Citation Nr: 21026435 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-08 512 DATE: May 3, 2021 ORDER Entitlement to service connection for left knee condition is granted. FINDING OF FACT The Veteran's left knee condition is related to his military service. CONCLUSION OF LAW The criteria to establish service connection for left knee condition have been met. 38 U.S.C. §§ 101, 1111, 1110, 1131 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.306 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1949 to August 1950. He appeals a September 2016 rating decision by the Agency of Original Jurisdiction (AOJ) denying service connection for left knee condition. In December 2020, the Board remanded the Veteran's claim to the AOJ for further development. The claim is back before the Board for further appellate proceedings. Service Connection Left Knee Condition The Veteran contends he severely aggravated his left knee in an in-service fall. See February 2017 VA Form 9. Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran 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"-the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Every Veteran shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment, and was not aggravated by such service. 38 U.S.C. § 1111. To rebut the presumption of sound condition under 38 U.S.C. § 1111, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. The Veteran is not required to show that the disease or injury increased in severity during service before VA's duty under the second prong of this rebuttal standard attaches. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). In the instant case, the Veteran's left knee condition was not noted on his May 1949 service entrance examination. As such, the presumption of soundness attaches. While there is ample evidence to rebut the first prong of the presumption of soundness as the Veteran's left knee condition clearly pre-dated service, there is not ample evidence to rebut the second prong of the presumption of soundness, namely that the Veteran's left knee condition was clearly and unmistakably not aggravated by service. To the contrary, a June 16, 1949 service treatment record (STR) reflects that the Veteran's left knee began to swell after boxing at a gym, and that physical examination revealed that the Veteran's left knee was markedly swollen. The treatment provider diagnosed the Veteran with left knee internal derangement, medial meniscus. See June 1949 STR. A June 19, 1949 STR reflects that the physical examination revealed moderate swelling in the Veteran's left knee. A June 20, 1949 STR reflects that the Veteran's left knee had improved and he was fit for duty. In addition, the Veteran has contended that he suffered a fall in the engine room while aboard the U.S.S. John W. Thomason and that "[i]t was this injury (ies) and severe aggravation that led to his discharge." See February 2017 VA Form 9. Furthermore, the Veteran contended that he was transferred to Balboa Naval Hospital based on the severity of the injuries. Id. The Veteran's contentions are consistent with what is reflected in his STRs. An October 1949 STR reflects that the Veteran reported a sore left knee with associated swelling and tenderness. The Veteran was again diagnosed with left knee internal derangement, medial meniscus, and it was recommended that he be seen by an orthopedic specialist. See October 1949 STR. He was then transferred to the naval hospital for further treatment. There, the medical provider diagnosed the Veteran with marked relaxation of the left knee anterior cruciate ligaments and an unstable left knee joint. Id. Notably, the October 1949 diagnosis was the first diagnosis involving the Veteran's anterior cruciate ligament. In addition, the October 7, 1949 STR reflects that "during boot camp and since that time, [the Veteran] has had recurrent swelling, tenderness and instability of knee." The evidence of the symptoms starting in boot camp and continuing forward, along with the involvement of the anterior cruciate ligament and the competent and credible evidence of an in-service incident in October 1949, provide strong evidence that the symptoms of the Veteran's left knee condition increased in service. The evidence also does not demonstrate that the Veteran's increase in his left knee disability during service was due to the natural progression of the disability. To the contrary, aside from the evidence of a football injury to the left knee resulting in surgery to remove torn cartilage prior to his service, the evidence of record does not indicate that the Veteran was experiencing any symptoms of the pre-existing left knee condition upon entrance into service. Given the physical nature of boot camp and the evidence of an October 1949 in-service incident precipitating the transfer to a hospital for evaluation, over four months after the Veteran's entrance into service, it appears that his increase in symptoms was not due to the natural progression of the condition, but rather to the unique circumstances of service. The Board notes that the September 2016 VA examiner found that there was no aggravation of the Veteran's pre-existing knee condition since there was no injury on active duty. However, competent and credible evidence of an in-service injury was added to the file after the September 2016 VA examination. See February 2017 VA Form 9. Thus, the opinion was not fully informed. In short, the evidence demonstrates that the Veteran's pre-existing left knee condition was aggravated beyond its natural progression during service and the condition continued from service to the present. As such, service connection for a left knee condition, diagnosed as status post left knee meniscus tear and residuals status post traumatic arthritis secondary to laxity of cruciate ligaments, is warranted. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Breitbach, 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.