Citation Nr: 21040022 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 16-59 807 DATE: July 2, 2021 ORDER Entitlement to service connection for left knee patellofemoral syndrome is granted. FINDING OF FACT The Veteran's left knee patellofemoral syndrome begin during active service and is related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for left knee patellofemoral syndrome are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from September 2003 to October 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision (RD) of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In December 2018, the Board remanded the claim for additional development including an addendum medical opinion. The RO issued a June 2020 supplemental statement of case (SSOC) and the case was returned to the Board for further appellate consideration. 1. Entitlement to service connection for left knee patellofemoral syndrome The Veteran contends that his left knee patellofemoral syndrome (PFS) began during active service. Alternatively, he contends that his left knee PFS was caused by overcompensating for his service-connected right knee disability. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In general, there must be competent evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1164, 1166-67 (Fed. Cir. 2009). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In a September 2013 VA memorandum, VA indicated that they were unable to find the Veteran's service treatment records (STRs), but that they had followed all procedures, and had exhausted all efforts to obtain the files. See September 2013 VA Memo. The Veteran submitted copies of his STRs, however the Board notes there are records, including those from the Veteran's service in Japan, that are missing. Regardless, as the Board is granting the claim, there is no prejudice to the Veteran. The Veteran stated he never had pain in his knees until he started bootcamp in 2003. See July 2020 Statement in Support of Claim. On his July 2007 medical history form, the Veteran indicated that he had trouble with his knees. See December 2014 STRs. During a May 2009 medical appointment, the physician noted the Veteran's knees showed abnormalities, and ordered an MRI of the right knee. See October 2013 STRs. During a June 2009 follow up appointment, the Veteran reported knee pain while deployed to Japan and treatment with physical therapy, however he stated it made the pain worse. Id. During a July 2009 medical appointment, the Veteran reported pain in the anterior right knee, without numbness or tingling, and similar but milder symptoms in the left knee. In a July 2009 follow up appointment, the Veteran was referred to physical therapy for bilateral knee pain and patellar chondromalacia, worse on the right then the left. Id. On his August 2012 medical history form, the Veteran indicated that he had trouble with his knees, painful swollen joints, and reoccurring knee pain throughout his enlistment. See December 2014 STRs. After separating from service in October 2012, the Veteran was evaluated for bilateral knee pain in April 2013. See January 2014 VA Treatment Records. During a December 2013 VA examination, the Veteran reported that his knee pain started in bootcamp and had gotten progressively worse. He stated that while deployed to Japan he had pain in his knees while climbing stairs, that he was treated with physical therapy, but declined surgery. He stated his knees locked up on occasion, the left side worse than the right, and he had to pop them to get them to move again. The examiner noted the Veteran was diagnosed with right knee chondromalacia in 2009 and bilateral shin splints in 2010. The examiner opined that the Veteran's left knee condition was less likely than not caused by, or related to, his active service because the Veteran did not have treatment for a left knee condition while in service. Id. The Veteran had a March 2015 MRI of his left knee which indicated chondromalacia of the patella and a stable meniscal tear. See May 2017 Private Medical Treatment Records. The physician opined that the Veteran's left knee pain was likely due to patellar tendonitis and patellar chondromalacia. Id. During an October 2016 VA examination, the Veteran reported that his bilateral knee pain was constant and that he had it for years. The examiner noted the Veteran was diagnosed with right knee chondromalacia in 2009, bilateral shin splints in 2010, and a left knee strain in 2013. The examiner opined that the Veteran's left knee condition would interfere with his walking, standing, climbing stairs and squatting. Id. In a December 2018 decision, the Board remanded the case for an addendum medical opinion because the December 2013 VA examiner failed to consider the Veteran's statements regarding his left knee condition and the October 2016 VA examination raised the issue whether the Veteran's other service-connected disabilities aggravated his left knee condition. In an October 2019 VA examination, the examiner noted the Veteran was diagnosed with bilateral knee chondromalacia of the patella in 2009. The Veteran had undergone a left knee arthroscopy in November 2018 that indicated chondromalacia. The examiner opined that the Veteran's left knee condition was less likely than not caused by, or related to, his service-connected disabilities. In addition, the examiner opined that the Veteran's left knee condition was less likely than not aggravated beyond its natural progression by an in-service event or injury. In support of his opinion, the examiner stated that the Veteran's STRs were silent for a left knee condition during service. Id. Although the VA examiners opined that the Veteran's left knee condition was not due to service, the evidence of record is consistent that the Veteran reported having left knee pain during service and that his pain has continued since his separation from service. See January 2013 Claim, October 2013 STRs, December 2013 VA Examinations, December 2014 NOD. The evidence of record also supports that the Veteran was diagnosed with left knee chondromalacia during service. See October 2013 STRs and October 2019 VA Examination. Further, the October 2019 VA examination is inconsistent as the examiner indicated the Veteran was diagnosed with left knee chondromalacia, then opined the Veteran's left knee condition was not related to service because his STRs were "silent except for mild knee pain in June 2009". In addition, the Board remanded the case in December 2018 after finding that the December 2013 VA examination failed to consider the Veteran's lay statements and that the October 2016 VA examination raised the issue of aggravation. The Board finds that the October 2019 VA medical examination did not comply with the prior remand directives as the rationale did not fully address the Veteran's lay statements, however, as the Board is granting the Veteran's claims, there is no prejudice. The Board finds that the Veteran's current left knee disability is due to service. Although there are numerous negative VA opinions in the record, the opinions all indicate the Veteran's condition was not due to service in large part because the Veteran's service treatment records were silent for any complaints, treatment, or diagnosis of a left knee injury. See December 2013, October 2016, and October 2019 VA Examinations. The negative opinions essentially rely on the absence of reported symptoms during service for the negative conclusions, which is erroneous. Further, the Veteran did report onset of symptoms during service, service treatment records noted a left knee condition, and the October 2019 VA examiner indicated he was diagnosed with left knee chondromalacia in June 2009. Overall, the VA opinions have little probative value. The Veteran's statements regarding the onset and continuity of his left knee symptoms since service are not contradicted by the evidence of record and are consistent with the circumstances of his service. Therefore, the Board finds that the Veteran's statements are credible and have probative value. The Board finds that the Veteran's lay statements regarding his left knee symptoms, resulting in his current diagnosis, demonstrate onset of the disabilities during service and continuity of symptomatology since service. The third element of service connection is met. Shedden, 381 F3d at 1166-67. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current left knee PFS began during active military service. The Board concludes that service connection for left knee patellofemoral syndrome is warranted. Entitlement to service connection for left knee patellofemoral syndrome is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Aubee, 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.