Citation Nr: 22010146 Decision Date: 02/22/22 Archive Date: 02/22/22 DOCKET NO. 17-38 303 DATE: February 22, 2022 ORDER Service connection for a left knee condition is denied. Service connection for chondromalacia of the right knee (right knee condition) is denied. REMANDED The claim for service connection for a back condition is remanded. FINDINGS OF FACT 1. The evidence of record persuasively favors the conclusion that the Veteran does not have a left knee condition as a result of her active military service. 2. The evidence of record persuasively favors the conclusion that the Veteran does not have a right knee condition as a result of her active military service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee condition have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. § 3.303, 3.307(a)(3), 3.309(a), 3.310(a). 2. The criteria for service connection for a right knee condition have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. § 3.303, 3.307(a)(3), 3.309(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from September 1984 to June 1992. The matter is on appeal before the Board from March 2014 and August 2017 rating decisions. The Veteran provided testimony at an October 2021 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established with certain chronic diseases, based upon a legal presumption, which occurs by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Additionally, service connection may be established under 38 C.F.R. § 3.303(b), when a symptom or symptoms of a chronic disease are noted in service, or within a year of the date of separation from service, and when chronicity is established through a continuity of symptomatology after service. The continuity of symptomatology provision is an alternative method to establishing service connection for the specific chronic diseases listed under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 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, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). 1. Service Connection Left Knee and Right Knee Conditions The Veteran contends that she has left and right knee conditions that are related to her active military service. She also asserts that he left knee condition is secondary to her right knee condition. At the October 2021 Board hearing, the Veteran reported that she felt that all the exercising she underwent while in the military, in particular running and mountain climbing, caused wear and tear on both of her knees. In addition, she indicated that during her service, she worked predominantly in either the post office or in the mail room, which created wear and tear on her body. She explained that her work entailed a lot of lifting, bending, pulling, standing, and loading and unloading of mail trucks. Following her service, she noted that she worked in administrative roles, and had not undertaken hard labor. The Veteran indicated that she began having intermittent knee pain when she got out of the service, and that it continued to progressively worsen over time. She underwent knee surgery on her right knee in 2012, and has had continued treatment to include injections in her right knee. She has also received treatment for her left knee, to include injections. The Veteran also asserted that her right knee has affected her left knee, because she will place more weight on her left side when her right side is hurting. A review of the Veteran's service treatment records (STRs) does not reflect any diagnoses for any left or right knee conditions. In addition, there are no complaints or treatments that may be construed to be related to any left or right knee conditions shown in the Veteran's STRs. The Veteran's post-service medical treatment records provide that she was first seen in November 2011 for right knee pain that had started around two weeks prior. There was swelling, and her knee hurt medially. The Veteran denied a present injury as well as any specific injury in the past. X-rays showed minimal early degenerative changes, and she was assessed with knee pain that was consistent with meniscal pathology. A December 2011 MRI did not show a meniscal tear, but it did show a chondral fissure and chondromalacia. The Veteran underwent an arthroscopic chondroplasty on her right knee on January 30, 2012. Following the surgery on her right knee, her medical treatment records show that she had follow-up treatment that included injections. Pertaining to her left knee, her post-service medical treatment records first contain notations pertaining to her left knee beginning in September 2021, at which time she was seen for bilateral knee pain and received injections in both knees. As of September 27, 2021, the Veteran's current diagnoses pertaining to both her left and right knee, are patellofemoral pain and osteoarthritis. Based upon the foregoing, service connection for either a left knee condition or a right knee condition is not warranted. To begin, the Veteran's STRs do not contain any complaints, treatments, or diagnoses related to any left or right knee conditions. While the Veteran's representative in the March 2015 Notice of Disagreement asserted that her doctor told her that the problem with her knees could be her military days coming back to haunt her, there are no indications within any of her medical treatment records that either her left or right knee conditions may be related to her active military service. That is, there are no actual statements from any medical providers linking the Veteran's left and right knee conditions to her active military service. Additionally, no medical treatise evidence has been submitted to suggest that the Veteran's left and right knee conditions may be related to her active service. The Veteran's treatment records first document treatment for her right knee condition beginning in December 2011, which is a little over 19 years after her release from active military service. Her treatment records first document treatment for her left knee condition in September 2021, which is a little over 29 years after her release from active military service. Thus, other than the Veteran's belief that her left and right knee conditions are related to her active military service, there is no medical evidence of record linking her left and right knee conditions to her military service. Nor is there any evidence that may even suggest a link between her left and right knee conditions and her active military service. For example, other than her own statements, the Veteran has not submitted any statements from fellow service members or other individuals that knew her during her service that may have been able to attest to her knee conditions during her service or shortly thereafter. As such, the evidence of record persuasively favors the conclusion that the Veteran's left and right knee conditions are not related to her active military service. In addition, the evidence also does not suggest that a remand for VA examinations is warranted at this time. Consideration is given to the Veteran's contentions that her claimed left and right knee conditions were incurred in or caused by her active military service, as well as her contention that her left knee condition is secondary to her right knee condition. While lay persons are competent to provide opinions pertaining to certain medical issues, the etiology of left and right knee conditions, as is specific to this case, is outside the realm of common knowledge for someone, such as the Veteran, who does not possess medical training, specialized expertise, or experience. Jandreau v. Nicholson, 492. F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, no probative value shall be assigned to the Veteran's assertions. Accordingly, service connection for both a left knee condition and a right knee condition is denied. REASONS FOR REMAND 1. Service Connection Back Condition The Veteran's STRs contain multiple complaints of lower back pain, most of which appear to be associated with urinary tract infections, however, records from December 1990 note the Veteran's back pain to seem to have mechanical etiology. Additionally, a September 1991 record provides an assessment of lower back strain. The Veteran's post-service medical treatment records contain no complaints, treatments, or diagnoses pertaining to any back conditions, and the Veteran acknowledged at the October 2021 Board hearing that she has not received any treatment for her back following her military service. However, during the October 2021 Board hearing, the Veteran attested to having intermittent back pain following her service that continued to worsen over time. As the Veteran has reported having back pain since service, and her STRs contain complaints of back pain with assessments of back strain and mechanical etiology, a remand is warranted to obtain a VA examination to determine whether the Veteran has a currently diagnosed back condition, to include back pain, that is related to her active military service. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of her claimed back condition, to include back pain. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's claimed back condition, to include back pain, began in or was otherwise caused by her active military service? Why or why not? The examiner should review and discuss the December 1990 and September 1991 STRs pertaining to complaints of back pain with assessments of mechanical etiology and back strain, as well as the Veteran's testimony pertaining to her back at the October 2021 Board hearing. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, 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.