Citation Nr: 21020706 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-43 578 DATE: April 8, 2021 ORDER Entitlement to service connection for a right knee disability is denied. FINDING OF FACT The preponderance of the evidence does not establish that a right knee disability was initially manifested in service; manifested with knee arthritis to a compensable degree within one year of service separation; or is causally or etiologically related to service. CONCLUSION OF LAW The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1968 to May 1969. The Veteran appeared at a September 2019 videoconference hearing before the undersigned Veterans Law Judge. The hearing transcript is of record. In September 2020, the Board remanded the case for further development. The Board finds that there has not been substantial compliance with the Board's previous remand directives regarding the Veteran's claims for service connection for a right knee disability. Stegall v. West, 11Vet. App.268 (1998). Service Connection Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Furthermore, service incurrence will be presumed for certain chronic diseases if manifest to a compensable degree within one year after active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for a right knee disability The Veteran asserts that a right knee disability is the result of an injury when he fell into a hole while in service. The service medical records show a complaint of “sore and stiff joints” related to treatment for pericarditis or myocarditis. The records show no other complaints and do not show treatment or diagnoses of a right knee disability while on active service. The post-service records show complaints of knee pain in VA treatment records in May 1984, a Baker’s cyst behind the right knee in August 2011, and aspiration of right knee fluid in December 2012. During an April 2014 VA examination, the Veteran reported occasional pain in the right knee on flare-ups. He gave a history of falling in service, injuring the right knee, with pain and swelling. His first reported follow up treatment for the knee was in 2010 for an injection. The diagnosis was right knee strain from 1968. The report states that imaging studies of the right knee showed degenerative or traumatic arthritis, but did not indicate the date of the studies or diagnose arthritis. The examiner found that there was no evidence of any connection between the knee condition and service. Further, the evidence did not show a clearly documented continuum of care. The examiner concluded the right knee disability was less likely than not incurred in or caused by service. At a March 2021 VA examination, the examiner found no current diagnosis associated with a right knee condition. The Veteran reported frequent, severe right knee flare-ups, relieved by walking. On contemporaneous x-ray, the right knee showed no evidence of fracture or other abnormality. There was no evidence of arthritis. The examiner stated that there were no findings, signs, and or symptoms to support a diagnosis of a right knee condition. In conclusion, the examiner found it less likely than not that a right knee condition was related to service, noting that there was no documentation orf persistent or ongoing knee pain during or immediately after military separation. Further, complaints of chronic pain are not supported by x-ray evidence of arthritis or soft tissue imaging reports. The Board finds that service connection for a right knee disability is not warranted as the record does not show any clinical findings or diagnoses of arthritis within one year of separation from active duty. The Veteran's service medical records do not show a diagnosis of arthritis while in service or within one year of separation from service. The first competent evidence of a right knee disability comes more than 15 years after separation from active duty service. Accordingly, service connection for a right knee disability on presumptive basis is not warranted. The Board also finds that the weight of the evidence is against a finding that a right knee disability is etiologically related to active service on a direct basis. The Veteran has not asserted, and the service medical records do not show, evidence of in-service disease or injury involving the right knee. The Veteran's service medical records do not show any complaints or treatment for knee problems. Moreover, the evidence of record does not include lay evidence of continuity of symptomatology since service, or evidence that a competent medical professional has linked the Veteran's alleged any current knee condition to his period of service. The post-service VA treatment records do not show evidence of any knee problems until decades after separation from service. The Veteran has not identified any outstanding records of pertinent treatment regarding the claimed disability. The Veteran has not submitted any competent evidence relating any alleged knee condition to service and his own statements, if any, are not competent evidence because as a lay person he does not possess the training to provide that type of opinion. After reviewing the record, the Board finds no evidence of a current right knee disability. There is no evidence of record of any in-service event, injury or disease which relates to the claimed disabilities. Additionally, there is no evidence of a continuity of symptoms dating from the Veteran's service, which relates to the claimed disabilities. The report of an April 2014 VA examination shows a diagnosis of right knee strain from 1968. There is no diagnosis or x-ray evidence of osteoarthritis in VA treatment records. The record shows complaints of knee pain beginning in 1984. However, the Board finds that the preponderance of the evidence weighs against a finding that any current right knee disability began during service or is otherwise related to an in-service injury, event, or disease. As the preponderance of the evidence does not show that any claimed current right knee disability was incurred in-service, may be presumed to have been incurred in service, or show a medical nexus between the presently diagnosed condition and the Veteran's service, service connection for a right knee disability cannot be granted on a direct basis. The Board acknowledges the Veteran's contention that he has a current right knee disability that is the result of his active duty service. Although lay persons are competent to provide opinions on some medical issues, the specific musculoskeletal conditions in this case outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011). In this instance, the Veteran as a lay person has not been shown to be capable of making medical conclusions, especially as to complex medical questions, such as a link between his current right knee condition and active duty service. Thus, any lay statements from the Veteran regarding any such link are not competent. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for a right knee disability. The Board is appreciative of the Veteran's faithful and honorable service to our country. However, as the preponderance of the evidence is against the claim of entitlement to service connection for a right knee disability, the claim must be and is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Duke, 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.