRI at that time showed meniscal tears and osteoarthritis. None of this evidence, however, indicates that there may be an association between the Veteran’s current right knee disability and service. Although VA has a duty to assist the Veteran in the development of his claim, such duty is not “a one-way street.” Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, the Veteran also has an obligation to assist in the adjudication of his claim. “If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” Id. at 195. For the foregoing reasons and bases, the Board concludes that the preponderance of the evidence is against the claim of service connection for a right knee disability. Under these circumstances, the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. at 53-¬56. Timothy Berryman Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Hillan Sosa, 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.