Citation Nr: 21042259 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-37 093 DATE: July 12, 2021 ORDER Entitlement to service connection for a right knee condition is denied. FINDING OF FACT The Veteran's right knee degenerative arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically 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. §§ 1110, 1112, 1113, 1131, 1137, 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 May 1962 to May 1984. This matter comes before the board of Veterans' Appeals (Board) on appeal from a June 2012 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 May 2019. A transcript is of record. In September 2020 and March 2021, the Board remanded the claim for additional development, which has been completed. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900. 38 U.S.C. § 7107 (a)(2). 1. Entitlement to service connection for a right knee condition The Veteran contends that his current right knee arthritis is related to a right knee injury in physical training (PT) during his active service. At his hearing, the Veteran testified that he experienced knee pain from the time he retired in 1984 up until 2005. 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 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 Veteran has a current diagnosis of degenerative arthritis as evidenced by the December 2019 VA examination report. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Service treatment records reflect that the Veteran sought treatment for knee pain in February 1983. A March 1983 report of examination indicated normal clinical lower extremity findings. At separation, a January 1984 report of examination similarly indicated normal clinical findings. At his January 1984 medical history, the Veteran reported recurrent back pain but denied trick or locked knee. In August 1996, the Veteran was afforded a general VA examination. He reported bilateral knee pain when he walked long distances. Otherwise, he did not have any specific complaints. In April 1997, the Veteran presented for left hand numbness. Medical history indicated low back pain, bilateral knee pain, and hypertension. In August 2002, the Veteran sought treatment for bilateral knee pain. Physical examination noted pre-patellar grinding and tenderness to palpation at the left medial joint line. The clinician suspected arthritis. However, the August 2002 imaging indicated normal knees bilaterally. January 2007 VA treatment notes show the Veteran sought treatment for right knee pain. The Veteran reported right knee pain for 3 weeks. He denied specific trauma or injury. An MRI of the right knee revealed degenerative right joint effusion, degenerative changes of the right medial patella, and degenerative changes within the tibial plateaus and posterior lateral femoral condyle. A November 2010 orthopedic note indicate a history of mild degenerative joint disease and medial meniscus tear. The Veteran was afforded a VA examination in December 2019. The Veteran reported injuring his knee during PT in service, and that it had not gotten better. The examiner diagnosed degenerative arthritis bilaterally. The examiner opined the right knee condition is not at least as likely as not incurred in or caused by service. In the September 2020 Board remand, the Board determined that the rationale provided appears to conflict with the underlying record and because the opinion did not adequately address the Veteran's lay report of ongoing knee pain since discharge. Pursuant to Board remand, in February 2021 a VA examiner reviewed the record and offered an addendum opinion. The examiner opined the right knee condition was less likely than not incurred or caused by the claimed in-service injury. The examiner indicated that there is a lack of evidence in the record to support the conclusion that the condition is service related, especially given how common this condition is in the U.S. adults in the same age group as the Veteran. In the March 2021 remand, the Board found that the VA examiner did not discuss the significance, if any, of the Veteran's lay statements of recurrent knee pain symptoms in service and afterward. Pursuant to Board remand, in May 2021 a VA examiner reviewed the record and offered a second addendum opinion. The examiner opined the claimed condition was less likely incurred in or caused by the claimed in-service injury. The examiner explained that there was no evidence of an acute or chronic knee condition while in service. The Veteran was diagnosed with minimal, bilateral degenerative joint disease on x-rays in February 2018. The examiner noted that the condition was bilateral and equal at the time of diagnosis. The examiner explained that this eliminated the likelihood of influence from the right knee complaints decades earlier as an influence on the development of the degenerative joint disease. The examiner noted that degenerative joint disease is considered a natural aging process with a familial component. The Veteran was age-appropriate at the time of the diagnosis. Further, the fact that it is bilateral and minimal at the time of diagnosis did not support service connection. The examiner indicated that had the condition claimed influenced degenerative joint disease, it almost certainly would have manifest much earlier and been more severe by 2018. Thus, there was no nexus established. Finally, the examiner concluded that despite the Veteran's self-report, the separation examination was negative, and report of medical history was specifically negative for knee conditions. Even if the Veteran's complaints were conceded, the examiner concluded that the rationale would be unchanged. Any complaints during active service were more likely due to overuse, and would not cause degenerative joint disease decades later in the absence of an injury to the knee. The preponderance of the evidence is against finding that a medical nexus exists between the Veteran's right knee arthritis and an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. For this reason, service connection is not warranted. The May 2021 VA examiner opined that the Veteran's right knee degenerative joint disease is not at least as likely as not related to an in-service injury, event, or disease, including knee issues during service. The examiner explained that degenerative joint disease is considered a natural agin process with a familial component. The examiner also noted that the condition was bilateral and equal at the time of diagnosis, and this eliminated the likelihood of influence from the claimed right knee complaints decades earlier. Even if the Veteran's complaints in-service were conceded, the examiner explained that any knee complaints during service were likely due to overuse and would not cause degenerative joint disease decades later. Thus, the examiner concluded that there was no nexus established in service. The examiner's opinion and rationale are 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). Further, the Veteran's knee disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. The Veteran's initial diagnosis of degenerative arthritis of the knee was not until many years after service, with normal imaging findings of both knees in 2002. To the extent that the Veteran asserts he experienced knee pain in service and afterwards, and to the extent that such contentions are credible, he is not competent to determine that such pain was a manifestation of his current arthritis. However, the Veteran's assertion of continuity since discharge is contradicted by the January 1984 Report of Medical History, the Veteran denied having trick or locked knees specifically, and did not report any other knee difficulties, although he did report having problems in other areas. Thus, entitlement to service connection for degenerative arthritis of the knee on a presumptive basis is not warranted. Service connection for degenerative arthritis of the knee may not be presumed, or found to have onset in service based on chronicity, and continuity is not warranted. 38 C.F.R. §§ 3.303 (b), 3.307, 3.309. Accordingly, the competent evidence weighs against a nexus between the current disability and active service; the evidence does not support presumptive service connection. As such, there is no reasonable doubt to be resolved in this instance. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Service connection for a right knee condition is not warranted. 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.