Citation Nr: 22007167 Decision Date: 02/08/22 Archive Date: 02/08/22 DOCKET NO. 15-35 803 DATE: February 8, 2022 ORDER Service connection for a left knee disorder is denied. FINDING OF FACT A left knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, arthritis did not manifest to a compensable degree within one year of discharge from active duty, and such disorder is not caused or aggravated by service-connected right knee disability. CONCLUSION OF LAW The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1975 to October 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2013 by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In April 2020, the Board remanded the issue on appeal for additional development and the case now returns for further appellate review. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected right knee disability. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, 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). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as arthritis, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. At his September 2018 Board hearing and in documents of record, the Veteran contended that he injured his left knee during his military service. Specifically, he testified that, while in Germany, he performed duties in the field at night where he could not see and fell onto rocks, injuring his left knee. The Veteran also stated that that, while playing baseball, he fractured his left ankle and damaged the ligaments in his left knee. He further reported that he has experienced left knee pain since his military service. Additionally, the Veteran alleged, in the alternative, that he compensated for his service-connected right knee disability by placing greater weight on his left knee. Therefore, he contends that service connection for a left knee disorder is warranted. As an initial matter, the Board notes that the Veteran has a current diagnosis of left knee osteoarthritis as demonstrated on X-ray in February 2014 and February 2021, and at September 2013 and January 2021 VA examinations. Additionally, his service treatment records (STRs) reflect that, in October 1987, he reported that, while playing baseball in June 1986, he twisted his left ankle and knee, sustaining a fracture of the medial malleolus with disruption of ligaments of his left knee. He was taken to a local German facility where he underwent open reduction and internal fixation of the medial malleolus fracture in the left ankle with a simultaneous repair of ligaments in the left knee. In October 1987, he presented for the removal of hardware from the left ankle, and was diagnosed with left ankle fracture and a ligament injury to the left knee. However, the treatment provider noted that the Veteran's left knee caused him no symptoms, and an examination was within normal limits. Also, at the time of the Veteran's June 1994 separation examination, it was noted that he had pains in the knees, ankles, and toes for the past two years with no treatment and no current complaints, and clinical evaluation of the left knee was normal. Additionally, the Veteran's report of falling during night moves is consistent with the circumstances of his military service and he is currently service-connected for a right knee disability, characterized as osteoarthritis and residuals of lateral collateral ligament laxity. Thus, the remaining inquiry is whether the Veteran's current left knee osteoarthritis is related to his military service, or his service-connected right knee disability. In this regard, at a March 1995 VA examination, which was conducted within a few months of the Veteran's retirement from the military, he complained of a bilateral knee condition. While he denied a history of acute trauma, he reported that he started having pain in both knees about once a month in approximately 1990, which was precipitated by prolonged standing or walking. In this regard, the Board notes that the Veteran was diagnosed with shin splints at such time. Upon examination, he had mild stiffness, some crepitation, and minimal pain; however, he had limitation of motion. The examiner diagnosed patellar tendinitis involving both knees. June 1995 X-rays were normal. Thereafter, post-service treatment records beginning in July 2005 reflect the Veteran's reports of knee pain, weakness, and muscle spasms. See e.g., VA treatment records dated in July 2005, March 2007, August 2009, September 2010, September 2012, February 2014, April 2014, and September 2018; VA examination reports dated in September 2010, September 2013, and July 2015; Social Security Administration records. Additionally, at a January 2021 VA examination, the Veteran reported that the onset of his left knee disorder in 1990 when he fell off a launcher, which resulted in injury to his left knee. In this regard, the Board observes that such was the first report of such an injury, and is contradicted by the Veteran's contemporaneous STRs wherein he denied all relevant symptoms in August 1991 and September 1992 Reports of Medical History and reported pain only within the prior two years at the time of his June 1994 separation examination, and his denial of any acute trauma to the left knee at the time of his March 1995 VA examination, which was conducted within six months of his separation from service. Thus, the Board finds the Veteran's recent report of an injury to the left knee in 1990 to be not credible in light of the contradictory contemporaneous evidence of record. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes); cf. Gardin v. Shinseki, 613 F.3d 1374, 1380 (Fed. Cir. 2010) (upholding Board finding that vague and inconsistent lay statements were not credible because they were in direct contradiction to the more credible, competent, reliable, and clearly documented medical evidence). Nevertheless, following a review of the record, an interview with the Veteran, and a physical examination, the VA examiner opined that the Veteran's left knee disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, to include his reported injury when he fell on rocks during night moves and/or the disruption of the ligaments in his left knee after sustaining an injury while playing baseball as documented in the October 1987 STR. In support thereof, he noted that there was no evidence of chronic left knee pain or a chronic left knee disorder, to include arthritis, during service, and there was no evidence to suggest that arthritis of the left knee manifested on or before 1995. The VA examiner further opined that the Veteran's left knee disorder was less likely than not due to or aggravated by his service-connected right knee disability, to include as a result of compensation for such disability by placing greater weight on the left knee, as there is no evidence of an off-loading condition of the right knee that would contribute to his left knee disorder. Upon review, the Board finds that the January 2021 VA examiner's opinions, while succinct, sufficiently inform the Board of the medical expert's judgment on the relevant medical questions and the "essential rationale" for his opinions. Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement). In this regard, where the opinion is lacking in detail, "the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination." Acevedo, 25 Vet. App. at 294. In this regard, the Board observes that the VA examiner's determination that there was no evidence of chronic left knee pain or a chronic left knee disorder, to include arthritis, during service, is supported by the contemporaneous STRs, which reflect that the Veteran's left knee fully recovered from the June 1986 injury and he only reported a two year history of left knee pain in June 1994 without current treatment or symptoms, and no abnormalities on clinical evaluation. Additionally, his finding that there was no evidence to suggest that arthritis of the left knee manifested on or before 1995 is likewise supported by the contemporaneous post-service treatment records, which reflect that left knee X-rays conducted in June 1995 were normal. Furthermore, the VA examiner's determination that there was no off-loading condition of the right knee that would contribute to his left knee disorder was based on his contemporaneous examination of the Veteran. Thus, the Board affords great probative weight to the January 2021 VA examiner's opinions as such considered all of the pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Furthermore, as the examiner addressed all of the Board's inquiries articulated in the April 2020 remand, the Board finds that there has been substantial compliance with such directives. D'Aries v. Peake, 22 Vet. App. 97 (2008). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran's claim that his left knee disorder is related to his military service, or his service-connected right knee disability; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder, diagnosed as osteoarthritis, involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Specifically, such requires knowledge of the musculoskeletal system and the impact injuries and/or disability of the contralateral joint have on the knee joint. Thus, such matter may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinions as to the etiology of his left knee disorder is not competent evidence and, consequently, is afforded no probative weight. Furthermore, the evidence of record fails to demonstrate that arthritis of the left knee manifested to a compensable degree within one year of the Veteran's separation from service. In this regard, his left knee was found to be normal upon clinical evaluation at the time of separation in June 1994, X-rays conducted in June 1995 were normal, and arthritis was not diagnosed until September 2013. Moreover, while the Veteran reported left knee pain since service, he does not have the medical expertise to relate such complaints to a diagnosis of arthritis in the first post-service year. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). Moreover, the January 2021 VA examiner found that there was no evidence to suggest that arthritis of the left knee manifested in the first post-service year. Consequently, presumptive service connection for arthritis of the left knee, to include on the basis of a continuity of symptomatology, is not warranted. Based on the foregoing, the Board finds that the Veteran's left knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, arthritis did not manifest to a compensable degree within one year of discharge from active duty, and such disorder is not caused or aggravated by service-connected right knee disability. Consequently, service connection for such disorder is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim for service connection for a left knee disorder, the positive and negative evidence is not in approximate balance. Consequently, the benefit of the doubt doctrine is not applicable in the instant appeal and the Veteran's claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 16533, at *10 (Fed. Cir. June 3, 2021). A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dawn A. Leung, 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.