Citation Nr: 21022172 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 18-46 437 DATE: April 14, 2021 ORDER Service connection for a right knee disorder is denied. Service connection for a left knee disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from June 1988 to January 1992. 2. A bilateral knee disorder, diagnosed as arthritis, was not shown in service, not shown to a compensable degree within one year of service, and symptoms of a chronic bilateral knee disorder were not continuous since service; the current bilateral knee disorder is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. A right knee disorder was not incurred in service, and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). 2. A left knee disorder was not incurred in service, and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In connection with this appeal, the Veteran testified before the undersigned Veterans Law Judge (VLJ) in January 2021. A copy of the transcript has been associated with the record. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. The Veteran asserts that the current bilateral knee disorder began in, or was related to, active duty. Specifically, a progression from strenuous physical activity and parachute jumps. Initially, he was diagnosed with bilateral knee osteoarthritis by X-ray in 2018. Thus, current diagnoses are shown, and the first element of service connection is met with regard to both appeals. As to an in-service incurrence, the Veteran opted out of a separation examination; however, the service treatment records (STRs) are silent as to any complaints of or treatment for a knee disorder and his lower extremities were normal at an airborne examination. Nonetheless, he has testified that he had soreness in his knees during service for which he did not seek treatment and occasionally treated with Motrin. He asserted that his knee issues are due to about 27 parachute jumps he completed while in training. In this regard, his military personnel records (MPRs) reflect a certificate for airborne training. Thus, an in-service incurrence is shown. As to a medical nexus, at a May 2018 VA examination, the Veteran described the parachute jumps to the examiner, but denied any injury, trauma, or surgery during service. He reported that he slipped in an icy parking lot two years previously and landed on his left knee, and after an MRI, his knee was found to have only a left knee contusion. He denied any injury or trauma to his right knee. The examiner diagnosed osteoarthritis in both knees based on 2018 imaging. After reviewing the Veteran’s records and examining him, the examiner opined it was less likely than not that the bilateral knee disorders were due to service. The examiner reasoned that advanced age is one of the strongest risk factors associated with osteoarthritis and referred to the National Health and Nutrition Examination Survey statistics. The examiner reflected that, per the Veteran’s report, he had a total of 27 parachute jumps; however, the STRs were silent as to any evaluations, radiographic imaging, diagnosis, complaints, or treatment for a bilateral knee disorder. The examiner noted that the Veteran was diagnosed by X-ray in 2018 with osteoarthritis some 26 years following separation from service. The examiner opined that, according to the medical literature, at the Veteran’s current age, arthritis would be an expected finding. The examiner opined that the diagnosis of degenerative arthritis was more likely than not due to the natural progression of aging. At the January 2021 Board hearing, the Veteran testified that his treating physicians had relayed to him that his age was a likely factor for the development of arthritis in both of his knees. Nonetheless, he noted that a treating practitioner had opined that it may be related to service. He thereafter submitted a February 2021 private opinion from this practitioner, Nurse L.M., opining that she believed that the Veteran’s arthritic bilateral knees were strongly related to his time in service and the correlation with strenuous regimens and constant physical requirements. No further rationale was provided at that time. As to the conflicting medical opinions, it is the responsibility of the Board to assess the credibility and weight to be given the evidence. The weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated. In this regard, greater probative weight is assigned to the May 2018 VA opinion. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a physical examination. There is no indication that the VA examiner was not fully aware of the Veteran’s past medical history or that he misstated any relevant fact. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. While the February 2021 private opinion is also considered, it lacked a rationale. The clinician opined that the Veteran’s bilateral knee arthritis was due to strenuous physical requirements during service but provided no further rationale. A medical opinion that contains only data and conclusions without any supporting analysis is accorded lesser probative value and does not provide the degree of certainty required for medical nexus evidence. In this regard, when weighed against the May 2018 VA opinion, the February 2021 private opinion is afforded less probative weight. Specifically, and as mentioned, the May 2018 VA opinion was based on a thorough document review and examination of the Veteran, and considered the Veteran’s contentions while relying on medical literature and principles to provide a rationale. By contrast, the February 2021 private opinion provided no rationale, and there is no indication if the clinician reviewed or considered the Veteran’s past treatment history, STRs or MPRs. Thus, less probative weight is assigned to this opinion, and the weight of the medical evidence does not support the third element of direct service connection. As to presumptive service connection, no chronic disease or injury related to arthritis of the knees was shown in service. As discussed above, the STRs do not reflect a chronic bilateral knee disorder. Therefore, the medical evidence does not support presumptive service connection on a “chronic disease or injury shown in service” basis. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, while the Veteran reported occasional soreness, by his own admission, there was no treatment for years after service. Post-service treatment notes also do not reflect subjective complaints or objective findings of a right knee disorder at any time during the appeal period. The Veteran separated from service in January 1992, and the first indication of a chronic knee disorder was in 2018. The medical evidence also does not show signs of such disability until 2018 over 25 years after service. While the Veteran has maintained that he had knee soreness in service and symptoms of a chronic disability since, this is not supported by the contemporaneous evidence. As such, the medical evidence does not support service connection on a “continuity of symptomatology” basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1992 but did not note report symptoms until 2018. This evidence does not support presumptive service connection on a “manifest within one-year from separation” basis. Therefore, the medical evidence does not support presumptive service connection on any basis. The Board has also considered the Veteran’s lay statements that his disorders were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiologies of his current disorders due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yacoub, 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.