Citation Nr: 21015898 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 14-38 637 DATE: March 18, 2021 ORDER Entitlement to service connection for a left knee disability is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, the evidence of record is in relative equipoise as to whether the Veteran’s current left knee disability was related to service or to an incident of service origin. CONCLUSION OF LAW The criteria for service connection for a left knee disability have been met. 38 U.S.C. §§ 1101, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1977 to March 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file and has been reviewed. In June 2018 the Board remanded the Veteran’s claim for further development. The required development has been completed and the matter is properly before the Board at this time. The Board wishes to apologize to the Veteran for the delay in the full adjudication of his claim. Entitlement to service connection for a left knee disability The Veteran is seeking entitlement to service connection for a left knee disability which he attributes to an in-service injury and prolonged standing, walking and climbing while serving on duty in the Navy. 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; 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). As an initial matter, the Board finds that the Veteran has a current left knee disability for VA purposes, diagnosed as degenerative arthritis, chondromalacia patellae, and patellar tendinitis. See e.g., July 2019 VA Examination DBQ. In addition, the Veteran reported that approximately two years into his service, he began having left knee problems because he was required to go up and down stairs, go in and out of the engine room where he worked, as well as go up and down access ladders as part of his official military duties on board the ship. See Notice of Disagreement, January 2014. The Veteran reports he was on his feet a lot during “Throttles Watch” and he began having pain in his left knee and it began giving out on him from this time onward. Id. The Veteran further reported that he had an in-service injury to his left knee when his bunk locker fell on his knee, which is corroborated by his service medical records. See Id; August 1979 Service Treatment Record. The Board finds the Veteran’s lay statements regarding the onset of his left knee disability to be competent, credible and highly probative as to the second element of service connection, in-service incurrence or aggravation of a disease or injury. Importantly, the Veteran’s statements regarding onset of his knee pain, knee injury and his knee giving out in service are not contradicted by the other evidence of record, his statements are largely corroborated as to time, place and manner by his service treatment records, and the Veteran appears to otherwise be a credible historian of his medical history based on all the evidence of record before the Board. See e.g., Chronological Medical Care Notes, August 1979, October 1979, November 1979, February 1980, March 1980; Separation Physical Examination, February 1981. Accordingly, a current disability and in-service incurrence of an injury are conceded. The question in this case is whether a causal relationship or “nexus” exists between the Veteran’s current left knee disability and his active duty military service. The Veteran contends his left knee problems began in service and have continued since that time. See e.g., Statement in Support of Claim, November 2012; Veteran’s Correspondence, January 2013; Notice of Disagreement, January 2014; VA Form 9, October 2014; Hearing Transcript, April 2018. In support of his claim, the Veteran submitted a December 2014 private medical opinion from Dr. G.B.G., the Veteran’s treating physician, in which the examiner opined that the Veteran’s left knee “buckling”, unrelated to Osgood-Schlatter’s disease, had onset in service when a locker fell on the Veteran’s left knee in 1979 causing an internal derangement with buckling. The examiner opined that the Veteran’s current left knee disability was just as likely as not caused by his military service. The Board finds the December 2014 private opinion to be of limited probative value because the opinion appears to rely on an inaccurate factual premise regarding the nature of the in-service injury. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Specifically, the examiner reported the Veteran’s in-service injury caused internal derangement in his left knee. However, there is nothing in the service treatment records to support such a finding. See Black v. Brown, 5 Vet. App. 177, 180 (1995) (holding that a medical opinion is inadequate when it is unsupported by clinical evidence); see also Medical Progress Note, Dr. G.B.G. dated May 10, 2016 (MRI results show no internal derangement). The Veteran also submitted an August 2016 private medical opinion from his treating chiropractor. Dr. A.K. opined that the Veteran’s pre-existing Osgood-Schlatter’s disease, which had been asymptomatic prior to service, was aggravated in service, to include by the 1979 knee injury and also due to inadequate medical treatment during service. Dr. A.K. further opined that the Veteran’s current left knee disability, diagnosed as degenerative arthritis, chondromalacia patellae, patellar tendinitis and patellofemoral pain syndrome, was aggravated by service and related to knee trauma in 1979 and also due to improper care during service. Citing several medical journals, Dr. A.K. based the opinion, at least in part, on a finding that when a bunk fell on the Veteran’s left knee in August 1979, it forced the Veteran’s knee into loaded flexion and excessive and loaded extension could have stretched the patellar tendon in a way that would have aggravated his Osgood-Schlatter’s disease. Furthermore, Dr. A.K., again citing to several medical journals, opined that altered patellar tracking is known to be a factor in the causation of patella tendonitis and that the Veteran’s 1979 in-service trauma to his knee is a known causative factor of degenerative arthritis in the knee. The Board finds the August 2016 private opinion to be the most probative evidence of record because it is provided after a detailed review of the record on appeal and an examination of the Veteran as well as because it is supported by the evidence found in the record including the Veteran’s lay statements and service treatment records. Additionally, the examiner adequately explained the controlling medical principles that are cited with medical journal evidence in the report. Moreover, the examiner provided an adequate rationale for the opinion and discussed the different pathologies associated with the Veteran’s left knee condition and adequately opined on how each is connected to his service. The Veteran also underwent a VA examination in July 2019. The VA examiner noted the Veteran’s lay report of surgery on his left knee in 1983 at St. Cloud Orthopedic Associates, which could not be verified due to destroyed records. The examiner reported that one had to speculate if the 1983 surgery was for a new injury after service or if it was for the knee pain documented during his service. The examiner then speculated that if there is no evidence of an interceding intervening injury following military discharge, then it is at least as likely as not that his current diagnoses of chondromalacia patellae of the left knee, residua of Osgood-Schlatter’s disease and infrapatellar tendinopathy and osteoarthritis are the result of active duty service. The Board notes that there is no evidence in the record of an interceding intervening injury following military discharge. Moreover, while supportive of the claim, the Board assigns this opinion less probative weight because it is speculative in nature and does not provide the degree of certainty required for persuasive nexus evidence in this case. It is well established that medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient basis upon which to support a claim. McLendon v. Nicholson, 20 Vet. App. 79, 85 (2006). The Board also acknowledges two potentially negative medical opinions provided in January 2013 and April 2016. The Board finds the January 2013 and April 2016 VA opinions are inadequate for adjudication purposes and cannot serve as the basis of a denial of entitlement for service connection in this case. Both opinions fail to support their conclusions with anything other than a recitation of data from the record without rationale and both fail to address the Veteran’s other knee pathologies, other than Osgood-Schlatter’s disease. Therefore, both opinions lack sufficient detail to allow the Board to weigh the evidence for or against the claim and are of little probative value in the present claim. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (“[An adequate] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.” (citing Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007)). After a review of the record, the Board finds the August 2016 private medical opinion, supported by the Veteran’s lay statements, medical journal evidence and service treatment records, to be the most probative evidence of record in the matter. As the evidence is in relative equipoise, the claim must be decided in the Veteran’s favor. Under such circumstances and with granting the Veteran the benefit of any doubt in this matter, the Board concludes that service connection for a left knee disability is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher M. Davidson 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.