Citation Nr: 21022408 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 16-21 099 DATE: April 15, 2021 ORDER Service connection for a right knee condition is denied. Service connection for a left knee condition is denied. Service connection for a low back condition is denied.   FINDINGS OF FACT 1. The Veteran’s right knee condition did not have its onset in service or within one year of service and is not otherwise related to service. 2. The Veteran’s left knee condition did not have its onset in service or within one year of service and is not otherwise related to service. 3. The Veteran’s low back condition did not have its onset in service or within one year of service and is not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee condition have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a left knee condition have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a low back condition have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1973 to July 1975. The case is on appeal from a February 2015 rating decision. In April 2019, the Veteran testified at a Board hearing. In January 2019 and August 2020, the Board remanded the claims for additional development. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service Connection 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. A veteran seeking compensation under these provisions must establish three elements: “(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 or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain 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; 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; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In addition, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for a right knee condition. 2. Service connection for a left knee condition. 3. Service connection for a low back condition. The Veteran is seeking service connection for a right knee condition, left knee condition, and a low back condition. The Veteran, who had a preexisting left hip condition, contends that while he was serving on the U.S. Coast Guard Ship Southwind, he was caught up in a storm at sea and slammed down onto a hatch, directly on his left hip. He asserts that after the incident, his left knee, lower back, and right knee began bothering him and have worsened. The Veteran also contends that his knee and back conditions are secondary to his left hip condition. Initially, the current disability requirement is established for the right knee condition, left knee condition, and low back condition claims. Concerning the right and left knee conditions, a December 2020 VA examination reflects a diagnosis of degenerative arthritis of both the right and left knees. Concerning the low back condition, a December 2020 VA examination reflects diagnoses including degenerative arthritis of the spine and spinal stenosis. The evidence of record also reflects the occurrence of an in-service event or injury. The Veteran contends that while he was serving on the U.S. Coast Guard Ship Southwind, he was caught up in a storm at sea and slammed down onto a hatch, directly on his left hip. He asserts that after the incident, he began to experience symptoms in his left knee, lower back, and right knee. Although there are no explicit notations related to this incident reflected in the Veteran’s service treatment records (STRs), the Board finds that the Veteran is competent and credible to report what he experienced while in the military. Moreover, his contentions are consistent with the circumstances of his service. The Veteran’s service personnel records (SPRs) reflect that he served in the U.S. Coast Guard abord the Southwind. The Board finds that the Veteran it is at least as likely as not that the Veteran injured his knees and back as a result of a falling due to rough seas caused by a storm. See 38 U.S.C. § 1154(a). Thus, the evidence of record reflects the occurrence of an in-service injury to the Veteran’s right knee, left knee, and low back particularly when reasonable doubt is resolved in the Veteran’s favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the question becomes whether there is a nexus between the Veteran’s current degenerative arthritis of the knees and degenerative arthritis of the spine and his in-service injury. In this regard, the evidence of record includes the opinions of an examiner who provided a March 2020 VA examination, the opinions of an examiner who provided a December 2020 VA examination and a December 2020 addendum opinion. The examiner who provided the March 2020 VA examination concluded that it is less likely than not that the Veteran’s right and left knee condition and low back condition were incurred in or caused by the claimed in-service, event, or illness. The examiner examiner’s rationale relied exclusively the absence of any treatment for a knee or back condition in the Veteran’s STRs. The Board remanded the claim in August 2020 as it determined the March 2020 opinion was not entirely sufficient. Concerning the Veteran’s claim of service connection for a right and left knee condition, the opinion did not consider the Veteran’s diagnosis of degenerative arthritis of the knees. Concerning the Veteran’s claim of service connection for a low back condition, the opinion did not consider an April 1975 Medical Board report related to the Veteran’s hip condition that included a notation concerning the Veteran’s low back which stated “the results of the EMG show diffuse polyphasics in the L-5 distribution, right and left.” As a result, the Veteran underwent additional examinations in December 2020. The examiner determined that it is less likely than not that the Veteran’s low back condition and his bilateral knee condition were incurred in or caused by the claimed in-service injury. In this regard, the examiner explained the Veteran’s medical records reflect that his chronic knee pain and back pain began in 2003, which is many years after service. Instead, the examiner attributed the Veteran’s bilateral knee osteoarthritis and spinal conditions to his chronic left hip condition, that preexisted service, as it has altered his gait, stride, weight distribution, and center of gravity since 1974 and as a result has greatly compromised and accelerated the wear and tear of both his knees and his lower back. The evidence of record also includes a December 2020 addendum opinion addressing the Veteran’s spinal conditions and their relation to the notation in the Veteran’s April 1975 Medical Board report related to a hip condition that noted “the results of the EMG show diffuse polyphasics in the L-5 distribution, right and left, as an incidental during the EMG test.” The examiner concluded that it was less likely than not that the finding of diffuse polyphasics in the L-5 distribution was related to the Veteran’s current low back conditions. The examiner explained that the notation could be related to a lower back trauma or strain, but since no further evaluation was completed to investigate the abnormal EMG results, there is no definitive cause established for the condition. The examiner explained further that in light of the fact that the Veteran did not report a back condition at the time of separation, it is likely that the condition resolved. The examiner also noted that the Veteran’s records concerning a back condition were silent until 2003. The Board acknowledges the Veteran’s contention that his bilateral knee condition and low back condition are related to an in-service fall. However, the Veteran’s statements may not be used to establish a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). As the Veteran has no known or reported medical expertise, he is not legally competent to opine on a relationship between his bilateral knee condition and low back conditions and his reported fall. As such, his opinion lacks probative value, and an opinion by a qualified medical expert is required to decide the claim. Consequently, the Board gives more probative weight to the VA opinions described above. The Board finds the opinions to be persuasive, as they rely on expert knowledge and the Veteran’s medical history. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The opinions support that the bilateral knee condition and low back conditions are unrelated to his reported fall. In this regard, the December 2020 opinion attributes those conditions to the Veteran’s left hip condition that preexisted service. Moreover, there is no similar medical opinion of record weighing in favor of service connection. In addition, because the Veteran has diagnoses of arthritis, which is one of the listed chronic diseases, the Board has carefully considered whether service connection is warranted under 38 C.F.R. § 3.303(b) or on a presumptive basis. As explained by the Federal Circuit in Walker, there are two ways to establish service connection for a chronic disease. In this case, there is no evidence that Veteran was diagnosed with arthritis during service. As such, it cannot be said that the chronic disease (arthritis) was established and not subject to legitimate question during service. Furthermore, the evidence does not reflect arthritis to a compensable degree within one year of the Veteran’s separation from service. Rather, as noted above, the earliest complaint of knee and back problems is documented decades after the Veteran separated from service. Accordingly, in order to establish service connection, the Veteran must demonstrate a continuity of symptomatology. The Veteran contends that he has experienced right knee, left knee, and low back symptoms since his fall. The Veteran is competent to report the presence of symptoms and frequency of treatment. Jandreau, 492 F.3d at 1377. However, the evidence of record does not support a continuity of symptomology as related to degenerative arthritis of the bilateral knees and spine. In this regard, VA treatment record reflect the Veteran did not report left knee pain until June 1999 after falling from a ladder, back pain (with walking) in December 2003, and right knee pain in February 2018 after stepping into a prairie hole in April 2017. Thus, there is a significant gap of time between the Veteran’s discharge from service and the first documented report of complaints related to right knee, left knee, and low back pain. The Board will also address whether the Veteran is entitled to service connection for bilateral knee condition and low back conditions under a theory of secondary service connection, i.e., whether those condition are secondary to a left hip condition. In regard to the Veteran’s contention that his pre-existing left hip fracture was aggravated during service and that this hip condition caused or aggravated his low back condition, left knee condition, and right knee condition, the Board notes that the Veteran’s left hip condition is not service connected. The Veteran’s claim of service connection for a left hip condition was denied in an October 2001 rating decision that became final. Therefore, service connection for the Veteran’s low back condition, left knee condition, and right knee condition based on this theory is not warranted. In reaching the conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, under the direct and presumptive theories of service connection, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection is not warranted for a right knee condition, left knee condition, or low back condition. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Gray, 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.