Citation Nr: 21041151 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 18-21 715 DATE: July 8, 2021 ORDER Entitlement to service connection for a right knee condition is denied. FINDING OF FACT The preponderance of the evidence is against finding that a right knee condition began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a right knee condition are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1977 to September 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in March 2021. A transcript is of record. 1. Entitlement to service connection for a right knee condition The Veteran seeks contends that his current right knee condition is related to a right knee injury during active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases (like arthritis) will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. At his March 2021 hearing, the Veteran reported that when he was overseas in Korea, he was playing sports and came down on his knees hard. He reported that he was young and thought he was invincible, so small pains and stuff were simply tolerated. He reported knee pain when he walked or drove for long periods. Service treatment records reflect that the Veteran sought treatment for acute right knee sprain in September 1978. Physical profile indicates a sprain of the right knee. Treatment providers restricted exercise and physical training for 10 days. At the July 1980 separation examination indicated normal lower extremities findings. Private medical records from the Greenville Family Medical Center, Inc. show that in November 2009, the Veteran sought treatment for knee pain related to a work injury, and reported hitting his right knee on a machine at work. Another note dated that same month shows the Veteran reported complained of right knee pain after having twisted it. The clinical assessment was contusion, right knee. He was placed in a knee brace. In November 2010, additional medical records from the same facility reflect that the Veteran sought treatment for swelling and pain in the right knee. He reported knee pain after working in muddy conditions and lifting heavy objects. He indicated that the incident occurred a few days before. The clinical assessment was right knee strain. X-rays were within normal limits. In April 2015, the Veteran reported bilateral knee pain to VA providers. In September 2016, the Veteran reported bilateral knee pain, which he rated at 4 of 10. The Veteran reported that he continued trying to lose weight. The Veteran was afforded a VA examination in January 2017. The Veteran reported that he fell while playing flag football, and noted that his right knee was swollen later that day. He reported pain and stiffness. The examiner diagnosed right knee strain, osteoarthritis, and degenerative arthritis. The VA examiner opined the Veteran's knee conditions are less likely related to an in-service injury, event or illness. The examiner explained that service treatment records showed the Veteran an acute and self-limited right knee sprain during active service, and was on a temporary profile for 10 days. The examiner explained that a sprain is a stretching or tearing of ligaments, and this sprain was clearly a stretching of ligaments and not a tear, because the Veteran had a normal ligament examination decades later. The examiner determined that the sprain had resolved completely, and there was not found any mention of any knee complaints, problems, or pains in any other military note. The first finding of either knee being painful after service was November 2009, which was over 29 years after discharge, and over 32 years after the acute and self-limited right knee sprain in military after a work injury. The first finding of osteoarthritis was January 2017. For these reasons, the examiner concluded that it was significantly less likely than not incurred or caused by the claimed in-service injury of right knee sprain. The Board concludes that, while the Veteran has a current diagnosis of right knee strain and bilateral knee osteoarthritis, and although service treatment record show a right knee injury during active service, the preponderance of the evidence weighs against finding that the current right knee diagnoses began during service or are otherwise related to an in-service injury, event, or disease. The January 2017 VA opinion is the only competent medical opinion that addresses causal nexus in this case and the examiner opined that the Veteran's knee condition is not at least as likely as not related to an in-service injury, event, or disease, including right knee sprain during active service. The examiner's opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his right knee condition is related to an in-service injury, event, or disease but he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside his competence because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the January 2017 VA examiner's opinion. The Board acknowledges that the VA examiner indicated that the Veteran has arthritis. Although arthritis is a chronic disease under 38 U.S.C. § 1101(3) and 38 C.F.R. § 3.309 (a), it was not noted in service and did not manifest to a compensable degree within a year of his separation from service. Furthermore, the diagnosis of arthritis was initially made decades after the Veteran's separation from service. Therefore, service connection is not warranted on a presumptive basis under the provision of 38 C.F.R. § 3.309 (a). In sum, the preponderance of the evidence weighs against finding that the Veteran's right knee disability onset during service or is otherwise related to service. Accordingly, service connection for a right knee disability, is not warranted. The claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, 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.