Citation Nr: 22014533 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 19-08 864 DATE: March 14, 2022 ORDER Service connection for a left knee disorder is denied. REMANDED Entitlement to service connection for a left ankle disorder is remanded. FINDING OF FACT A left knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service. CONCLUSION OF LAW The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1994 to March 2000, April 2008 to March 2009, June 2009 to July 2010, and October 2011 to December 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in October 2016 by a Department of Veterans Affairs (VA) Regional Office. In July 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the Veteran waived Agency of Original Jurisdiction (AOJ) consideration of the evidence associated with the record since the issuance of the January 2019 statement of the case. 38 C.F.R. § 20.1305(c). The undersigned also held the record open for 30 days for the submission of additional evidence; however, none has been received to date. 1. Entitlement to service connection for a left knee disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease 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). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. The Veteran contends that she has a current left knee disorder related to her military service. Specifically, she testified at the July 2021 Board hearing that she first experienced symptoms while on active duty that have continued since such time and required treatment, to include physical therapy. In this regard, the Veteran's service treatment records (STRs) reflect that, in February 1997, she complained of left knee pain and swelling for one day. In this regard, the Veteran reported that she injured her left knee approximately two weeks earlier while performing indoor physical training running up stairs in January 1997 and, following her first run the prior day, she developed similar knee pain. An impression of knee sprain of the lateral collateral ligament was rendered. In March 1997, she again presented with complaints of left knee pain. Upon examination, there was minimal lateral swelling and tenderness, and the Veteran was diagnosed with a knee sprain in her lateral collateral ligament. She again sought follow up treatment in March 1997 for left knee pain. While X-rays were unremarkable, she had ecchymosis and crepitus with movement, and was placed on a profile with no running, jumping, or marching for 21 days. Subsequent STRs were negative for any complaints, treatment, or diagnosis referable to a left knee disorder, but reported experiencing swollen, stiff, and painful joints in June 2012 and September 2012 Post-Deployment Health Assessments. An October 2015 Reserve record reflects that the Veteran was placed on physical profile due, in part, to prolonged left knee pain. Post-service treatment records reflect complaints of left knee pain in December 2015, and the Veteran's report that her left knee hurts going down steps, she had a knee injury while on active duty between 1995 to 1997, and she experienced crepitus on full extension in March 2016. However, X-rays at such time and in May 2016 were clinically normal without significant findings. At an August 2016 VA examination, left knee patellofemoral pain syndrome was diagnosed. The examiner noted the Veteran's report of chronic episodic left knee pain that started in the mid-1990's and her in-service treatment for relevant complaints in February 1997 and March 1997, but opined that her left knee disorder is less likely as not caused by or the result of in-service subjective complaints, objective diagnosis, and/or treatment, to include in 1997. In support thereof, he noted that most sprains, strains, and musculoskeletal issues generally resolve without residuals, there was no objective continuity of care, and the Veteran's employment required a great deal of walking. Thus, the examiner determined that the Veteran's left knee disorder was likely related to her current employment. However, in October 2017 and January 2019, the Veteran challenged the August 2016 VA examiner's statement that there was no continuity of care in light of the aforementioned Post-Deployment Health Assessments that reflected reports of painful joints in 2012, and reported that she had only been working at her current position for a little over one year and had previously worked as a security guard, which mostly entailed sitting and monitoring surveillance equipment with minimal walking. In her latter statement, the Veteran also referenced a medical article discussing the risk of reoccurrence of injuries; however, such is not accompanied by any corresponding clinical evidence specific to the Veteran, and does not suggest a generic relationship between the Veteran's claimed left knee disorder and her in-service complaints with a degree of certainty such that, under the facts of this specific case, reflects plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. Consequently, such article is insufficient to establish service connection for the Veteran's left knee disorder. Wallin v. West, 11 Vet. App. 509 (1998); Sacks v. West, 11 Vet. App. 314 (1998); Libertine v. Brown, 9 Vet. App. 521 (1996). Thereafter, the Veteran was afforded another VA examination in January 2019, at which time left knee patellofemoral pain syndrome was again diagnosed. She also noted the August 2016 VA examiner's opinion that such disorder was related to the Veteran's current employment and the Veteran's subsequent report that she did not walk long distances in such position, but rather typically sat. Nonetheless, the examiner opined that her left knee disorder is less likely as not incurred in or caused by the left knee complaints in 1997 during service, and more likely due to the normal age progression. In support thereof, she noted that were no objective findings that document a chronic left knee disorder related to an event, subjective complaints, diagnosis, or treatment during service. The examiner also indicated there is no objective evidence of continuity of care related to a left knee disorder from 1997 until 2015. In this regard, she acknowledged the February 1997 and March 1997 complaints and findings referable to the Veteran's left knee, but noted that the Veteran denied medical problems in July 2008; bone pain in December 2009; swollen, stiff, or painful joints in May 2010; and chronic pain in April 2011 and, while she reported swollen, stiff, or painful joints in June 2012, such was related to a recent twisted ankle. The Board affords great probative weight to the January 2019 VA examiner's opinions as such considered all of the pertinent evidence of record, to include the Veteran's statements and her relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran's assertions as to the etiology of her left knee disorders; however, as a lay person, she does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder, diagnosed as patellofemoral pain syndrome, involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Moreover, whether the symptoms the Veteran reportedly experienced during or after service are in any way related to her currently diagnosed left knee disorder is a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). Accordingly, the Veteran's opinions as to the onset and etiology of her left knee disorder is not competent evidence and, consequently, is afforded no probative weight. Based on the foregoing, the Board finds that a left knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service. Consequently, service connection for such disorders is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claims for service connection for a left knee disorder, that doctrine is inapplicable and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Entitlement to service connection for a left ankle disorder. The Veteran contends that she has a current left ankle disorder related to her military service, to include as a result of repeatedly rolling her ankle. In this regard, her STRs reflect left ankle swelling when seeking treatment for her left knee complaints in March 1997, a reported history of rolling her ankles when seeking treatment for a right ankle injury in May 2009, and a report of twisting an unidentified ankle a few days previously in June 2012. The Veteran further reports that she has experienced left ankle pain since service, which she self-treated. However, August 2016 and January 2019 VA examinations reflected that the Veteran's left ankle was normal upon clinical evaluation, there was no functional impairment associated with her reported symptoms, and no diagnoses of a left ankle were rendered. Nonetheless, an October 2019 VA examination, conducted in relation to the Veteran's right ankle, revealed a diagnosis of left lateral collateral ligament sprain (chronic recurrent). Thus, in light of the Veteran's report of rolling her left ankle during service, the aforementioned documented in-service complaints, and a current diagnosis, the Board finds that a remand is necessary in order to obtain an opinion addressing the etiology of her claimed left ankle disorder. The matter is REMANDED for the following action: Forward the record, to include a copy of this remand, to an appropriate VA clinician in order to obtain an opinion addressing the etiology of the Veteran's left ankle disorder. Following a review of the record, the examiner should offer an opinion as to whether it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's left ankle disorder, currently diagnosed as left lateral collateral ligament sprain (chronic recurrent), had its onset in, or is otherwise related to her military service, to include her documented in-service ankle complaints in March 1997, May 2009, and June 2012. In rendering such opinion, the examiner must consider and discuss the Veteran's lay statements of record regarding the onset of her left ankle disorder and the continuity of symptomatology of such disorder, to include her statements that she rolled her ankle repeatedly while on active duty and has continued to experience pain since such time, which she self-treated. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Spielmann, Jill F. 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.