Citation Nr: 21042255 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 10-47 682 DATE: July 12, 2021 ORDER Entitlement to service connection for a right knee/leg disability for purposes of accrued benefits is denied. INTRODUCTION The Veteran served on active duty from April 1953 to February 1958. He died in March 2016; the Appellant is his surviving spouse and has been substituted as the claimant in these matters. In June 2018, the Appellant testified at a hearing before the undersigned Veterans Law Judge. A transcript of this hearing has been associated with the claims file. When this case was before the Board in August 2018, May 2019, and January 2021, the above-noted claim was remanded for additional development. The case has since been returned for additional appellate review. FINDING OF FACT The Veteran's right knee osteoarthritis was not present in service, was not etiologically related to service, and was neither caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a right knee/leg disability, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C. §§ 5103, 5103A, and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159, provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The record reflects that all pertinent available service treatment records (STRs) and all available post-service medical evidence identified by the Appellant have been obtained. The Board also acknowledges that a comprehensive VA medical opinion from an Orthopedic Specialist was obtained in response to the claim for service connection for a right knee/leg disability in March and May 2021. The Appellant was also afforded a hearing before the Board in June 2018. The Appellant has not identified any outstanding evidence that could be obtained to substantiate the claim; the Board is also unaware of any such evidence. Accordingly, the Board will address the merits of the claim. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 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). Service connection may also be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310 (a). Accrued benefits are periodic monetary benefits (other than insurance and servicemen's indemnity) to which an individual was entitled at death under existing ratings or decisions and under laws administered by the VA Secretary, or those based on evidence in the file at date of death and due and unpaid, that shall, upon the death of such individual, be paid to the surviving spouse or other appropriate party. 38 U.S.C. § 5121; 38 C.F.R. § 3.1000. Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Factual Background and Analysis By way of background the Veteran initiated a claim for a right knee/leg disability in October 2009. Subsequently, in a March 2010 rating decision, the RO denied the Veteran's claim. The Veteran then initiated a timely appeal in April 2010. Unfortunately, in March 2016 the Veteran died. Thereafter, his spouse submitted a request to be substituted as the claimant in April 2016. She has been properly substituted as the claimant in his pending claim. The Appellant has asserted the Veteran's disability was either incurred in service, caused by his service-connected bilateral foot disability, or aggravated by his service-connected bilateral foot disability. Initially, the Board observes the Veteran's service treatment records (STRs) show he experienced a right leg injury in service, with resulting severe bruise in April 1954. The Veteran stated he slipped on ice and got hung up on steps by his leg. Further, the Appellant provided testimony in June 2018 indicating the Veteran reported his leg injury occurred while he was loading the back of a truck. Additionally, the Veteran's treatment reports from the Crockett Clinic and Houston VAMC show he was diagnosed with right knee osteoarthritis with resulting pain prior to his death. As such, the central issue in this case is whether the Veteran's right knee osteoarthritis disability was incurred in service, caused by a service-connected disability, or aggravated by a service-connected disability. The RO has obtained several medical opinions addressing these matters. Initially, the RO obtained a medical opinion in October 2018, wherein the examiner concluded the Veteran's right knee disability was less likely than not caused by his bilateral foot disabilities. The examiner indicated "evidence based medicine has shown that the foot or one lower extremity joint does not affect other extremity joints." In November 2020 the RO obtained a second medical opinion. This examiner also found the Veteran's right knee osteoarthritis was neither incurred in service, caused by his service-connected bilateral foot disability, or aggravated by his service-connected bilateral foot disability. Thereafter, in March and May 2021 the RO obtained comprehensive medical opinions from a physician specializing in Orthopedic Sports Medicine and Orthopaedic Surgery. This physician also found the Veteran's right knee osteoarthritis was neither incurred in service, caused by his service-connected bilateral foot disability, or aggravated by his service-connected bilateral foot disability. In this regard, the examiner noted the Veteran's medical history, to include his self-reports. Although the examiner acknowledged the Veteran's more contemporary reports of ongoing knee pain following his 1954 leg injury, she noted other evidence which called the accuracy of those reports into question. In particular, the examiner noted the Veteran's STRs made no mention of knee problems following his April 1954 fall. During service, the Veteran underwent a comprehensive medical evaluation board (MEB) in July 1957 wherein he was thoroughly evaluated for his ongoing fitness for military service. The examiner found these documents would be expected to note the presence of knee impairment, as the Veteran's total physical capabilities were being evaluated at that time; however, those records were silent for any knee condition. Additionally, the examiner noted the Veteran underwent routine physical examinations in February 1955 and October 1957, at which time his lower extremities were assessed as normal. The Veteran made no mention of knee problems at those times. The examiner also noted the Veteran's December 1957 separation examination, where his lower extremities were again assessed as normal. The Veteran again denied experiencing knee manifestations at that time such as trick or locked knee, or other joint/bone problems. The examiner also carefully reviewed and discussed the Veteran's post-service medical records. She observed these records show the Veteran first sought treatment for his right knee in 1988. At that time, the Veteran stated he had experienced knee pain for the prior 8 years. In sum, the examiner found the substantial documentation in the record directly contradicted the Veteran's subsequent reports of ongoing knee pain following his 1954 fall. By both the Veteran's own contemporaneous reports and physical evaluations, the examiner concluded the Veteran's April 1954 injury was acute and healed without ongoing residual impairment. The examiner also explained the Veteran's right knee disability was less likely than not caused or aggravated by his service-connected bilateral foot disabilities. Like the October 2018 examiner, the March 2021 physician found the conditions to be separate entities that were not medically related. In this regard, the examiner explained the impairments caused by the Veteran's service-connected bilateral foot disabilities would in fact have a protective effect on the Veteran's knees. Here, the examiner explained the Veteran reported he reduced his physical activities as a result of his bilateral foot manifestations. The examiner explained this would decrease the load placed on his knees. In sum, having reviewed the entire record thoroughly, the examiner found the Veteran's right knee disability was more likely than not attributable to normal aging. Although the Appellant may sincerely believe the Veteran's disability was consequentially related to his military service, her lay opinion concerning these matters requiring medical expertise is of less probative value than the several medical opinions against the claim. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). The Board has accepted the Veteran and Appellant's accounts as competent; however, a layperson is generally not considered capable of opining, however sincerely, in regard to the diagnosis or causation of a complex disability. Rather, it is the province of trained health care professionals to enter conclusions that require medical expertise, such as opinions as to diagnosis and causation. Jones v. Brown, 7 Vet. App. 134, 137 (1994). For example, a veteran is competent to state that he experiences symptoms that are commonly associated with a knee disability, such as pain, but he is not competent to state the etiology of a complex medical condition such as osteoarthritis. Further, as discussed above, both the medical and lay evidence in this case calls into question the accuracy and credibility of the Veteran's reports. Based on the foregoing, service connection for a right knee/leg disability must be denied. In reaching this decision the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. Nonetheless, the Board does extend its sincerest condolences to the Appellant for her loss, as well as its highest appreciation to the late Veteran for his honorable service. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.