Citation Nr: 22015045 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 19-30 439 DATE: March 16, 2022 ORDER Entitlement to service connection for a right knee disability is granted. REMANDED Entitlement to service connection for cold injury residuals, left hand, is remanded. Entitlement to service connection for cold injury residuals, right hand, is remanded. Entitlement to service connection for cold injury residuals, left foot, is remanded. Entitlement to service connection for cold injury residuals, right foot, is remanded. FINDING OF FACT The Veteran's right knee pain was incurred in service. CONCLUSION OF LAW The criteria for entitlement to service connection for right knee pain are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from July 2011 to May 2014. For his meritorious service, the Veteran was awarded (among other decorations) an Air Force Achievement Medal and an Air Force Outstanding Unit Award. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified at a video conference hearing held before the undersigned Veterans Law Judge. A transcript of this hearing has been added to the record. 1. Entitlement to service connection for right knee pain. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Moreover, where a veteran served continuously for 90 days or more during active service, and arthritis becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The Veteran is seeking entitlement to service connection for right knee pain. Initially, the Board finds there is competent evidence of a current right knee disability. A December 2017 VA examination of the knee noted the Veteran's complaints of pain and limitation of motion in the right knee. Physical examination of the right knee revealed an abnormal range of motion, as well as medial and anterior instability. At his August 2021 Board hearing, the Veteran offered competent testimony that his right knee pain was productive of functional impairment, to include limitations with range of motion, instability, and an inability to work physically demanding jobs. See Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). Thus, the first element of service connection, a current disability, classified as right knee pain, has been met. In support of his claim, the Veteran testified that he twisted his right knee during a field training drill at Minot Air Force Base. He testified that he was diagnosed with a sprained knee ligament, and that he was prescribed pain medications and a knee brace to treat this condition. The Veteran also testified that he has had worsening pain in his right knee ever since. An in-service treatment report, dated in December 2012, noted the Veteran's complaints of knee pain. The report concluded with an assessment of sprained medial collateral ligament of the right knee. Thus, the second element of service connection, an inservice event, has also been met. As to the third and final element, the Veteran has testified that he has experienced increasing levels of right knee pain ever since his inservice injury. The Veteran is competent to report having symptoms through this period. A September 2015 VA treatment report, just over a year after his discharge from the service, noted that he was given replacement knee braces. An August 2017 VA treatment report noted the Veteran's history of right knee pain for the past four years. In support of his claim, the Veteran submitted a September 2021 private medical opinion that his current right knee pain was at least as likely as not related to his inservice right knee injury. In support of this opinion, the private physician noted the Veteran's inservice right knee injury, along with the Veteran's reported history of ongoing right knee pain since that time. Standing in contrast to this conclusion is the June 2019 VA examiner's opinion that the Veteran's right knee disability was less likely than not related to his claimed inservice injury. In support of this opinion, the VA examiner erroneously noted that the Veteran's service treatment reports were silent as to any complaints of or treatment for a right knee injury. Based upon a longitudinal review of the evidence of record, the Board finds that the preponderance of the evidence weighs in favor of the appeal and service connection for right knee pain is granted. REASONS FOR REMAND 1. Entitlement to service connection for cold injury residuals, left hand, is remanded. 2. Entitlement to service connection for cold injury residuals, right hand, is remanded. 3. Entitlement to service connection for cold injury residuals, left foot, is remanded. 4. Entitlement to service connection for cold injury residuals, right foot, is remanded. The Veteran contends that he suffered cold injuries to his upper and lower extremities while stationed at the Minot Air Force Base in North Dakota. A September 2014 VA treatment report noted the Veteran's complaints of cold sensitivity and aching hands and fingers that turn blue in cold weather. The Board cannot make a fully-informed decision on the issue of whether the Veteran currently has cold injury residuals of the upper and lower extremities because no VA examiner has fully addressed the Veteran's contentions. The matters are REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed cold injury residuals to the upper and lower extremities. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Schedule the Veteran for a VA examination for his cold injury residuals, upper and lower extremities. The examiner must review the claims file. The examiner should provide diagnoses of any cold injury residuals, upper and lower extremities, found. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Are any cold injury residuals found at least as likely as not related to service, including his inservice exposure to extreme cold while stationed at Minot Air Force Base in North Dakota? Provide a rationale to support the opinions. In providing the requested opinion, consider the Veteran's description of his inservice cold injuries and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. Yates, 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.