Citation Nr: 21024450 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-19 143A DATE: April 22, 2021 ORDER Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability, to include as secondary to a right knee disability, is denied. Entitlement to service connection for a bilateral eye condition is denied. FINDINGS OF FACT 1. The Veteran’s right knee disability is not etiologically related to service. 2. The Veteran’s left knee disability is not etiologically related to service, to include as secondary to a right knee disability. 3. The Veteran’s eye conditions are not etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to service connection for a left knee disability, to include as secondary to a right knee disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. The criteria for entitlement to service connection for a bilateral eye condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1966 to March 1969. He appeals a June 2015 rating decision denying entitlement to service connection for a right knee condition and a bilateral eye condition, and an August 2015 rating decision denying entitlement to service connection for a left knee condition. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), 3.304, 3.307, 3.309, 3.310. Generally, the evidence must show: (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, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). 1. Entitlement to service connection for a right knee disability. 2. Entitlement to service connection for a left knee disability, to include as secondary to a right knee disability. The Veteran contends that his right knee condition is attributable to service. He further argues that his left knee condition has manifested as a result of his right knee condition. He specifically asserts that his knees hurt in service due to the rigors of serving in Vietnam. After review of the evidence, the Board finds that service connection is not warranted for either knee. As an initial matter, a review of the Veteran’s service treatment records does not reveal complaints of or treatment for any knee conditions. Furthermore, the Veteran did not report any knee conditions at his separation examination in March 1969. In fact, the post-service evidence does not reflect symptoms related to a left or right knee disorder until he filed his claim in 2014, where he complained of bilateral knee pain. The Board emphasizes that this first indication of knee pain is approximately 46 years after he left active duty. As such, a continuity of symptoms is not shown based on the clinical evidence. As part of this claim, the Board recognizes the Veteran's statements regarding his history of symptoms. In this regard, while the Veteran is not competent to diagnose a disorder such as arthritis of the knees, as it may not be diagnosed by its unique and readily identifiable features and thus requires a determination that is "medical in nature," he is nonetheless competent to testify about the presence of observable symptomatology, which may provide sufficient support for a claim of service connection, if credible, regardless of the lack of contemporaneous medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). However, the Board determines that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not sufficient by itself to grant service connection. Specifically, although he has attributed his current knee pain to service, he specifically denied any knee pain at an evaluation in September 1971. Had the Veteran experienced knee pain in 1971, there seems to be no reason why he would not have identified it at that time. Therefore, continuity is not established based on the clinical evidence of record or the Veteran's statements. Moreover, the Veteran has not truly asserted that his left knee pain has continued since service, as he has attributed it to his right knee symptomatology. Next, service connection may also be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's claimed disorders to active duty, despite his contentions to the contrary. In this regard, the Veteran was afforded a VA examination in November 2019, where he was diagnosed with bilateral knee arthritis and tendonitis. The examiner acknowledged that the Veteran’s left knee disability was likely attributable to his right knee disability, reasoning that the altered gait resulting from his right knee disability could cause alterations in normal biomechanics eventually leading to the development of disability in the opposing knee. However, the examiner determined that his right knee disability was less likely than not related to active service. The examiner reasoned that there is no objective medical evidence provided in service records that could establish a direct relationship between the Veteran’s current right knee condition and his military service. Moreover, to the extent that the Veteran asserted that his knee symptoms were due to physical activity in-service, the examiner noted that extrapolating a nexus to the potentially injurious effects of physical activities related to military training is not possible from an objective point of view. Such a nexus requires medical evidence of an actual injury in line of duty. As noted above, the first report of actual knee pain does not occur until several decades after service. The Board affords significant probative weight to the opinion rendered by the VA examiner. The Veteran has not submitted any medical evidence which would refute the examiner’s opinion. Specifically, he has not submitted any medical evidence linking his current right knee condition to service nor any other evidence indicating that he has suffered from any knee conditions since service. As such, a nexus between the Veteran’s current right knee condition and active service has not been established. Based on the foregoing, service connection for a right knee disability is not warranted. As service connection is not warranted for the Veteran’s right knee disability, it follows that service connection for a left knee disability secondary to the right knee disability is unavailable. The Board acknowledges that the Veteran’s statements indicate that he may have injured both knees during service. However, the medical and lay evidence of record does not support a direct causal nexus between the Veteran’s current left knee disability and service any more so than his current right knee disability. Hence, service connection is not warranted for the Veteran’s left knee disability on a direct basis. In summation, the preponderance of the medical and lay evidence is against a finding that the Veteran’s current knee disabilities are related to active service. As the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not applicable. See Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). Accordingly, service connection is not warranted, and the claims are denied. 3. Entitlement to service connection for a bilateral eye condition. The Veteran contends that he has vision issues attributable to active service. After review of the evidence, the Board finds that service connection is not warranted. Review of the Veteran’s service treatment records shows treatment for injury to both eyes after typewriter cleaning solution was splashed in his eyes. On that occasion, he was seen by medical personnel within 10 minutes of the injury was treated with an eye wash. While he noted symptoms such as a slight burning sensation when looking into bright lights, no further treatment for an eye condition is noted in his service treatment record. The Veteran also contends that he had a small metallic object removed from his one his eyes, but he cannot remember which eye and there is no documentation of such an incident in his service treatment record. Of note, the Veteran reported no eye problems upon separation from service and his separation examination showed no difference in visual acuity when compared to his entrance examination. Prior to a June 2016 optometry assessment, the medical evidence shows no diagnosis of or treatment for any eye conditions. At the assessment, the Veteran was diagnosed with astigmatism, myopia, and presbyopia. The optometrist also noted mild amblyopia without obvious etiology. Glaucoma was notes as “suspect” in the right eye, but no formal diagnosis of glaucoma was rendered. As before, the Board emphasizes that decades passed between his in-service eye injury and his current disorder. Moreover, as the Board has already determined that service-connection can not be granted solely on the basis of his inconsistent statements, continuous symptoms have not been shown. Moreover, the evidence does not otherwise show that the Veteran’s eye disorders are related to service. In this regard, the Veteran has been afforded the opportunity to attend VA eye examinations twice in the past, but failed to appear for either one, and did not provide a reason for his absence. As such, medical evidence which may have been vital to his claim is unavailable for review. Specifically, a medical opinion attesting to a link between the Veteran’s eye conditions and service is essential to his claim for service connection. The Board does acknowledge the Veteran’s assertions regarding a link between his present eye conditions and service but finds them unpersuasive. In this case, a determination regarding the etiology of his eye conditions must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed.Cir.2010) (recognizing that in some cases lay testimony “falls short” in proving an issue that requires expert medical knowledge). Hence, the evidence does not show a nexus between the Veteran’s current eye conditions and active service. In summation, the medical evidence of record does not support the conclusion that the Veteran’s current eye conditions are etiologically related to active service. Therefore, service connection is not warranted, and the claim is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, Associate Counsel