Citation Nr: 21024637 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 16-58 843A DATE: April 23, 2021 ORDER Entitlement to service connection for a bilateral knee disorder is denied. FINDING OF FACT A bilateral knee disorder was not shown in service or many years thereafter; and, the preponderance of the evidence fails to establish that a bilateral knee disorder is etiologically related to active service. CONCLUSION OF LAW The criteria for service connection for a bilateral knee disorder are not met. 38 U.S.C. §§ 1110, 1111, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the Army from June 1965 to June 1967. The appeal originates from a November 2018 decision of a Department of Veterans Affairs (VA) Regional Office. The matter was remanded in July 2020 to obtain updated VA treatment records, authorization for private treatment records, and an examination with opinion. The record reflects that VA treatment records were obtained and that the Veteran submitted private treatment records he identified in a VA Form 21-4142a. See August 2020 Medical Treatment Record. An examination with opinions was procured in February 2021. There has been substantial compliance with the Remand directives. Entitlement to service connection for a bilateral knee disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic diseases, such as arthritis, will be presumed related to service 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, 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). A veteran is presumed to be in sound condition when entering service, except for conditions “noted” on entrance or where clear and unmistakable evidence demonstrates that an injury or disease preexisted service, and that the disease or injury was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b); Cotant v. Principi, 17 Vet. App. 116 (2003); VAOPGCPREC3-2003 (2003). Only such conditions as are recorded in entrance examination reports are considered as “noted” for purposes of the presumption of soundness. 38 C.F.R. § 3.304(b). A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306(a). The Veteran argues that he had a preexisting bilateral knee disability which was aggravated by his in-service duties. See June 2019 NOD. Service treatment records show that the Veteran reported “trick” or locked knee from a “torn knee ligament” on a February 1965 report of medical history at entry to service. That report notates “injured knees” prior to service and “instability demonstrable” with the remaining text being illegible. However, the lower extremities were evaluated as normal on a contemporaneous examination and at separation in 1967. The February 2021 examiner provided nexus opinions addressing both direct service connection and aggravation of a preexisting disability. In the latter opinion, the examiner indicated that diagnosed bilateral degenerative arthritis and residuals of right and left knee arthroplasty clearly and unmistakably preexisted but were not aggravated by service. The examiner offered no explanation as to how the finding of a preexisting disability was made, and the medical evidence clearly shows that degenerative arthritis was not diagnosed, and the Veteran did not undergo knee arthroplasty, until decades after service. Given the absence of clear notation of a preexisting knee disability at entry to service or a current diagnosis linked to the pre-service history of knee problems, the Board finds that there is not clear and unmistakable evidence that a bilateral knee disorder preexisted service. As such, the analysis turns to direct service connection. As previously noted, the February 2021 examination report indicates diagnoses of bilateral degenerative arthritis and residuals of right and left knee arthroplasty. Element (1) of Shedden is met. Service treatment records are silent as to complaints, treatment, or diagnosis of a knee disorder. In an April 1967 report of medical history completed shortly before separation, the Veteran reported being “in good health” and denied a history of swollen or painful joints; arthritis; bone, joint, or other deformity; “trick” or locked knee; any illness or injury not stated therein; or self-treatment for illnesses other than minor colds. The lower extremities were evaluated as normal at a contemporaneous examination. Though he contends that he had knee symptoms in service, he is not a credible historian (see discussion below.) In the absence of credible evidence of an in-service illness, injury, or disease, Shedden element (2) is not met. Regarding a nexus or Shedden element (3), the February 2021 examiner opined that a bilateral knee disorder is less likely as not related to service. The examiner found insufficient evidence to support complaints related to the bilateral knees in service and noted that the separation exam in 1967 was normal for the lower extremities. The examiner determined that medical evidence did not establish a diagnosis of arthritis until several decades after service at which time the Veteran underwent arthroplasties. The examiner explained that degeneration/osteoarthritis is the result of remodeling due to adaptation to loads to meet mechanical demands and that bone alterations play a major role in degeneration. Based on the examination results, review of the record, and the lay evidence, the examiner was unable to link a bilateral knee disorder to service. The examiner’s opinion concerning direct service connection outweighs the opinion regarding aggravation of a preexisting disability as the former is persuasive and well rationalized, whereas the latter (per the previous discussion) is poorly supported and contradicted by medical evidence. Turning to presumptive service connection for arthritis, the record does not reflect a diagnosis of arthritis until many decades after service. The Veteran does not contend otherwise. As to continuity of symptomatology, despite the Veteran’s assertion of persistent knee symptoms since service, he denied having a history of joint, arthritis, bone, or knee problems at separation. See March 2021 Form 9. The Board affords greater weight to contemporaneous evidence as it is more likely an accurate reflection of his symptom history than later contradictory statements. Consideration is given to various arguments raised by the Veteran. See March 2021 Form 9. He contends that his knees were aggravated by serving in a “combat zone,” that he had knee pain in service, that he self-medicated with pain medication, that his separation examination was too short, and that the February 2021 examiner did not ask in-depth questions regarding his knee. The Board need not determine whether he had combat service because his assertions are contradicted by his own earlier reporting. As previously noted, he denied joint, bone, knee, or other problems, as well as any knee illness, injury, or self-treatment at separation. He identifies no deficiencies in the separation examination related to length. With respect to the February 2021 examination, the examination report shows that the examiner solicited a detailed history from the Veteran, and he fails to identify any deficiencies in the examination. Consideration is given to the personal assertions of the Veteran that a bilateral knee disorder is related to service. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disability at issue is not a condition that is readily amenable to probative lay comment regarding etiology. The Veteran is competent to report observable symptoms, but there is no indication that he is competent to etiologically link any such symptoms to a current diagnosis. He is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating his disorder. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. The lay opinion is also outweighed by the VA opinion. As such, the claim must be denied. Robert N. Scarduzio Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Alhinnawi 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.