Citation Nr: 21025817 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 16-53 595 DATE: April 29, 2021 ORDER Entitlement to service connection for a right knee disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that a right knee disability began during service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1981 to January 1982. The appeal was most recently before the Board in November 2020 when it was remanded for further development. The Board finds there has been substantial compliance with the remand directives for the claims decided herein. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a right knee disability. The Veteran seeks entitlement to service connection for a right knee disability. He contends that he injured his right knee during service after falling on a rock and continues to experience pain. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran's right knee disability either began during active service or is otherwise related to an in-service disease or injury. The Board concludes that the Veteran has a current diagnosis of a right knee disability. He underwent a medial unicompartmental knee replacement in February 2014 and a total knee joint replacement in December 2015. See September 2016 and December 2019 VA examinations. However, the preponderance of the evidence is against finding that a right knee disability began during service, or is otherwise related to an in-service injury, event, or disease. Service treatment records (STRs) reflect that in January 1982, the Veteran reported right knee pain with possible fluid build-up after hitting his knee on a rock. The assessment was soft tissue trauma to the right knee. When the Veteran separated from service at the end of January 1982, he signed a form indicating that he did not desire a separation medical examination. The STRs do not otherwise document any complaints, diagnoses, or treatment related to a right knee disability. In an August 2014 Social Security Administration (SSA) determination, the SSA found that the Veteran was disabled as of February 1, 2014; the primary and secondary diagnoses were diabetes mellitus and essential hypertension, The disability determination itself did not address any knee disability. Medical records associated with the SSA determination include extensive records related to treatment for a left knee disability and more limited references to the right knee. None of the records includes any information, lay or medical, that relates a right knee disability to the Veteran’s service. The Veteran has asserted that his right knee problems began in service and continued since. At the February 2019 Board hearing, the Veteran testified that he injured his right knee in service when he fell on a rock. The Veteran indicated that he received private medical treatment for his right knee. The Board remanded the claims to obtain an adequate medical opinion. A September 2016 VA examination included a negative nexus opinion, but the Board previously determined that opinion was inadequate because it did not specifically address the Veteran’s lay assertions of continuous symptoms. On a December 2019 VA examination, the examiner noted the current status of the Veteran’s right knee and his reported history of the injury in service. The Veteran said he fell on a rock in 1981, that his knee swelled up and bloody fluid was drained, but he doesn’t recall how it was treated. He said his knee continued to bother him after service but he didn’t seek treatment until “about 2014.” In the same report, the Veteran said he was first treated in 2007 and that problems with his right knee became worse when his left knee was replaced. Based on the examination and review of the record, the examiner concluded that it is less likely than not that the Veteran’s right knee disability is related to service. The examiner cited records related to the in-service treatment after falling on a rock, noting full range of motion, no instability, tenderness to the touch and a diagnosis of “soft tissue trauma.” A physical therapy noted dated the next day noted the Veteran was given a profile for “no running for 2 days.” He separated from service less than 2 weeks later and declined a separation examination. The examiner noted that the Veteran was seen multiple times by orthopedic surgeons from 1996 to 2010 for a left knee condition, however there was no mention of a right knee condition until January 2014. The examiner observed that “the absence of a history of a right knee condition noted by his orthopedic surgeons is ‘absence of a medical record.’ It is the absence of documentation of a right knee condition that one would expect an orthopedic surgeon to routinely include among the multiple notes” from 1996 to 2010 “if such right knee condition were present.” Additionally, the Veteran reported working for 10 years on his hands and knees doing concrete work, and then at a forklift job which stressed his knees. The examiner summarized their opinion by noting the Veteran had a single episode near completion of his 2 month period of active service where he suffered a right patella tendon contusion with prepatellar bursitis, which is typically a self-limited condition. The Veteran declined a separation physical examination a few days later. He then undertook work for many years that is much more likely to be the cause of his knee conditions. His left knee was affected first. The examiner concluded that, considering the Veteran’s competent report of continuous symptoms since service, it was still less likely than not that the current right knee disability was related to service. Upon review of all the evidence of record, both lay and medical, the Board finds that the weight of the evidence is against the claim for service connection for a right knee disability. The Board acknowledges that the Veteran has a currently diagnosed right knee disability and he reported right knee pain in 1982. However, as noted by the VA examiner, there was an absence of any documentation in pertinent treatment records, prior to 2014, regarding the right knee that one would expect an orthopedic surgeon to routinely include. Further, the in-service injury is considered a self-limited condition. The December 2019 VA opinion is are probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Although lay persons are competent to provide opinions on some medical issues, the diagnosis and etiology of a right knee disability is outside the realm of common knowledge of a lay person because it involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). As the preponderance of the evidence is against the claim, service connection for right knee disability is denied. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.