Citation Nr: 21021854 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-42 986 DATE: April 14, 2021 ORDER Entitlement to service connection for left knee patellofemoral syndrome is granted. Entitlement to service connection for right knee patellofemoral syndrome is granted. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, the evidence of record is approximately in equipoise as to whether his current left knee condition arose during or as a result of his active service. 2. Resolving all reasonable doubt in favor of the Veteran, the evidence of record is approximately in equipoise as to whether his current right knee condition arose during or as a result of his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left knee patellofemoral syndrome have been met. 38 U.S.C. §§ 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.306, 3.310. 2. The criteria for entitlement to service connection for right knee patellofemoral syndrome have been met. 38 U.S.C. §§ 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.306, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from October 1995 to March 2000. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision of a VA Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a November 2018 hearing before the Board of Veterans’ Appeals (Board). In March 2019, the Board remanded these claims for additional development. In September 2020, the Board remanded these claims again after finding that the RO had not substantially complied with its prior remand directives. The Board finds that the RO has now substantially complied with its remand instructions, and the Board may proceed with adjudication. The Veteran asserts that he has left and right knee patellofemoral syndrome (PFS) due to his active service and that he has had this disability since service. See November 2015 Form 9. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In this case, the Veteran’s service treatment records (STRs) note “popping” in both knees in February 2000 shortly before leaving service, and the Veteran’s February 2000 discharge examination notes that he had mild bilateral patellofemoral syndrome with crepitus. The Veteran’s VA and private treatment records are negative for evidence of complaints or treatment of patellofemoral syndrome in 12-month period immediately after leaving active service. During the Veteran’s September 2015 VA examination for knee and lower leg conditions, the examiner diagnosed the Veteran with bilateral patellofemoral syndrome but found that the Veteran’s knee condition was less likely than not due to service. The examiner’s rationale was based on the lack of evidence in the Veteran’s medical records showing patellofemoral syndrome became a chronic problem that required any continuity of care following service. However, the examiner failed to provide any medical or etiological basis to support this conclusion. In a November 2015 Form 9 statement, the Veteran asserted that his bilateral patellofemoral syndrome had been chronic since leaving active service and caused him chronic pain. During the Veteran’s December 2018 Board hearing, the Veteran testified that his knees began to hurt during service and that he had experienced chronic pain since active service. He testified that he did not begin applying for benefits until 2014, when a VA employee and family friend convinced him to do so. The Veteran felt that his condition could be tolerated, and other veterans required more urgent care than he did, so he did not initially pursue a claim for the condition. In December 2018, the Veteran submitted a statement by his private physician in support of his claim. The physician noted that the Veteran had bilateral knee chondromalacia patella and chronic degenerative changes in his knees. The physician stated that it was reasonable to conclude that the Veteran was experiencing knee pain while in service. In an October 2019 VA examination for knee conditions, the VA examiner opined that the claimed condition was less likely than not related to active service. However, there is no indication in the rationale of consideration of the Veteran’s reports. Instead, the rationale is based primarily on the lack of documented on going treatment since the Veteran left service. In a November 2020 VA addendum medical opinion, the VA examiner found the condition was less likely than not related to active service. The examiner stated that patellofemoral syndrome was generally considered to be caused by overuse, running frequent bending/squatting, etc. The Veteran was first diagnosed with the condition in service, and he was noted to have crepitus (“popping”) on the separation exam. The condition usually resolved with appropriate rest/treatment. The examiner found that the claimed current condition was more likely than not a separate condition, arising many years after service. It was more likely than not that the Veteran’s in-service PFS had resolved, as no evidence supports a chronic condition, despite the Veteran’s claims. It was more likely than not that the condition resolved after cessation of the stressful, strenuous activities expected while serving in the military. The Veteran reported continuous symptoms since service. The examiner found it was unlikely the Veteran would have gone a span of approximately 15 years before seeking care for a condition that would limit strenuous activity, running, use of stairs, etc. The examiner found no continuity of the condition was supported by medical records. As noted, given the limitations to activity due to PFS, it is at least likely as not the Veteran would have sought care in the ensuing 15 years. In considering the Veteran’s contentions, the Board notes that he is competent to observe lay symptoms, such as chronic pain, but he does not have the training or credentials to provide a competent opinion as to etiology, diagnosis, or the onset date of a medical disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that there is positive and negative evidence regarding the Veteran’s claims for service connection. The Veteran is presumed sound upon entrance to service. The claimed conditions are noted in his STRs, including in his discharge medical examination. While the various VA examination opinions found the claimed conditions less likely than not related to active service, their rationales are primarily based on the lack of documentation of post-service treatment. Consequently, the Board finds the September 2015 and October 2019 VA examinations to be of only limited probative weight. The November 2020 medical opinion stated that PFS usually resolves over time, and the Veteran was unlikely to have not sought treatment for the condition for over a decade. The Veteran testified under oath at his Board hearing that he had experienced chronic knee pain since leaving active service. In summary, while the VA examination reports and the gap in documented medical treatment weigh against the Veteran’s claim, his condition was documented during service, and he has consistently and credibly asserted that it has been chronic since leaving service. Resolving all reasonable doubt in favor of the Veteran, the Board finds the evidence of record to be roughly in equipoise. 38 U.S.C. § 5107(b). Accordingly, the benefit of the doubt will be accorded to the Veteran. The claims for service connection for left and right knee patellofemoral syndrome will be granted. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Hicks, 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.