Citation Nr: 21024868 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 16-29 298 DATE: April 26, 2021 ORDER Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. FINDING OF FACT The preponderance of the evidence does not show the Veteran’s bilateral knee disability had its onset in service or is otherwise related to his active duty. Nor was arthritis diagnosed within one year of separation. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.309. 2. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty with the U.S. Army from October 1988 to October 1992. He testified at hearing in February 2018 before the undersigned Veterans Law Judge. A transcript is associated with the record. The Board remanded the appeal in September 2020 in order to afford the Veteran new VA examinations. Service connection for the lumbar spine was granted in the October 2020 rating decision while on remand and therefore, that issue will not be addressed in this decision. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. §3.303. Service connection may also 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). Where a Veteran served for at least 90 days during a period of war and manifests arthritis to a degree of 10 percent within one year from the date of termination of that service, hypertension shall be presumed to have been incurred in service, even though there is no evidence of the disability during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The disease entity for which service connection is sought must be chronic and not acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. For certain chronic diseases set forth in 38 C.F.R. §3.309(a), continuity of symptoms is required when the condition noted in service is not shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. §§ 3.303(b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Entitlement to service connection for a left knee disability. 2. Entitlement to service connection for a right knee disability. The Veteran contends that he has a bilateral knee disability as a result of his time in service. Specifically, he asserts that he injured his knees while carrying extremely heavy rounds for a howitzer. An October 2019 VA examination confirms diagnoses of osteoarthritis and patellofemoral pain syndrome in both knees. As such, the first element of service connection has been met. Review of the service treatment records does not show an event, injury, or disease of the knees in service. In February 1990, the Veteran experienced a fall from a howitzer, and he was seen for pain in his left shoulder, ribs, arm, and neck. There was no indication that the fall impacted his knees, nor did he so report at that time. Post-service treatment records show he was seen for knee pain in 2004 and reported that it had been present for years. The examiner noted there was no trauma. In June 2006, he was treated once more for chronic knee pain. He reported pain and swelling for one to two months without any known trauma. The examiner noted possible bursitis or tendonitis. It was recommended he start physical therapy. During the February 2018 hearing, the Veteran testified that he had a diagnosis of degenerative arthritis. He was told by a physician that the development of arthritis at such a young age is typical following an injury. His representative indicated that the Veteran’s initial MOS was physically demanding. Eventually, he was moved to a different MOS (finance clerk) due to his lack of physical capabilities caused by his back and knees. The September 2013 VA knee examiner confirmed a diagnosis of patellofemoral pain syndrome and x-rays reveal minimal degenerative changes. The summary of his condition noted that he was not seen in service for his knees, but he had knee pain since. During the April 2018 VA examination for fibromyalgia, the Veteran reported lower extremity weakness that put him at risk for falls. During the October 2019 VA examination, the Veteran reported that his knees hurt from the first day of combat in 1990-91. He had a lot of wear and tear on his knees from carrying heavy loads that has worsened over time. Ultimately, the examiner found that the knees were less likely than not related to service. The Veteran’s service records did not show any complaints of knee symptoms. He later had complaints in 2004-06 but the onset was not specified. An x-ray in 2006 was negative for degenerative joint disease. The howitzer accident during service did not show knee involvement. “Military service is physical in nature but is not known to be a cause of PFS or DJD in the absence of a knee complaints or knee injury (none was shown in STR).” Upon review of the record, there is no competent or probative evidence to indicate a correlation between the Veteran’s bilateral knee disability and his military service. The Board acknowledges the Veteran’s contentions that he experienced significant wear and tear on his knees due to carrying heavy loads during service. The Veteran is certainly competent to report his knee injuries and symptoms, but he is not competent to provide a nexus opinion linking his bilateral knee disabilities to an event, injury, or disease in service. He has not been shown to have the requisite medical expertise to provide such an opinion. The record shows complaints and treatment for his knees well after service. However, the earliest dated treatment record in evidence post-service to show any complaints of a disability related to the knees, is dated 2004, approximately 12 years after his separation. In addition, there is no competent evidence of record to indicate a link between his current bilateral knee disability and his military service. There is one medical opinion in evidence for the knees, and that examiner concluded that the Veteran’s knee disability is not related to service. The examiner provided the opinion following review of the file, consideration of the Veteran’s lay reports, and included a detailed rationale for the opinion reached. As such, a preponderance of the evidence is against his claim for service connection. The Board notes that the record reflects a diagnosis of osteoarthritis of the left knee which is considered a chronic disease. However, the record does not support a continuity of symptomatology of arthritis symptoms. The earliest record in evidence to show a diagnosis of arthritis/degenerative changes is dated 2013—over two decades post his 1992 separation. The 2006 x-ray was negative for degenerative disease. Further, the 2013 x-ray showed minimal degenerative changes. As such, service connection such for osteoarthritis of the knees is not warranted on a presumptive/continuity of symptomatology basis. The Board also acknowledges the Veteran’s representative’s statements during the hearing regarding his experience working with soldiers in the same grade as the Veteran. Specifically, he indicated that “the only reason they take a good 13 series person off the gun line is if they’re injured and they can’t do their job. So the guys I met who drove trucks in the artillery battalions are usually people that had an injury. It was a back or a knee, something like that.” Although the Board welcomes the representative using his own experiences to advocate for his client, it has not been shown that he possesses the appropriate medical background to determine the diagnosis, onset, and severity of the Veteran’s knee condition during or after service. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). (Continued on the next page)   Service connection for the claim for bilateral knee disability is denied. The preponderance of the evidence is against the Veteran’s claim and the doctrine of reasonable doubt is not applicable in the instant appeal. Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990); 38 C.F.R. § 3.102. H.M. WALKER 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.