Citation Nr: 21029454 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 15-31 403A DATE: May 13, 2021 ORDER Entitlement to service connection for a right knee condition is denied. FINDING OF FACT There is no evidence of a currently diagnosed disability manifested by right knee pain that was incurred in or caused by service, and there are no reported symptoms which amount to functional impairment of earning capacity. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for a right knee condition have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 2005 to September 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2012 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in February 2019, it was remanded for additional development. Specifically, the RO was instructed to obtain the Veteran's medical records and afford the Veteran for an examination regarding the etiology of his claimed knee pain disability. The medical records were obtained, and the Veteran was provided with the relevant examination. As such, the Board finds that the AOJ substantially complied with the directives in the February 2019 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service ConnectionLegal Criteria Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may 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). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this case, the Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Right Knee Pain alone, even without an underlying pathology or diagnosis, can constitute a disability under VA law where such pain results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Court recently held that Saunders is not limited to pain, such that a disability for VA purposes includes any condition that results in functional impairment of earning capacity. Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). The Board finds that the probative evidence of record does not document that the Veteran has a current diagnosis of any right knee disability. Further any symptoms experienced do not rise to compensable levels or result in impairment of function capacity. As such, service connection is not warranted on direct or presumptive bases for the claimed disabilities. Martinez-Bodon, supra. The Board has thoroughly reviewed the Veteran's medical records. Treatment records from Tripler Army Medical Center, recorded during the Veteran's time in service, contain complaints of knee pain and swelling upon physical exertion, though no knee diagnosis is given. The Board specifically notes a 2008 right knee MRI which noted an edema in the "superolateral portion of Hoffa's fat which may represent impingement, patellar maltracking, or trauma," however, no diagnosis was provided. The Veteran was afforded an April 2012 VA examination regarding his knee claim. The Veteran reported that he experienced intermittent pain in his right knee since 2007 and further reported flare-ups of pain which cause him to avoid prolonged standing and walking. His right knee flexion was to 120 degrees with no objective evidence of pain reported. The Veteran was able to perform repetitive-use testing with no change in range of motion. Further, the Veteran was reported to have no functional loss/impairment of his knee, no pain or tenderness on palpitation, and normal joint stability. No subluxation or ankylosis was noted. The examiner noted the Veteran's 2008 MRI discussed above. A May 2014 VA treatment note recorded that the Veteran reported initially developing right knee problems in Iraq in 2006 and 2007 with intermittent pain ever since. Upon examination, normal alignment was noted. No effusion, instability, or limitation of motion were present. A patellofemoral click on the right was noted as was patellofemoral pain without evidence of maltracking. The treatment note cited to March 2014 imaging studies done of the Veteran's right knee which were all normal. The Veteran testified in a June 2016 Decision Review Officer (DRO) hearing that his right knee pain began before his ankle pain and that he was told he "had an abnormal track in [his] patella" and that he would just have to live with the pain. The Board further notes an August 2018 VA right knee x-ray imaging study treatment note which showed the Veteran's right knee as unremarkable. Additionally, a November 2018 primary care treatment note where the Veteran reported his right knee pain resolved after doing therapy. In response to the Board's February 2019 Remand, the Veteran was afforded an August 2020 VA Knee Conditions examination. During the examination, the Veteran reported that his right knee pain began in 2007 and causes sharp pain and swelling in his right knee. The Veteran did not report flare-ups during this examination. The examiner found that the Veteran does not have a currently diagnosed knee disability. The Veteran's range of motion was reported as all normal with no pain on motion reported during the examination. Further, there was no objective evidence of pain or tenderness on palpitation, no pain with weightbearing or non-weight bearing, no pain on passive range of motion, no ankylosis, normal muscle strength, and no instability. The examiner indicated that the Veteran's knee does not impact his ability to perform any type of occupational task. The examiner opined that the Veteran did not have a currently diagnosed right knee disability; there was no chronic disability from service; and that the Veteran's claimed right knee condition, including pain, is less likely than not (less than a 50 percent probability) etiologically related to his active duty service. Based on the above, the Board does not find evidence of any right knee disability at any time during the pendency of the appeal. Additionally, the Board does not find that the Veteran experiences any compensable symptoms, or functional impairment, thereof. The Board has considered the Veteran's lay contentions and finds the lay statements are competent insofar as they report observable symptoms. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, to the extent that the Veteran asserts that his claimed condition is related to his active service, such statements are of no probative value, as the Veteran lacks the medical expertise to diagnose complex conditions or to render medical nexus opinions. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Moreover, to the extent the Veteran asserts that he has a current condition, such statements are inconsistent with the medical evidence of record that does not document any relevant diagnoses at any time during the pendency of the appeal. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995); see also Martinez-Bodon, supra. (Continued on the next page) Based on the foregoing, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claims for service connection for a right knee disability. As the preponderance of the evidence is against the Veteran's claims for service connection, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.