Citation Nr: 22012213 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 18-50 800 DATE: March 2, 2022 ORDER Entitlement to service connection for a bilateral knee disability is granted. Entitlement to service connection for a bilateral ankle disability is granted. Entitlement to service connection for bilateral eye cataracts is granted. FINDINGS OF FACT 1. The Veteran's bilateral knee disability is related to his active service. 2. The Veteran's bilateral ankle disability is related to his active service. 3. The Veteran's bilateral eye cataracts are related to his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a bilateral ankle disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for bilateral eye cataracts are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from October 1972 to October 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. Service Connection Service connection may be established for a disability resulting from injury or disease incurred during active service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection the evidence must show: (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 in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 1. Entitlement to service connection for a bilateral knee disability is granted. The Veteran asserts that his bilateral knee disability is due to the cumulative impact of running, jumping, and carrying heavy packs on his back during service. To this end, he maintains that he began to experience knee pain as a result that has continued since that time. He also asserts that he incurred a specific knee injury when a wing cover trailer snapped and hit his right knee, knocking him to the ground. See August 2017 Notice of Disagreement (NOD) and July 2020 Board Hearing Transcript at 3,11. Here, the Veteran has current diagnoses of bilateral knee degenerative arthritis and bilateral knee joint replacement. See January 2020 VA examination report. Thus, element one is met. Regarding element two, the Veteran's service treatment records (STRs) are silent for diagnoses, complaints, and treatment for any bilateral knee disability. However, the Board finds his reports of a cumulative impact injury from running, jumping, and carrying heavy packs on his back to be competent and credible and consistent with the circumstances of his service. See 38 U.S.C. § 1154(a)). Additionally, the Veteran recalled a specific injury to his right knee when a wing cover trailer snapped and hit his right knee, which the Board finds competent and credible. Thus, element two for an in-service injury is also met for reasons outlined below. Thus, the pertinent inquiry here is whether the Veteran's bilateral knee disability has been medically associated, nexus, with service. Resolving all reasonable doubt in favor of the Veteran, the Board concludes it has. Specifically, in an August 2020 private opinion, Dr. M. G., an orthopedic surgeon who has treated the Veteran for more than 10 years, opined that it is highly probable that the Veteran's bilateral knee disability is due to the rigors of his military service. In support of his opinion, Dr. M. G. stated that the Veteran underwent a bilateral total knee replacement surgery in February 2010 at age 57, and determined that it was highly probably that his past military service and the extremely strenuous and physical nature of such service caused his arthritis at such an early age. He reasoned that the Veteran was required to run on a regular basis and also worked doing aircraft maintenance and that typically patients require knee replacement surgery later in life. Thus, he concluded that the Veteran's bilateral knee disability was connected to his time in service. The Board finds that this opinion tends to substantiate the relationship between the Veteran's bilateral knee disability and his in-service knee injuries as Dr. M. G. provided an adequate rationale for his conclusion. Notably, he provided an understandable and rational basis for the opinion, which relied on an accurate history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). Further, the Board finds nothing in the record to doubt the qualifications of Dr. M. G., and thus finds this medical opinion to be competent. For these reasons, the Board affords this opinion high probative value. There is no competent evidence to the contrary. The Board acknowledges the January 2020 VA examiner ultimately reached a conclusion unfavorable to the Veteran's claim. However, the opinion is inadequate, as the examiner relied on lack of documented treatment of a bilateral knee disability during service and did not address the Veteran's lay statements and conceded in-service cumulative impact injury. As such, the Board finds the evidence supports entitlement to service connection for a bilateral knee disability, and, therefore, the claim is granted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Entitlement to service connection for a bilateral ankle disability is remanded. The Veteran asserts that his bilateral ankle disability is due to the cumulative impact of running in combat boots during basic training. To this end, he maintains that he began to experience ankle pain as a result that has continued since that time. See August 2017 NOD and July 2020 Board Hearing Transcript at 5,11. Here, the Veteran has a current diagnosis of bilateral collateral ligament sprain. See January 2020 VA examination report. Thus, element one is met. Regarding element two, the Veteran's STRs are silent for diagnoses, complaints, and treatment for any bilateral ankle disability. However, the Board finds his reports of cumulative impact injury form running in combat boots to be competent and credible and consistent with the circumstances of his service (see 38 U.S.C. § 1154(a) and his reports of the onset of bilateral ankle pain as a result are credible in this regard. Thus, element two for an in-service injury is also met for reasons outlined below. Thus, the pertinent inquiry here is whether the Veteran's bilateral ankle disability has been medically associated, nexus, with service. Resolving all reasonable doubt in favor of the Veteran, the Board concludes it has. Specifically, in an August 2020 private opinion, Dr. M. G., the same orthopedist who has treated the Veteran for more than 10 years, opined that it was more likely than not the Veteran's bilateral ankle disability was due to his military service. In support of his opinion, Dr. M. G. noted his past military service and the extremely strenuous and physical nature of such service and determined it is highly probable that this is the cause of his ankle pain. He emphasized that the Veteran was required to run on a regular basis and worked doing aircraft maintenance and that is more than likely the cause of his chronic ankle pain. Thus, he concluded that the Veteran's bilateral ankle disability was connected to his time in service. The Board finds that this opinion tends to substantiate the relationship between the Veteran's bilateral ankle disability and his in-service ankle injuries as Dr. M. G. provided an adequate rationale for his conclusion. Notably, he provided an understandable and rational basis for the opinion, which relied on an accurate history. See Nieves-Rodriguez, 22 Vet. App. 295, 302. Further, the Board finds nothing in the record to doubt the qualifications of Dr. M. G., and thus finds this medical opinion to be competent. For these reasons, the Board affords this opinion high probative value. There is no competent evidence to the contrary. The Board acknowledges the January 2020 VA examiner ultimately reached a conclusion unfavorable to the Veteran's claim. However, the opinion is inadequate as the examiner relied on lack of documented treatment of a bilateral ankle disability during service and did not address the Veteran's lay statements or cumulative impact injury. As such, the Board finds the evidence supports entitlement to service connection for a bilateral ankle disability, and, therefore, the claim is granted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. Entitlement to service connection for bilateral eye cataracts is granted. The Veteran maintains that his bilateral eye cataracts are due to sunlight/UVA radiation exposure during service in Texas. Specifically, he asserts that he began to have headaches and sore eyes during service due sunlight exposure without sunglasses or other protective gear. See August 2017 NOD and July 2020 Board Hearing Transcript at 6, 12. Here, the Veteran has a current diagnosis of bilateral eye cataracts. See private treatment records submitted in July 2020. Regarding element two, the Veteran's STRs are silent for diagnoses, complaints, and treatment for any bilateral eye disability. However, the Board finds the Veteran is competent enough to report headaches and sore eyes during service and his exposure to excessive sunlight without eye protection is conceded as it consistent with the circumstances of his service in Texas. See 38 U.S.C. § 1154(a)). Thus, element two is also met for reasons outlined below. Thus, the pertinent inquiry here is whether the Veteran's bilateral eye cataracts have been medically associated, nexus, with service. Resolving all reasonable doubt in favor of the Veteran, the Board concludes it has. Specifically, in an August 2020 private opinion, Dr. M. B., who treated the Veteran with cataract surgery 14 years ago, stated that the Veteran's extreme exposure to sunlight accounts for his early onset of cataracts in his eyes. In support of his opinion, Dr. M. B. stated that in some cases in younger patients exposure to radiation, trauma, or steroid use can cause development of early cataracts. To this end, he noted that in the Veteran's case his extreme exposure to sunlight was the cause of his early cataract surgery in 2006. The Board finds that the Veteran's reported extreme sunlight/UVA radiation exposure in Texas during service is the same extreme sun exposure referenced in Dr. M. B.'s opinion. The Board finds that this opinion tends to substantiate the relationship between the Veteran's bilateral eye cataracts and his in-service sunlight exposure as Dr. M. B. provided an adequate rationale for his conclusion. Notably, he provided an understandable and rational basis for the opinion, which relied on an accurate history. See Nieves-Rodriguez, 22 Vet. App. 295, 302. Further, the Board finds nothing in the record to doubt the qualifications of Dr. M. B., and thus finds this medical opinion to be competent. For these reasons, the Board affords this opinion high probative value. Lastly, the medical literature submitted by the Veteran in August 2020 supports the Veteran's assertions and Dr. M. B.'s opinion as it relates cataracts to sunlight exposure. Critically, there is no competent evidence to the contrary. As such, the Board finds the evidence supports entitlement to service connection for bilateral eye cataracts, and, therefore, the claim is granted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.