Citation Nr: 22014447 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 18-11 820 DATE: March 12, 2022 ORDER Entitlement to service connection for left knee disability is denied. Entitlement to service connection for right knee disability is denied. FINDINGS OF FACT 1. The evidence does not reach the level of equipoise to find right knee disability was caused by active-duty service. 2. The evidence does not reach the level of equipoise to find left knee disability was caused by active-duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for right knee disability have not been met. 38 U.S.C. §§ 101 (24), 106, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304. 2. The criteria for service connection for left knee disability have not been met. 38 U.S.C. §§ 101 (24), 106, 1110, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 2010 to December 2010. In January 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. Service Connection 1. Entitlement to service connection for left knee disability is denied. 2. Entitlement to service connection for right knee disability is denied. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran 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 or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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). In addition, service connection for certain chronic diseases, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309 (2017); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran alleges that his bilateral knee condition began during service and has existed since that time. First, the Board finds that there is a current disability. The Veteran was diagnosed with right knee joint osteoarthritis in a January 2018 VA examination and left knee strain in a June 2018 VA examination. Second, the Board finds that there was an in-service event, injury, or disease. November 2010 STRs noted that the Veteran injured his left knee after tripping. The records noted left anterior lateral knee pain for four days. Subsequent November 2010 sick call sheets confirmed a knee injury, though it did not specify which knee. In the January 2021 hearing, the Veteran stated that he hurt both his knees in service. He stated that he was tripped and fell onto both his knees on concrete. The Board finds the Veteran's lay statements and sworn testimony credible evidence to support the occurrence of an in-service injury to both knees. Notably, the Veteran's report of in-service events has remained consistent over time; and he is indeed competent to attest to matters which he has personally experienced or about which he has firsthand knowledge. Third, the Board finds that the evidence of record does not support a finding that the bilateral knee condition is related to active service. The Veteran was provided with a VA examination for his right knee in January 2018. The examiner determined that the Veteran's right knee condition was less likely than not related to his active-duty service as there was no actual documentation of right knee complaints in the service treatment records (STRs). The examiner noted that the in-service record noting a knee injury did not specify which knee was injured. The Veteran was provided with a VA examination to evaluate his left knee in June 2018. The Veteran was diagnosed with left knee strain. The examiner determined that the Veteran's left knee condition was less likely than not related to service as there was a single incident of left knee pain in service. The examiner determined that the lack of documentation of further complaints for the left knee in or out of service indicated a lack of severity or chronicity of the condition. The examiner also noted that the Veteran was not seen again for left knee issues until 2017 leaving a gap of seven years. The examiner stated that documentation of knee issues on a more consistent basis would have better substantiated the claim. The Board founds both of these opinions to be inadequate in a May 2021 Board decision for lack of proper rationale. As such, the Board provides these opinions less persuasive weight. Following the May 2021 Board remand, additional VA opinions were provided in June, July, and August 2021. In the June 2021 opinion, the examiner denied nexus. He noted that there was documentation of injury to the left knee in service and then stated that there were no other documented complaints of or treatment for the left knee in the STRs. The examiner also noted that the STRs were negative for any complaints or treatment regarding the right knee in service. He found that post-service records were negative for any right knee complaints until 2017 and that January 2018 x-rays showed early osteoarthritis. The examiner emphasized that a diagnosis was made 18 years after service and that without documented continuity of care, it could not be determined that the knee condition was due to injury in service. There was no documentation of arthritis in service. The examiner stated that the Veteran's statements regarding his symptoms were considered, but he was not qualified to ascribe those symptoms to a diagnosis. As such, nexus was denied. This exact opinion was reiterated and affirmed in July 2021. In August 2021, another addendum opinion was provided. The examiner again denied nexus. He noted that the Veteran only had one isolated left knee condition in service, which was diagnosed as iliotibial band syndrome. There was no evidence of a right knee condition. The examiner noted that there was no evidence of knee complaints following service until right knee issues were reported in August 2017. The x-ray at the time was negative and anterior lateral pain consistent with iliotibial band syndrome was diagnosed. There was no evidence of a left knee condition until 2018. The examiner determined that even if it was conceded that the bilateral knee condition arose in 2017, nexus was still not established. The examiner noted that the June 2018 x-ray was negative for degenerative joint disease in the left knee, and he was instead diagnosed with left knee strain. The examiner noted that the presently diagnosed knee conditions were separate from the condition diagnosed in service. The examiner stated that DJD was considered a naturally occurring condition due to normal wear and tear. He also stated that IT band syndrome of the left knee would not be confused with the currently diagnosed strain-type injury due to location and complaints. Therefore, neither condition the osteoarthritis of the right knee or left knee strain could be related to the IT band syndrome diagnosed in the left knee in service. They were new and separate conditions that manifested following service. The examiner noted that it was not just the absence of documentation in the records leading to this conclusion but rather that the medical evidence of record does not support the current claim or diagnosis. The examiner found that the IT band syndrome resolved after the stint in active duty and could not be confused with the current left knee strain. The current conditions were different symptomatically to the conditions documented in service. The Board finds this opinion is persuasive evidence as it is provided upon review of the relevant facts (to include lay statements of symptomatology that the Board found competent and credible) and is supported by medical explanation. The Board emphasizes that none of the post-service treatment records contains a medical opinion relating the Veteran's bilateral knee disabilities to service. The only evidence that the Veteran's knee disabilities are related to service are his own lay statements. But, again, as previously discussed, as a lay person without any medical training and expertise, the Veteran is simply not competent to render a medical opinion in this regard. He is competent to comment on his symptoms of bilateral knee pain since service, he is not competent to attribute them to a clinical diagnosis. As such, the most persuasive evidence as to the nexus element are the VA medical opinions. When read together, the examiners found no link between the Veteran's active-duty service and his bilateral knee condition diagnosed seven years later. The examiners included a discussion of the Veteran's medical history and his lay testimony. Even considering his lay reports, the examiners found no link between the in-service accident and his claimed disabilities. There is no competent opinion to the contrary. Finally, the Board acknowledges that the Veteran stated in the January 2021 hearing that he experienced knee pain since leaving service and that he received treatment immediately following service until his insurance ran out. When the Board remanded to obtain information from the Veteran regarding this private physical therapy treatment, the Veteran's representative stated that the Veteran did not receive physical therapy in 2010 and 2011 following service in a November 2021 correspondence. As such, there is no evidence that the Veteran's bilateral knee condition manifested to a compensable degree within one year of discharge. Accordingly, service connection is denied. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AK 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.