Citation Nr: 21023483 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-21 498 DATE: April 20, 2021 ORDER Entitlement to service connection for right knee disability is denied. FINDING OF FACT A preponderance of the evidence does not show the Veteran’s current right knee condition had its onset in service, that arthritis was diagnosed within one year of separation, or that it is otherwise causally or etiologically due to service. CONCLUSION OF LAW The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the U.S. Air Force from October 2009 to January 2011, from December 6, 2011 to December 17, 2011 and from January 20, 2012 to January 31, 2012. The Board remanded the appeal in August 2019 to obtain an opinion and outstanding treatment records. Entitlement to service connection for right knee disability. The Veteran contends that his right knee disability is due to an in-service incident in which he twisted it during turbulence on a flight. He also reported some trauma from running during service. Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases 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, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of a right knee meniscal tear and degenerative arthritis per the January 2021 VA examination and treatment records. As such, the first element of service connection has been met. The evidence as to whether he suffered an injury, event or disease during service and a nexus connecting his diagnosis to that in-service event is not so clear. The Veteran denied any knee problems in July 2009 and June 2010. A December 2012 note indicated the Veteran was seen in November 2011 for knee pain and was told to have a magnetic resonance image (MRI). He was told to avoid running until the MRI had been performed. Other records show the Veteran reported severe right knee pain that started in 2010 due to running, as well as knee popping in 2009. In July 2013, the Veteran was seen for dull, aching knee pain, aggravated by sitting and standing. At that time, he was diagnosed with osteoarthritis. An April 2014 record showed the Veteran suffered an accident while skiing and twisted his knee; swelling and pain persisted despite conservative treatment. An MRI of the right knee showed a complex tear of the medial meniscus body. He had not undergone surgery and reported pain and swelling with activity. Following an assessment in March 2015, an examiner diagnosed chronic complex tear medial meniscus right knee with some early degenerative joint disease. In J.C.’s March 2019 statement, he indicated that he served with the Veteran in the same unit from 2009 to 2015. While on a flight in December 2012, the Veteran fell during turbulence and injured his knee. The knee became swollen and he needed assistance walking. The Veteran was unwilling to see the flight doctor because he would have been removed from the trip and sent home. J.C. agreed not to tell anyone or talk about it to protect the Veteran. The January 2021 examiner opined that the Veteran’s right knee disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness because the injury in service was acute only. There was no evidence of chronicity of care or diagnoses of torn meniscus or osteoarthritis during service or within 12 months post discharge. A nexus was not established. After review of the foregoing, the Board finds that service connection for the right knee is not warranted. The Board determines that the 38 C.F.R. § 3.303(b) presumptions have not been met. Following service, the first medical evidence of degenerative arthritis did not appear until July 2013, when the Veteran was diagnosed with degenerative joint disease. As such, there is no medical evidence showing that arthritis was diagnosed for VA purposes either during service or within a year of service. Likewise, degenerative arthritis has not been continuous since service, as it was not shown by x-ray at his separation physical or within the year after. Nevertheless, service connection may be granted if the evidence establishes a nexus between degenerative arthritis and the Veteran’s military service. While the Veteran is competent to report an injury and symptoms of severe knee pain and stiffness both during and since service, the Board finds the reports of continuity of symptomatology not credible. Moreover, service records show he was medically cleared for flying or operational duty in April 2010 and January 2011, without any conditions. There was no mention of knee problems. Rather, the only concerns at the time were his cholesterol and vision. It was not until April 2014 that physical limitations/restrictions due to his knee were discussed following a skiing incident, and in October 2014, he was medically restricted from flying or special operational duty. Further, while the Veteran asserts that the reported symptoms were manifestations of his current disability, he is not competent to make this determination as he has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Service connection for a right knee disability may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s current diagnosis and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. There is no probative medical evidence of record supportive of the Veteran’s claims. Rather, the January 2021 VA examiner found that the claimed disorder did not develop due to service but the injury he experienced was acute and not chronic. The VA examiner specifically considered the Veteran’s in-service complaints and treatment regarding the knee. The opinion was proffered after review and consideration of all the pertinent evidence of record, to include the statements of the Veteran, and while brief, provided a complete rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). This opinion is supported by the other evidence of record showing the Veteran was continuously cleared for flying/service prior to 2014, despite any right knee injury. Absent a competent opinion linking the current right knee disability to service, service connection must be denied. The preponderance of the evidence is against entitlement to service connection for a right knee disability; the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. L. ANDERSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Price, 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.