Citation Nr: 21029799 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 15-31 418 DATE: May 17, 2021 ORDER Entitlement to service connection for a right leg disability is denied. FINDING OF FACT The Veteran's right leg disability did not manifest during service, was diagnosed more than one year after service, and is etiologically not related to service. CONCLUSION OF LAW The right leg disability did not manifest during service, may not be presumed to have been incurred therein, and is unrelated to service. 38 U.S.C. §§ 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Navy from June 1956 to June 1960. This case is before the Board of Veterans' Appeals (Board) on appeal from a January 2013 Department of Veterans Affairs (VA) rating decision. In October 2015, a hearing before a Decision Review Officer was held in lieu of a Board hearing. A September 2017 Board decision reopened the claim of service connection for a right leg disability and remanded the case to the Regional Office (RO) for further development of the matter on the merits. In July 2019 and January 2021, the Board remanded the case to the RO again for further development of the claim. Entitlement to service connection for a right leg disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for arthritis, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran in his VA application filed in June 1972 asserted that he injured his right leg in approximately December 1957, while aboard the USS Brinkley Bass. In the October 2015 hearing testimony the Veteran described a right leg injury during service. He stated that during Operation Strongback, while his ship was traveling between Okinawa and Manila, an alarm sounded during a monsoon, and he ran to his battle station. While running, he slid under a metal ladder, injuring his right leg. Later, upon inspecting his leg, he observed that it was purple from his knee cap to his toes, and a corpsman advised him to soak his entire leg in a bucket with hot water and Epsom Salts for a couple of weeks. He stated that he has been taking pain medication (Naprosyn) for his leg and that the treatment has been ongoing, since the 1960s. VA outpatient treatment records show that the Veteran was seen in October 2011 with a complaint of bilateral leg numbness for the past 50 years. He reported a history of a small laceration above the knee during task force "strong back." September 2012 and January 2013 VA outpatient records note a report of a right knee contusion from being struck by a car in July 2012. In September 2014, the Veteran complained of pain in the lower legs and stated that he was using pain medication. He reported that it had been a problem in his right leg with a "war injury," and now it was more in the left leg. The assessment was lower extremity pain, most likely osteoarthritis. In January 2015, during a pre-operative screening, the Veteran reported a vascular condition since an injury aboard a military ship, with possible damaged blood vessels, although he also noted that his primary care physician believed he had osteoarthritis (there was a reference to occasional swelling on the knee cap). A July 2015 VA outpatient record, notes complaints of lower leg pain and a diagnosis of arterial insufficiency. VA examinations in March 2018 and August 2019 show a diagnosis of right knee strain. Although VA examinations were conducted in March 2018 and August 2019 whereby the examiner rendered unfavorable opinions, the Board in remands dated in July 2019 and January 2021 found them to be inadequate and thus they need not be further addressed. On the February 2021 VA artery examination the examiner noted that the Veteran was diagnosed with arterial insufficiency in 2015 and has a history of peripheral vascular disease. On the February 2021 VA knee examination the examiner determined that the Veteran had a diagnosis of right knee strain. The examiner acknowledged that the Veteran reported that in 1956, when he was deployed between Okinawa and Philippines on a ship, he slipped and fell, and injured his right knee in the process. He was seen on sick-bay, and was placed on crutches for a few weeks secondary to right knee pain/injury. After 3 weeks, his right knee condition improved, he was off crutches and continued full duty on the ship. When he came back States side, he was seen and evaluated at the San Diego Naval Hospital for his right knee injury. After he separated from the military in 1962, he still had recurring intermittent right knee pain with walking. His right knee condition worsened through the years with more intensity and frequency of aching pain. In an accompanying opinion in March 2021, the examiner noted that VA treatment records in September 2012 and January 2013 note a right knee contusion from being struck by a car in July 2012; a September 2014 VA outpatient record, shows an assessment of lower extremity pain, most likely osteoarthritis; a January 2015 VA outpatient record shows a report of a vascular condition since an injury on a military ship, with possible damaged blood vessels; a July 2015 VA outpatient record, notes complaints of lower leg pain and a diagnosis of arterial insufficiency; and March 2018 and August 2019 VA examinations show a diagnosis of right knee strain. The examiner also acknowledged that in the January 2021 remand the Board instructed that the Veteran's statements and hearing testimony regarding a right leg injury from sliding under a metal ladder on deck during service and his reports of leg numbness ever since be considered. As for the question whether each diagnosed right leg (to include vascular) disability is at least as likely as not (a 50 percent or greater probability) etiologically related to the Veteran's June 1956 to June 1960 military service including the claimed injury from a fall on a ship (alleged to have occurred on various dates in 1956, August to September 1958, and December 1957), the examiner opined that the claimed disorder was less likely than not incurred in or caused by the claimed inservice injury, event, or illness. As for the arterial insufficiency in the right leg, the examiner explained that even though July 2015 VA outpatient records note complaints of lower leg pain and a diagnosis of arterial insufficiency, no other medical records and or follow-up evaluation/diagnostics/treatments verify the diagnosis given on July 2015 for right leg arterial insufficiency. The examiner opined that currently, the Veteran's bilateral lower extremities are noted with good capillary refill, no claudication, no history of DVT, no ulceration, no dark discoloration to his bilateral lower extremities, no weakness, no varicose veins noted, no pain to bilateral calf areas with ambulation, no claudication, with good and symmetric femoral, pedal, and popliteal pulse. The examiner pointed out that the Veteran did not complain of right leg pain/claudication with ambulation. The examiner was unable to give any medical diagnosis at this time based on signs/symptoms presented during the examination and the lack of other diagnostic results and or follow-up medical evaluations and treatment for the Veteran's claimed right leg arterial insufficiency. As for the right knee strain the examiner found it significant that a treatment note in September 2012 shows the Veteran reported that in July a car struck his knee on the crosswalk where it hit the Veteran's knee and his wife's hand. The examiner explained that a review of the Veteran's entire medical records showed no documentation confirming the injury while in active service, and the Veteran's lay statement does not explain the lack of treatment from the alleged time of onset in 1956 to 2012, when he was seen for right knee/leg pain after getting hit by a vehicle. While the examiner acknowledged the Veteran's lay report of injuring his leg during service, the examiner found it significant that there were no right knee x-rays, recurrent evaluation and treatments found in the Veteran's medical records. Thus, the examiner opined that the Veteran's right knee strain was less likely than not incurred in or caused by or is etiologically related to the Veteran's military service from June 1956 to June 1960. The Board finds the February 2021 VA examinations and accompanying March 2021 VA opinion to be highly probative as they were based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). The examiner considered the nature of the Veteran's right leg disability in proffering the opinion. The opinion is uncontroverted by the other competent evidence of record. As a lay person, the Veteran is competent to report symptoms pertaining to his right leg disability and the Board finds his statements to be credible. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the etiology of the right leg disability falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The Veteran's right leg disability is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding its etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorder. The lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent, the matter of whether it is credible is not reached. Accordingly, because the preponderance of the evidence is against the claim of service connection for a right leg disability, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mac, 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.