Citation Nr: 22017933 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 17-46 403 DATE: March 27, 2022 ORDER Service connection for a right knee disability, diagnosed as patellofemoral pain syndrome and knee joint osteoarthritis is granted. Service connection for a left knee disability, diagnosed as patellofemoral pain syndrome and knee joint osteoarthritis is granted. FINDING OF FACT Competent evidence links the current bilateral knee disability to service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for bilateral knee disability have been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1989 to July 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2021, the Veteran testified at a Board video conference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. Service Connection 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. 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). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). 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. 1. Entitlement to service connection for a right knee disability 2. Entitlement to service connection for a left knee disability The Veteran seeks service connection for bilateral knee condition. In August 2021, the Veteran testified that her bilateral knee pain onset in service while running. She contends that she was treated in service for knee pain and was diagnosed with patellar syndrome in 1989. A review of the Veteran's service treatment records (STRs) corroborates that she received treatment for her knees multiple times, to include in March 1989, July 1989 and November 1989. A review of the record shows that she was diagnosed with retropatellar pain syndrome in November 1989 and this diagnosis was noted on her physical profile in in January 1990. As an initial matter, the Board notes that the Veteran was diagnosed with bilateral patellofemoral pain syndrome and mild bilateral knee joint osteoarthritis in her June 2015 VA examination. Thus, the question becomes whether the knee disabilities are related to service. On this question, there are opinions both in favor and against the claims for service connection A June 2015 VA examiner, a physician's assistant, opined that that Veteran's bilateral knee condition is less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that the Veteran has a diagnosis of medial-compartmental arthritis of both knees, and her in-service condition was retro-patellar pain syndrome. The examiner explained that this condition does not have an effect on the medial and lateral joint spaces. Her need for surgery on her knees was due to meniscal tears and these are unrelated to her knee diagnosis in the military. In addition, the examiner stated there is a lack of chronicity in regard to the Veteran's bilateral knee conditions. She separated from the military in 1990 and did not require further medical evaluation of her knees until approximately 2010. Conversely, an October 2021 letter from the Veteran's treating nurse practitioner. The clinician notes that the Veteran has chronic knee pain and continues to be treated for this medical issue. She notes that the Veteran enlisted in the Army in 1989 with no deficits and was injured while running track on June 4, 1989. After that incident, there were multiple medical entries where the Veteran was treated for knee pain to include July 1989, January 1990 and March 1990. The clinician noted that the Veteran has had continued pain and detrition. The clinician opined that it is more likely than not that the Veteran's chronic knee disability is a result from an injury while serving in the military. In October 2021, a VA orthopedic physician's assistant notes that the Veteran currently has bilateral moderate to severe tricompartmental arthritis in her knees. She states that the Veteran has had pain in the knees since active duty and is currently getting conservative treatment. The clinician notes that the Veteran had multiple visits in the period between 1989-1990 while on active duty. There was no report of injury or trauma, but pain developed with her active duty training. She was diagnosed with retropatellar pain syndrome and prescribed physical therapy as well as placed on a profile. The clinician notes the Veteran's report that the pain continued, and she eventually sought treatment in 2012-2014. The clinician notes a current diagnosis of severe arthritis in both knees. He opines that it is more likely than not that the Veteran's retropatellar pain syndrome would predispose her to developing progressive disease in her knees over time. The Board notes that the VA examiner and the treating clinicians all reviewed the service treatment records and considered the Veteran's contentions in rendering their opinions. Upon review of the record, the Board finds that the evidence is in relative equipoise as to whether the Veteran's current bilateral knee disability arose in or is related to her military service. Thus, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral patellofemoral pain syndrome and bilateral knee joint osteoarthritis is warranted. 38 C.F.R. §§ 3.102, 3.303. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Asare, 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.