Citation Nr: 22010486 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 20-18 848 DATE: February 23, 2022 ORDER Entitlement to service connection for a right knee disability is granted. FINDING OF FACT The preponderance of the evidence supports a finding that the Veteran's current right knee disability is etiologically related to active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for right knee condition have been met. 38 U.S.C. §§ 1111, 1131; 38 C.F.R. § § 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1998 to September 2003. This matter comes before the Board of Veteran's Appeals (Board) from a June 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board observes that in an April 2020 Form 9, the Veteran limited her appeal to the issue as listed on the title page of this decision. Additionally, the Veteran requested a hearing before a Veterans Law Judge (VLJ), which was held in February 2022 via video conference, wherein she affirmed her choice to limit the appeal to the issue as listed on the title page. Service Connection Service connection may be established for disability due to a disease or injury that was incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may also 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). In general, in order to prevail on the issue of service connection, the evidence must show: (1) the existence of a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. §§ 1111, 1132. To rebut the presumption of soundness for disorders not noted on the entrance or enlistment examination, VA must show by clear and unmistakable evidence both: a) the disease or injury existed prior to service, and b) that the disease or injury was not aggravated by service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). 1. Entitlement to service connection for a right knee disability The Veteran is seeking service connection for a right knee disability. A review of the Veteran's service treatment records (STRs) reveal that the Veteran was diagnosed with patellofemoral syndrome while on active duty service. Accordingly, the Board finds that the Veteran had a qualifying in-service injury. VA treatment records show that the Veteran presently receives treatment for a right knee disability and is diagnosed with bilateral meniscal tears, patellofemoral syndrome, and knee pain. Accordingly, the Board finds that the Veteran has a present disability for VA purposes. In support of her claim, the Veteran submitted a medical opinion from her private treatment provider regarding the nature and etiology of her right knee disability in October 2017. The private provider opined the following: "[T]here is a very high probability (more likely than not) that the torn medial meniscus in her right knee and the torn medial meniscus in her left knee are a direct result of walking and running while carrying very heavy backpacks and other gear. This is because the menisci are adapted to her bodyweight but not her bodyweight plus the extra weight of all the gear she was required to carry." The Board notes that this provider stated that he was the Veteran's treating physician, was familiar with the Veteran's medical history, and had reviewed the Veteran's service treatment records. In February 2020, the Veteran received a VA examination regarding the nature and etiology of her claimed right knee disability. The February 2020 examiner diagnosed the Veteran with right knee strain, right knee meniscal tear, and right patellofemoral pain syndrome. The examiner opined, however, that the right knee disabilities were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury. By way of rationale, the examiner stated that the during service the "condition was acute only" and relied on a lack of evidence showing chronicity of care. The examiner did not address the Veteran's noted in-service diagnosis of patellofemoral pain syndrome nor the opinion provided by the Veteran's private treatment provider discussed above. Having reviewed the medical evidence of record, the Board finds the October 2017 opinion provided by the Veteran's private treatment provider to be more probative than the February 2020 VA medical opinion as it adequately addresses the Veteran's theories of entitlement and symptomatology and is based on knowledge of the Veteran's medical history gained through regular treatment and review of the Veteran's STRs. Conversely, the February 2020 medical opinion is inadequate as it fails to adequately address the Veteran's medical history and theories of entitlement. Specifically, the February 2020 examiner fails to address the positive opinion provided by the Veteran's private treatment provider nor the Veteran's contention that her knee disability is the result of running in combat boots while bearing heavily weighted back packs and gear. Thus, from the foregoing, the Board finds the October 2017 private medical opinion to be the most probative of record. Based on the foregoing and affording the Veteran all benefit of the doubt, the Board finds that the preponderance of the competent and credible evidence of record supports a finding that the Veteran's claimed right knee disability is etiologically related to active duty service. Accordingly, service connection is warranted. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Gorum, 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.