Citation Nr: 21028331 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 09-12 127 DATE: May 11, 2021 ORDER Entitlement to service connection for a right wrist disability is granted. Entitlement to service connection for a bilateral knee disability is granted. FINDINGS OF FACT 1. The Veteran's right wrist disability is etiologically related to active duty service. 2. The Veteran's bilateral knee disability is etiologically related to active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right wrist disability have been met. 38 U.S.C. § 1101, 1110, 1117, 1131, 1154, 5107; 38 C.F.R. § 3.303, 3.304, 3.307, 3.309, 3.317. 2. The criteria for entitlement to service connection for a bilateral knee disability have been met. 38 U.S.C. § 1101, 1110, 1117, 1131, 1154, 5107; 38 C.F.R. § 3.303, 3.304, 3.307, 3.309, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1991 to October 1991, and from January 2005 to October 2005, with additional service in the Naval Reserve. These matters were previously denied by the Board of Veterans' Appeals (Board) in June 2012 and the Veteran appealed to the Court of Appeals for Veterans Claims (the Court). In a September 2013 Memorandum Decision, the Court remanded the claims for further adjudication after it was determined that the Board provided inadequate reasons and bases for its denial. The Board subsequently remanded the matter in May 2014, October 2015, June 2017, August 2019, and November 2020 to obtain updated medical records and addendum opinions. Most of the requested development has been completed, and the appeal has returned to the Board for further appellate consideration. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). 1. Entitlement to service connection for a right wrist disability 2. Entitlement to service connection for a bilateral knee disability The Veteran contends that his right wrist disorder and bilateral knee disorders are related to his active duty service. Specifically, he contends that his bilateral knee disorders are related to a mortar blast in service in April 2005 and wearing heavy gear while jumping and getting in and out of trucks. He also alleges that his right wrist disorder began in 1993 and is also due to a right wrist sprain he suffered in Iraq during an attack in 2005. After reviewing all evidence currently of record and resolving all reasonable doubt in favor of the Veteran, the Board determines that service connection for a right wrist disability and bilateral knee disability is warranted. As an initial matter, the Board notes that VA examinations from May 2019 found a generally normal right wrist, although tendinitis was identified early in the appeal period in 2010. He did, nonetheless, complain of wrist pain with mild loss of range of motion. To the extent that wrist pain has resulted in some physical loss of movement, this satisfies the present disability criteria in the right wrist. He has a diagnosis of a right knee strain and degenerative arthritis of the left knee. The Board also notes that the Veteran participated in active combat in Iraq in April 2005. Thus, the combat presumption for combat-related injuries or diseases, under which a veteran's lay statements alone regarding service incurrence, must generally be presumed credible if consistent with the circumstance, conditions, or hardships of such service (absent clear and convincing evidence to the contrary). See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). First, the Board notes that the Veteran's service treatment records do not exhibit symptoms of a right wrist disability, although they do mention evidence of a right wrist scar from a childhood wrist surgery. There is also evidence in June 1994, between the Veteran's two periods of active duty service in 1991 and 2005, that he suffered a right wrist strain. The Veteran contends that he has experienced pain since the initial strain documented in the records, and that he hurt it again landing on his wrist during an April 2005 mortar blast. The Board finds the Veteran's lay testimony credible as it has been confirmed that the Veteran was subject to a mortar blast in April 2005, and he is competent to report symptoms such as pain. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, in conjunction with the Veteran's credible statements, the service treatment records confirm that the Veteran suffered a mortar attack in April 2005. Additionally, the Veteran has sought treatment for right wrist pain over the years since service. Similarly, the Veteran's service treatment records indicate that the Veteran sought treatment for knee pain in July 2005, reporting that he experienced pain since the mortar attack. He also first sought treatment for chronic pain in the bilateral knees in May 2007, less than two years after separating from service, and reported at the time that his pain had been constant since service. During May 2019 and January 2021 VA examinations, the examiners diagnosed the Veteran with right knee strain and left knee degenerative joint disease, chondromalacia, and degenerative arthritis. The Board acknowledges the negative nexus opinions from November 2007, November 2010, June 2013, June 2015, May 2019, November 2019, and January 2021 regarding the Veteran's right wrist and bilateral knee claims. However, in each of those examinations, the examiners did not adequately discuss and consider the evidence of record and provide adequate supporting rationale for the opinions, as outlined by the Board. In the most recent January 2021 VA examination, the examiner specifically failed to discuss evidence of medical treatment of the Veteran's wrist in 1994 or evidence of medical treatment for the Veteran's knees in July 2005 as instructed by the Board, and the examiner provided a negative nexus opinion stating that the claim was based entirely on subjective allegations, despite instruction that the Board had found the Veteran's assertions of ongoing pain to be credible and worthy of consideration. Essentially, VA has been given ample opportunity after multiple remands to provide an adequate opinion that fully addresses the questions on appeal, but has been unable to do so, and the VA has not made a case against service connection. The Board will not further delay the outcome of this appeal with another remand. (Continued on the next page) Consequently, the Veteran participated in combat, his testimony concerning symptoms of his right wrist and bilateral knee disabilities is consistent with both the combat-related event and the medical evidence of record, and there is no clear and convincing evidence to rebut the combat-related presumption that he sustained additional injury to both his knees and wrist during that incident. By virtue of the foregoing, and resolving all reasonable doubt in the Veteran's favor, the Board concludes that the evidence is at least in equipoise that he has a current right wrist disability and bilateral knee disabilities that are etiologically related to active duty service and that service connection is warranted. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The claims are granted. M. Pryce Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Veltri, 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.