Citation Nr: 21023529 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-02 925 DATE: April 20, 2021 ORDER Entitlement to service connection for left knee osteoarthritis is granted. FINDING OF FACT The Veteran’s left knee osteoarthritis is related to his in-service fall/injury to the knees. CONCLUSION OF LAW The criteria for entitlement to service connection for left knee osteoarthritis have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had qualifying service from March 1969 to March 1971 and January 1991 to March 1991, including service in the Republic of Vietnam from August 1969 to August 1970. See DD Form 214s. As such, presumed herbicide agent exposure is conceded. 38 C.F.R. § 3.307(a)(6)(iii) (2018). In January 2017, the Veteran testified at a Board Videoconference Hearing before the undersigned Veterans Law Judge. In December 2017, July 2020, and December 2020 Decisions, the Board, in pertinent part, remanded the issue herein. 1. Entitlement to service connection for a left knee disability Direct service connection generally requires evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Although a competent medical opinion is generally required to establish etiology, competent and credible lay evidence of chronicity and continuity of symptomology may also establish etiology. 38 C.F.R. § 3.303(b); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran generally contends that his left knee disability is at least as likely as not related to his service, including an in-service fall/injury to the knees (which the Board has already found to be credible) and/or in-service herbicide agent exposure (which the Board has already conceded). See January 2017 Board hearing transcript (the Veteran testified that he fell and injured his knee in service); see also February 2020 Letter by Dr. RS (linked the Veteran’s joint issues to his in-service herbicide agent exposure by stating that the Veteran’s exposure to Agent Orange likely led to his severe joint pain). In its December 2020 Decision, the Board explained why the July 2020 VA opinion was inadequate and remanded for further etiological development. Stegall v. West, 11 Vet. App. 268, 271 (1998). Upon remand, the AOJ obtained an addendum opinion in January 2021. The January 2021 VA examiner rendered a partially-unfavorable opinion, concluding, in pertinent part, that: (a) the evidence does not reflect that the left knee condition clearly and unmistakably existed prior to service; (b) the left knee condition was less likely than not caused or aggravated by Agent Orange exposure because review of the VA presumptive conditions for Agent Orange and of National Library of Medicine did not reveal any associations of Agent Orange exposure with degenerative arthritis or osteoarthritis; (c) the Veteran’s military occupational specialty does not identify particular causal factors for degenerative joint disease of the knees; and (d) the Veteran had a 40-year long career at GM as an inspector, which is much longer than either of his service periods in terms of exposure to contributing or causal factors; (e) medical records regarding the knees first appeared in 2013. However, the January 2021 VA examiner also concluded that the Veteran’s description of his in-service fall/injury to the knees is “insufficient to determine whether it would cause degenerative process of the joints” such that it was “not possible to make a determination that the left knee condition is incurred in or caused by conditions during service, including a reported fall.” (Continued on the next page)   Based on this evidence, the Board finds that the Veteran’s left knee disability is at least as likely as not related to his in-service fall/injury to the knees. Despite the partially-unfavorable portion of the January 2021 examiner’s opinion, the Board highlights that the examiner indicated that the Veteran’s in-service fall/injury to the knees may have caused degenerative process of the joints, but that further description of the event was needed. It is unclear whether the January 2021 VA examiner actually read the January 2017 Board hearing transcript, in which the Veteran described the fall/injury as him sliding, tearing the skin off the knee, and busting it such that a scar remained. Nevertheless, when resolving reasonable doubt in the Veteran’s favor, the Board finds that the January 2021 opinion is sufficient to find that the Veteran’s left knee disability is at least as likely as not related to his in-service fall/injury to the knees. Thus, service connection is warranted and the Board grants the claim. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Daus, 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.