Citation Nr: 21026870 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 13-18 651A DATE: May 4, 2021 ISSUES 1. Entitlement to service connection for right ankle degenerative joint disease (claimed as right ankle residuals) (hereinafter, right ankle disability). 2. Entitlement to service connection for right knee strain with degenerative joint disease (claimed as right knee residuals). (hereinafter, "right knee disability"). ORDER Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for a right knee disability is denied. FINDINGS OF FACT 1. The Veteran's right ankle disability did not have its onset during service or within the first post-service year and is not otherwise related to any disease or injury in service (2018). 2. The Veteran's right knee disability was not manifested in service or within the one year following separation and is not related to his military service. CONCLUSIONS OF LAW 1. The Veteran's right ankle disability was not incurred in or aggravated by active military service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113 (West 2012); 38 C.F.R. §§ 3.303, 3.307, 3.09, (2018). 2. The Veteran's right knee disability was not incurred in or aggravated by active military service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309, 2018. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1974 to January 1977. The matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2011 decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was before the Board in April 2018 and October 2020. In that April 2018 decision, the Board remanded the matter to obtain an original copy of the Veteran's VA Form 9 and to obtain SSA records and medical records based on an SSA award letter received in August 2015. The Board also notes that on his July 2013 substantive appeal (VA form 9), the Veteran requested a hearing. He subsequently withdrew his request for a hearing in a March 2018 letter; the Board considers his request withdrawn and will proceed. See March 12, 2018 Correspondence. In the October 2020 decision, the Board remanded the Veteran's claims for (1) a low back disorder (2) right ankle disorder and (3) right knee disorder for new VA examinations. In a March 2021 rating decision, the Veteran was granted service connection for a low back disorder (lumbosacral strain & myositis with degenerative disc & degenerative joint disease lumbar spine with spondylolisthesis). See March 13, 2021 Rating Decision. Therefore, that issue is no longer before the Board. In a March 2021 Supplemental Statement of the Case (SSOC), the Veteran's claims for service connection for a right ankle and right knee disability remained denied. See March 13, 2021 SSOC. These matters have returned to the Board for appellate review. Upon review of the Veteran's claim file, the Board finds that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). See also October 30, 2020 and December 10, 2020 VA Correspondence re: record development. This appeal has been advanced this appeal on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2018). 38U.S.C. §7107 (a)(2) (2012). Service Connection In order to obtain service connection under 38 U.S.C. §§ 1110, 1131 and 38 C.F.R. § 3.303(a) a Veteran must satisfy a three element test: (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, 1166-67 (Fed. Cir. 2004); Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). VA has established certain rules and presumptions for chronic diseases, such as arthritis. See 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303 (b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Entitlement to service connection for a right ankle disability. The Veteran contends that his right ankle disability is related to service and that he has had right ankle pain of and on since separation from service. See January 19, 2011 VA Form 21-526; See also January 20, 2021 VA Ankle Conditions Examination, pg. 2. There is evidence that the Veteran has a current right ankle disability, namely degenerative joint disease of the right ankle. See January 20, 2021 VA Ankle Conditions Examination, pg. 2; See also, April 26, 2011 VA examination. Hence, the Board finds that the first prong of service connection, a current disability, has been met in this case. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). With regards to an inservice injury or treatment for a right ankle disability: March 1974 treatment records show the Veteran complaining of pain and tenderness with swelling of the right ankle, tenderness, lateral aspect of right ankle. On diagnostic testing, the Veteran's x-ray for his right ankle was negative. The Veteran was given a diagnosis of an ankle sprain. The Veteran was proscribed a gel cast for 10 days. See March 6, 1974 STR; See also, March 25, 2974 STR's re: cast removal. April 1974 treatment records show the Veteran with complaints of pain in right ankle with considerable pain when marching and standing for any length of time. See April 2, 1974 STR. July 1974 treatment records show the Veteran complained of reinjuring his right ankle. The Veteran had minimal tenderness, swelling. His right ankle required an ace wrap, and elevation. See July 31, 2974 Service treatment records. August 1974 treatment records show that the Veteran returned for follow-up treatment. On diagnostic testing, the Veteran's x-ray was negative. Daily whirlpool treatment was recommended for the next seven days. See August 1, 1974 Service Treatment records. The Veteran October 1976 Separation physical on clinical evaluation was silent with regards to a right ankle condition. See October 5, 1976, Report of Medical Examination Notwithstanding, based on these in-service treatment records for his right ankle, the Board finds that the second element of service connection has arguably been met. See Shedden, 381 F.3d at 1167. Hence, the question for the Board is whether there is a nexus between the Veteran's current disability and service. Post service: January 2013 medical records shows treatment for right medial ankle pain, possible tarsal tunnel due to space occupying lesion, varicosity, medial right ankle. There is no history of arthritis, arthralgias, or myalgias. There is no history of pedal edema. There is no history of implanted orthopedic hardware, joint implants/prostheses. See January 29, 2013 treatment notes; See also January 26, 2009 treatment records (Premier Orthopedics re: ankle pain on examination for right knee). The Board now turns to a discussion of the examinations of record in the evaluation of this Veteran's claim. The Board notes that the Veteran has been afforded VA examinations and medical opinions in April 2011 and January 2021 regarding his right ankle disability. In its October 2020 decision, the Board found the April 2011 examination and medical opinion inadequate for adjudication purposes because it did not consider the Veteran's competent lay assertions that he experienced right ankle pain on and off since his separation from service. See October 26, BVA Decision, pg. 11. Therefore, reference to the April 2011 VA examination is only made for the limited purpose of either depicting the Veteran's current diagnosis or his lay assertions by medical history. Pursuant to the Board's Remand directives, the Veteran was afforded a January 2021 VA Ankle Conditions Examination and Medical Opinion. During this January 2021 VA examination, the examiner noted review of the Veteran's claims file. The examiner also recorded that this was an in-person examination. The examiner also reviewed the Veteran's medical history, as reported by the Veteran. The examiner noted the Veteran's report of ankle pain since he was released from military service. The examiner reported that the Veteran rated this pain in his right ankle 4/10. The examiner recorded that the Veteran still has intermittent pain in his right ankle. The examiner recorded that the Veteran's pain could be precipitated by standing for long periods of time. The examiner also reported that the Veteran uses voltaren, arnica, and ice pads. Previous medications alleviate his condition. See January 20, 2021 Ankle Conditions examination, pgs. 1-2. After noting review of the Veteran's claims file, reviewing the Veteran's medical history (as reported by the Veteran) and conducting an in-person examination, the examiner rendered a negative nexus opinion to service. The examiner determined that the Veteran's current disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner provided the following reasoning to support this opinion: "This is a case of a 66-year-old male veteran who entered active service on January 22, 2974 and was released on January 18, 1977. Medical literature establishes that right ankle degenerative joint disease, or osteoarthritis often develop slowly and worsen over time; and that it occurs when the cartilage that cushions the ends of bones in joints gradually deteriorates. osteoarthritis increases with age. Diagnosis right ankle degenerative joint disease was granted through radiographic study, on July 26, 2019, date which is 42 years after separation from active service period. The service records are silent regarding any diagnosis or symptoms of right ankle degenerative joint disease during active service. There is no evidence of any manifestation or diagnosis of right ankle degenerative joint disease within a year after separation from active service." See January 20, 2021 VA Medical Opinion, pgs. 1-2. Analysis In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Te Board finds this VA examination probative for the following reasons: First, the Board notes that the examiner acknowledged review of the Veteran's claims file, including his in-service and post-service treatment records. Second, the examiner factored in the Veteran's lay assertions of continuity of right ankle symptoms since separation from service before formulating an opinion. Third, the examiner provided a reasoned medical analysis for the conclusion reached, explaining the nature of degenerative disease process and linking this analysis to the pertinent evidence of record as it applies to this Veteran. Fourth, this opinion was based on an accurate review of the facts of the case. As such, the Board finds that this January 2021 VA Ankle Conditions medical opinion is entitled to significant probative value. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). Lay statements With regards to the Veteran's contention that a nexus exists between his current right ankle disability and service: It is clear that the Veteran believes that a nexus exists. Such a lay belief sometimes is sufficient. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). However, the question of whether there exists a nexus in this case is medical in nature. Of note in this regard are the complexities of degenerative joint disease. In this case, medical knowledge, training, and/or experience is required to provide a competent opinion on the nexus between degenerative joint disease and in-service treatment for a right ankle strain. See Jones v. West, 12 Vet. App. 460 (1999). Thus, while the Board has considered the Veteran statements, it finds the January 2021 Ankle Conditions Examination and VA medical opinion to outweigh them. The January 2021 VA examiner explained that the "medical literature establishes that right ankle degenerative joint disease, or osteoarthritis often develop slowly and worsen over time; and that it occurs when the cartilage that cushions the ends of bones in joints gradually deteriorates. osteoarthritis increases with age." See January 20, 2021 VA Medical Opinion, pgs. 1-2. The Board underscores that after an in-person examination of the Veteran, review of the Veteran's medical history as reported by the Veteran, and describing the Veteran's current disability as per the VA examination, the examiner reasoned that the Veteran service records are silent regarding any diagnosis or symptoms of right ankle degenerative joint disease during active service. Id. at pg. 2. In other words, the January 2021 examiner did not find a nexus between the Veteran's current right ankle disability and in-service treatment or complaints for his right ankle disability. With respect to the etiology of this Veteran's right ankle disability, the Board finds this medical opinion the most probative evidence of record regarding the etiology of this Veteran's current right ankle disability and therefore persuasive. There is no other contrary medical opinion of record. The Board further finds that presumptive service connection is not warranted because the evidence does not show that he has a diagnosis of arthritis becoming manifest to a degree of 10 percent of more within one year from the date of separation. Pointing to the pertinent evidence of record, the January 2021 examiner explained that the diagnosis of the Veteran's right ankle degenerative joint disease was granted through radiographic study, on July 26, 2019. The examiner concluded that there is no evidence of any manifestation or diagnosis of right ankle degenerative joint disease within a year after separation from active service." See January 2021 VA Medical Opinion, pg. 2. Regarding continuity of symptomatology: Although the Veteran has asserted that his right ankle pain began in service and continued thereafter, it is noted that the Veteran's right ankle was evaluated as normal at the time of his separation examination. There are no records of treatment for right ankle pain or any right ankle disability until 2009, more than 30 years post service. See January 26, 2009 treatment records (Premier Orthopedics reference to right ankle pain). Accordingly, the Board finds that the weight of the lay and medical evidence is against a finding of continuity of symptoms since service separation. In summary, based on a review of the lay and medical evidence of record, Board finds that the Veteran's right ankle disability did not have its onset during service or within the first post-service year and is not otherwise related to any disease or injury in service. As the preponderance of the evidence is against the claim for service connection for a right ankle disability, the benefit-of-the-doubt rule does not apply, and this claim must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for a right knee disability. The Veteran contends that his right knee disability is related to service and that his right knee has been giving him problems for some time. See February 23, 2011, VA 21-4138, Statement in Support of Claim. There is evidence of a current disability. The Veteran has been diagnosed with degenerative joint disease. See January 20, 2021 VA examination, pg. 2; See also April 2011 VA examination, pg. 4. Hence, the Board finds that the first prong of service connection, a current disability, has arguably been met in this case. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004) With regards to an in-service injury or treatment: February 1976 service treatment records show that Veteran with complaints of right knee pain. The Veteran had been lifting weights, exercising. On evaluation, there was lateral joint-line tenderness, decreased of range of motion secondary to pain. Joint stable, negative for crepitance, clicking, popping. The Veteran was assessed for right knee strain. See February 2 &10, 1976 STR's. March 1976 service treatment records (STR) show complaints of right knee pain. The service treatment records showed a diagnosis of bilateral condromalasia. ASA of no value. Nothing more to offer at this time. See March 20, 1976 STR. May 1974 service treatment records show the Veteran with complaints of right knee pain for two weeks. Pain was present in interpatellar joint when extending. Diagnostic testing: X-Ray of the right knee was negative. See May 3, 1974 STR. September 1976 service treatment records from the orthopaedic clinic show the Veteran complaining of pain and swelling of right knee off and on for the past several months. On physical exam, there was no significant instability, no swell or effusion. X-Ray was not remarkable. Impression, possible traumatic synovitis. Recommendation for Quadriceps exercise. See September 2, 1976 STR's September 1976 service treatment records show that the Veteran was diagnosed with a contusion on his right knee. The Veteran had pain in his right knee with swelling. On physical exam, the Veteran had minimal amount of edema, no crepitus, no joint line pain. The Veteran was provided with a cylinder cast for 1 week to 10 days. See September 16, 1976 STR. September 1976 service treatment records show that the Veteran was receiving physical therapy for his right knee. Swelling in his right knee has increased. The Veteran continued to participate in sports. The Veteran was to be referred to orthopedics upon next physical therapy appointment if possible. See September 28, 1976 STR. The Veteran's October 1976 Separation physical on clinical evaluation was silent with regards to a right knee condition. See October 5, 1976, Report of Medical Examination. Notwithstanding, based on these in-service treatment records for his right knee, the Board finds that the second element of service connection has arguably been met. See Shedden, 381 F.3d at 1167. Hence, the question for the Board is whether there is a nexus between the Veteran's current right knee disability and service. Post service, August 2007 medical records show that the Veteran presented for an evaluation secondary to a reported work-related injury occurring on August 22, 2007. The physician recorded that this Veteran is a preload individual who loads trucks for United Parcel Services in the course of performing his work activities he was kneeling down and as he was arising or standing he felt a burning sensation and developed pain in his right knee. See August 22, 2007 treatment records, New Patient Extended Office evaluation. On physical examination, the physician recorded that inspection of the knee demonstrates no evidence of a mons or bruising No effusion or calor noted Bony palpation demonstrates normal bony prominences. Soft tissue palpation demonstrates tenderness along the insertion of the lateral collateral ligament There is also tenderness at the lateral joint line and there is full range of motion with discomfort and negative McMurray s and negative anterior drawer test. There is normal lateral stability Motor and sensory status is intact throughout the lower extremity Deep tendon reflexes are brisk and present. Straight leg testing is negative. The physician recorded a diagnosis of strain. See August 22, 2007 treatment records, New Patient Extended Office evaluation. January 2008 medical records show that the Veteran was treatment for right knee pain secondary to an August 22, 2007 work related injury. On physical examination, the physician record that the Veteran's right knee showed no obvious abnormalities or deformities There is no bruising, swelling or discoloration He still continues to have some tenderness along the lateral collateral ligament. He is able to demonstrate a full flexion and extension. Neurological Examination Gan is normal. It was recorded that the Veteran had an MRI in the past and that a MRI was done on September 15, 2007 and it did show minimal if any chondromalacia of the medial compartment with no significant defect. The physician recorded that at that time he had a mild patellofemoral joint effusion. The physician recorded that the Veteran has worked 20-plus years doing horseshoes, which requires him to be in a position, which is hard on his knees, and he was asymptomatic until he started working at UPS, but he did only do five months at UPS. Given the fact that he was asymptomatic up until that point, the physician recorded that I do feel, and Dr P. also feels, that his symptoms are causally related to his work at UPS, but we would recommend apportionment for him. The physician recorded that on at least two separate occasions we have offered steroid injections and we continue to stand by that, but at this time, the Veteran does not wish to go forward with the steroid injections until after he sees Dr S., so I will go ahead and set him up with that and then consider the steroid injections or see if there are any surgical options for him at this time. See January 28, 2008 medical records (Established Extended Evaluation); See also, September 15, 2007 MRI Report (Colorado Springs Imaging). Continuing with post service medical records: October 2008 medical records treatment records show the Veteran was treated for knee pain in connection with a work-related injury on August 22, 2007. The physician recorded that the Veteran indicates that several days ago he was working and twisted his knee and, as a result, aggravated his pre-existing pain condition in his knee. He now presents and indicates that he continues to experience discomfort, but he has not experienced any swelling or laxity or giving way of the knee. On examination, the physician recorded that inspection of the knee demonstrates no evidence of effusion, rubor or calor. There is full and fluid motion of the knee There is no specific tenderness at the medial or lateral collateral ligaments and joint line palpation is unremarkable. There is normal stability anteroposteriorly as well as laterally. The physician's diagnosis was knee strain. See October 21, 2008 treatment records (Established Extended Office Evaluation). January 2009 treatment records show the Veteran was treated for an evaluation of his right knee. The clinician recorded that the Veteran stated that two years ago he had an injury while at work where he felt significant pain to the lateral aspect of his knee. His pain was intolerable at the time and radiated from his knee joint distally to his ankle on the lateral aspect. On physical examination the right knee showed that visually he has no edema ecchymosis or deformity. He is mildly tender to palpation over his fibular head and just distally to his fibula laterally on the right side. He has a negative anterior posterior drawer negative Lachman s negative varus valgus He has medial joint pain with internal rotation with McMurray's. He has no pain laterally with external rotation with McMurray's three views of the knees are negative for any significant bony deformities. The physician reported that his MRI results show mild chondromalacia of his medial joint compartment otherwise negative Review of his EMG is negative for any significant nervous pathology. The physician a diagnostic impression of right knee pain with early medial joint chondromalacia. See January 26, 2009 treatment records (Premier Orthopedics). An October 31, 2014 MRI of the right knee showed, osteoarthritis with chondromalacia patella, oblique tear, chronic posttraumatic medial collateral ligament. See October 31, 2014 MRI Report; See also, November 3, 2016 treatment records (Physical Medicine and Rehab Resident Outpatient Note). The Board now turns to a discussion of the VA examinations of record in the evaluation of this Veteran's claim. As referenced above in this decision, the Veteran has been afforded VA examinations and medical opinions in April 2011 and January 2021 regarding his right ankle and right knee disorder. The Board found the April 2011 examination and medical opinion inadequate for adjudication purposes because it did not consider the Veteran's competent lay assertions of continuity of symptoms since service. Pursuant to the Board's Remand directives, the Veteran was afforded a January 2021 Knee and Lower Leg examination and Medical Opinion. During this examination, the January 2021 examiner noted review of the Veteran's claims file. The examiner also noted this was an in-person examination. The examiner recorded the Veteran's medical history as reported by the Veteran, as knee pain starting since the time he was released from military Service. The examiner noted that the Veteran still has pain in his right knee, which is intermittent and produces a stabbing sensation. The pain is 4/10 and could be precipitated when kneeling, sitting for long periods of time, or climbing stairs. The Veteran uses voltaren, and ice pads. previous measures alleviate his conditions. See January 20, 2021 Knee and lower leg examination, pgs. 1-2. After review of the claims file (including in-service and post-service treatment records) and an in-person examination of the Veteran, the January 2021 examiner rendered a negative nexus opinion to service. The examiner determined that the Veteran's current knee disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned that "this is a case of a 66 year -old male Veteran who entered active service on January 22, 1974 and was released on January 18, 1977. Medical literature establishes that bilateral knee degenerative joint disease, or osteoarthritis occurs when the cartilage that cushions the ends of bones in joints gradually deteriorates, increasing and being part of aging process. Diagnosis bilateral knee degenerative joint disease, was granted through radiographic study, performed on July 26, 2019, date which is 42 years after separation from active service. The service records are silent regarding any diagnosis or symptoms of bilateral knee degenerative joint disease during active service. There is no evidence of any manifestation or diagnosis of bilateral knee degenerative joint disease within a year after separation from active service." See January 20, 2021 Knee and Lower Leg Conditions Medical Opinion, pgs. 2-3. Analysis The Board finds this January 2021 VA examination and medical opinion probative for the following reasons: First, the examiner acknowledged a complete review of the Veteran's claims file, including in-service and post-service treatment records; Second, the examiner acknowledged the Veteran's medical history, as it relates to his statements of a continuity of his symptoms since leaving the military; Third, the examiner refers to medical literature to support his reasoning, while linking this reasoning to the pertinent evidence of record as it relates to the Veteran's current diagnosis of bilateral knee degenerative joint disease. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (holding that among the factors for assessing the probative value of a medical opinion are the examiner's access to the claims file and the thoroughness and detail of the opinion). Additionally, the Board is satisfied that the January 2021 VA physician duly considered all salient evidence, both clinical and lay. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008) (noting that greater reliance may be placed on an opinion rendered by an examiner who is fully informed of the pertinent factual premises (i.e., history) of the appeal). For the reasons stated above, the Board finds the examiner's opinion to be of significant probative value and persuasive as to the etiology of this Veteran's right knee disability. Lay statements With respect to the Veteran's contention that his right knee disability is related to service: It is clear that the Veteran believes that a nexus exists between his in-service right knee complaints, treatment and his current right knee disability. Such a lay belief sometimes is sufficient. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board is cognizant that it is indeed is error to suggest that lay evidence can never be enough to establish that there is a nexus between a claimed condition and service. See Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010); Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). However, the causal relationship between the Veteran's claimed right knee disability (degenerative joint disease) is a complex medical issue for which the Veteran is not qualified to offer an opinion and therefore his opinion on the etiology of his right knee disability has no probative value. Thus, while the Board has considered the Veteran's statements, it finds the January 2021 VA Knee and Lower Examination and Medical Opinion to outweigh them. There is no contrary medical opinion of record. Finally, the Board observes that service connection may be awarded on a presumptive basis for certain disabilities such as arthritis that become manifested within a proscribed period following active military service. 38 C.F.R. §§ 3.307, 3.309. In this case, however, the Veteran's right knee degenerative joint disease was not initially manifested within a year following service. The Board underscores that the January 2021 VA examiner explained that "there is no evidence of any manifestation or diagnosis of bilateral knee degenerative joint disease within a year after separation from active service." See January 20, 2021 Knee and Lower Leg Conditions Medical Opinion, pgs. 1-2. Regarding continuity of symptomatology: Although the Veteran claims to have had right knee problems since separation, these assertions are at odds with the contemporaneous medical record. The Board observes that the earliest evidence of right knee problems associated with the claims file is in 2007, which was in connection with a work-related injury. See August 22, 2007 Medical Records, New Patient Extended Office evaluation; See also, January 26, 2009 treatment records (Premier Orthopedics). The Board is cognizant of the Veteran contention's that he was never informed or had any knowledge that he could qualify for medical benefits or compensation for injuries that he had while on active duty. See February 28, 2012 Correspondence. The Board observes however that the medical record does not show that he sought treatment for a right knee condition until many years after service. Accordingly, the Board finds that the weight of the lay and medical evidence is against a finding of continuity of symptoms since service separation. In summary, based on the lay and medical evidence of record, the Board finds that the Veteran's right knee disability was not manifested in service or within the one year following separation and is not related to his military service. Given that the Board has found the unfavorable January 2021 VA Knee Conditions examination and medical opinion to be the most probative evidence of record, the preponderance of the evidence is against the Veteran's claim for service connection, and the claim must be denied. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.