Citation Nr: 22009673 Decision Date: 02/17/22 Archive Date: 02/17/22 DOCKET NO. 16-38 693 DATE: February 17, 2022 ORDER Entitlement to service connection for a low back disability, diagnosed as lumbar strain, is granted. Entitlement to service connection for a right knee disability, diagnosed as right patellofemoral pain syndrome, is granted. Entitlement to service connection for a right wrist disability, diagnosed as a right wrist sprain, is granted. Entitlement to service connection for a left wrist disability, diagnosed as a left wrist sprain, is granted. FINDING OF FACT The evidence is at least in relative equipoise as to whether the Veteran's low back, right knee, and bilateral wrist disabilities were incurred in his active duty. CONCLUSIONS OF LAW 1. The criteria for service connection for a low back disability, diagnosed as lumbar strain, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right knee disability, diagnosed as right patellofemoral pain syndrome, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right wrist disability, diagnosed as a right wrist sprain, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a left wrist disability, diagnosed as a left wrist sprain, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from August 2002 to December 2005. This appeal to the Board of Veteran's Appeals (Board) arose from a February 2015 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). During the current appeal, and specifically in August 2019, the Board remanded this appeal for further evidentiary development. During the pendency of the appeal, the Agency of Original Jurisdiction (AOJ) granted service connection for post-traumatic stress disorder (PTSD) with bruxism and for chest pains (claimed as heart palpitations). The Board notes that the Veteran's claimed condition of "grinding teeth" was diagnosed as bruxism, and is now being evaluated with his PTSD. As the Veteran has not yet filed a NOD contesting either the effective date or the level of compensation assigned following the grant of service connection, these issues is no longer part of the current appeal. Grantham v. Brown, 111 F.3d 1156 (Fed. Cir. 1997). Service Connection Service connection requires evidence shows that an injury or disease that results in a current disability was incurred during service or was aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. §3.303(a). To be entitled to service connection, the evidence must support (1) a current disability; (2) an in-service injury or event; and (3) a nexus between the current disability and the in-service injury or event. 38 C.F.R. §3.303(a). Regarding an in-service injury or event, the Veteran asserts that he suffered from low back and right knee pain due to his physical activity during his service, such as lifting. The Board finds that the physical activity described by the Veteran is consistent with the types, places, and circumstances of his service. 38 U.S.C. 1154(a). Lower Back & Right Knee The Veteran asserts that he developed back and right knee disabilities as a result of his service. The evidence of the record establishes that he has current diagnoses of lumbar strain and right patellofemoral pain syndrome. Regarding whether there is a nexus, in June 2015, the Veteran's primary care physician opined that it was more likely than not that the Veteran's back and right knee conditions were caused by his military service during training or in actual performance of duty. No rationale was provided. See June 2015 VA Medical Treatment Record. In October 2020, a VA examiner opined that it was less likely than not that the Veteran's back and right knee conditions were due to his service. The rationale provided was that there were no medical records during his service to support these conditions. The examiner concluded that, without such evidence, the Veteran's low back and right knee conditions did not incur during his active service. Significantly, however, a lack of medical evidence in service does not serve as an absolute bar for entitlement to service connection. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). Also, relying on the absence of evidence in medical records, without regard for lay statements, to provide a negative opinion is contrary to established case law, and such opinions are therefore inadequate. Dalton v. Nicholson, 21 Vet. App. 23 (2007) & Dalton v. Peake, 21 Vet. App. 23 (2007). The Veteran has consistently asserted to the onset of back and right knee pain being during his active service. In a February 2014 VA medical record, he reported that he had a long history of low back and right knee painindeed, for over 10 years. He denied any significant injury and stated that they were just the usual daily activity or work. Regarding his right knee, he stated that he injured his right knee in the heavy seas in 2004 while in service. Since then, he has experienced problems with his knee. See February 2014 VA Medical Treatment Records. See also August 2015 VA Form 9 (Substantive Appeal) (in which he noted that he had complained of these conditions on numerous occasions but was told that he was trying to "get out of training or work"). Further review of the evidence shows that the Veteran was involved in a motor vehicle accident in July 2011. He was found to have a right knee contusion and strain to his back area. These records do not include any reports from the Veteran regarding the initial onset of any right knee or back problems and provide limited information regarding the nature and circumstances of the reported accident. See January 2014 Private Medical Treatment Records. After a thorough consideration of the evidence of the record, the Board finds that the evidence is at least in relative equipoise as to the initial onset of the Veteran's low back and right knee disabilities. The competing medical opinions provided both contain some flaws, as noted herein. Importantly, however, the Board finds the Veteran's statements regarding his physical activity and his resulting pain symptoms to be competent and credible. Considering what has been proffered in the opinions, taken with the available evidence of the record, there is enough competent evidence to raise a reasonable doubt regarding the onset of the Veteran's back and right knee disabilities. Resolving all reasonable doubt in favor of the Veteran, the Board finds that a nexus has been established. Accordingly, the Board finds that the criteria for service connection for lumbar strain and patellofemoral pain syndrome of the right knee have been met. Entitlement to service connection for these disabilities is warranted. Service Connection Bilateral Wrist Disabilities The Veteran seeks service connection for a bilateral wrist disability. The evidence of the record establishes that he has a current diagnosis of bilateral wrist sprain. Regarding an in-service injury or event, the service treatment records show that, in April 2005, the Veteran complained of wrist pain. He was assessed with sprains and strains of his wrists and hands. In June 2005, he complained of a spider bite on his left wrist. See December 2005 Service Treatment Records (STR-Medical). Regarding whether there is a nexus, in January 2015, the VA examiner opined that it was less likely than not that the Veteran's bilateral wrist disabilities was due to his service. The examiner stated that, although the Veteran was evaluated and treated for a wrist sprain and a spider bite and cellulitis to his left wrist during active duty, these conditions responded to treatment and were of short duration. The examiner further explained that the Veteran did not undergo any X rays that reflected the presence of a fracture at that time and that his service separation examination did not reveal any wrist conditions. In October 2020, a VA examiner provided a negative nexus opinion. The examiner based this conclusion on the absence of in-service documentation, which, as shown by the evidence as discussed herein, is inaccurate. The Veteran has continuously asserted to experiencing wrist pain during, and since, his service. The post-service medical records do not attribute his wrist condition to any other causes or injuries. The Veteran is currently diagnosed with wrist sprain, which was also his in-service diagnosis. The medical records and examinations show that the Veteran's sprain has not resolved, as he still experiences limited motion, pain, and other symptoms. After a thorough consideration of the evidence of the record, the Board finds the Veteran's statements and testimony as to onset and continuity of symptomatology regarding his wrist conditions to be credible. His statements have been consistent with each other, his service records, and post-service treatment records. When thoroughly considering his accounts of symptoms during and after service, the fact that he has had the same diagnosis of a wrist sprains during and post-service, and the fact that there is no indication of an intercurrent injury, the evidence raises a reasonable doubt as to the initial onset of his bilateral wrist condition. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, in resolving all reasonable doubt in favor of the Veteran, the Board finds that his bilateral wrist sprains are related to his service. The criteria for service connection for left and right wrist sprains are met. Service connection for these disabilities is warranted. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Middleton, 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.