Citation Nr: 21023226 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 18-42 123 DATE: April 20, 2021 ORDER Service connection for a right knee disability, to include patellofemoral syndrome is granted. Service connection for a left knee disability, to include patellofemoral syndrome is granted. FINDING OF FACT The Veteran’s current right and left knee disabilities, to include patellofemoral syndrome, at least as likely as not, had its onset during active service. CONCLUSIONS OF LAW 1. Resolving all doubt in favor of the Veteran, the criteria for service connection for a right knee disability, to include patellofemoral syndrome, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Resolving all doubt in favor of the Veteran, the criteria for service connection for a left knee disability, to include patellofemoral syndrome, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1961 to October 1963. This case is before the Board of Veterans’ Appeals (Board) on appeal from a September 2017 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In that rating decision, the RO confirmed and continued a prior denial of service connection for bilateral patellofemoral syndrome because new and material evidence had not been received to reopen that previously denied claim. The Veteran’s notice of disagreement was received in July 2018. The RO issued a statement of the case in August 2018. The Veteran’s VA Form 9, substantive appeal to the Board, was received in August 2018. In February 2019, the Board reopened the previously denied claims of service connection for right and left knee patellofemoral syndrome, expanded the claims to “right and left knee disabilities” to include all potential knee diagnoses; and, remanded those claims to the RO for additional development and adjudicative action. The Board remanded the claims again in February 2020. Entitlement to service connection for right and left knee disabilities, variously diagnosed as patellofemoral syndrome and arthritis. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 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). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove a claim. 38 C.F.R. § 3.102. The Veteran contends his current bilateral knee disability, diagnosed as bilateral patella femoral syndrome, had its onset during active service. In his March 2016 Statement in Support, the Veteran states: As a Paratrooper I jumped from [] aircraft with a parachute, full field transport pack which contains shelter half, survival equipment, rifle. This was a great amount of weight on my small body frame [] which affected both of my knees, and feet, when landing, or hitting different types of terrain on the ground; and dragged by the parachute, depending on the wind conditions, where not all landings are soft, but hard. The link to my disabilities you will find in my service treatment records, Army Airborne. The Veteran further describes weighing 123 pounds and carrying 75 pounds of equipment when jumping out of a flying aircraft, during which the ground impact (sometimes being dragged) and attempts to control the parachute under windy conditions affected his body and caused chronic pain and clicking in his knees. See August 2013 and July 2018 Statements in Support. While he has alleged, in the alternative, that a current bilateral knee disorder is caused or aggravated by his service-connected disabilities, to include as a result of cold injuries due to frostbite, service connection in this case is granted on a direct basis. In this respect, the record reflects a current diagnosis of bilateral patellofemoral syndrome. See March 2012 VA Knee Examination; March 2019 VA Knee Examination. Additionally, the Veteran’s DD-214 shows his military occupational specialty (MOS) was that of a paratrooper. Further, an August 1963 service treatment record notes the Veteran complained of “locking knees.” Accordingly, the first two elements of service connection have been met in this case and, therefore, this case turns on whether there is a nexus between the current disability and service. To determine such, the Veteran underwent a VA knee examination in March 2016. The Veteran reported being a paratrooper in the military and having experienced many hard landings that banged up his knees, which resulted in knee pain. He further reported the pain was on and off and worsened with squatting, going up and down stairs, exercising, and running. The examiner, a physician, noted the Veteran was positive for buckling and had a positive patellar grind test. The examiner found that the Veteran “has patellofemoral syndrome which is due to biomechanics and repetitive type of motion.” The examiner, however, further opined that the Veteran’s bilateral knee condition was not related to his military service “based on the fact that [he saw] no evidence of any trauma to the knees.” The examiner failed to address the service treatment records showing his report of locking knees, which detracts from the probative value of the negative opinion provided. In addition, although the record also includes two additional medical opinions unfavorable to the Veteran’s claim, such opinions likewise ignore the aforementioned service treatment record and do not address the Veteran’s lay statements regarding clicking knees and chronic knee pain since service. Moreover, the most recent examiner’s opinion addressed only a diagnosis of arthritis. See March 2019 and March 2020 VA Knee Examinations. Accordingly, such opinions are not highly probative. Nevertheless, the March 2016 examiner’s rationale regarding “biomechanics and repetitive type of motion” is notably consistent with the Veteran’s MOS as a paratrooper, the duties of which include repetitive jumping from aircraft onto hard terrains. Additionally, as noted above, the Veteran is competent to testify as to the occurrence of observable events and the presence of symptoms subject to lay observation, and there is no reason to doubt the Veteran’s credibility with regard to his reports of in-service injury and continuity of symptomatology since service, particularly when coupled with the pertinent service treatment records and his MOS. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Jandreau, 492 F.3d 1372. Accordingly, in consideration of the entire record and resolving all reasonable doubt in the Veteran’s favor, the Veteran’s right and left knee patellofemoral syndrome first manifested during service and has continued ever since. Therefore, service connection for right knee and left knee patellofemoral syndrome is warranted. 38 C.F.R. § 3.303. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Ardalan, 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.