KNEE IMPAIRMENT OF

Summary

The Veteran, who served in the U.S. Marine Corps Reserve and the Navy between 1981 and 1991, appeals the denial of service connection for a right knee disability. The Veteran's military occupation specialty as a tanker crewman involved heavy lifting, and he testified to suffering a direct trauma to his right knee in August 1985 while at tank school, for which he received crutches and later sought treatment at a Naval Hospital. Post-service records from May 1986 indicated a diagnosis of right knee injury residuals from an August 1985 football game injury, with the clinician noting the Veteran was no longer able to perform orthopedic exercises. The Veteran also reported a scar on his right knee at his May 1986 separation examination. A July 2018 VA examination concluded the disability was not related to service, citing a lack of evidence for an in-service injury and noting normal x-rays in 1985 compared to 2015 x-rays showing tricompartmental arthritis. The Board found this VA examination inadequate because the examiner offered conclusory opinions without sufficient rationale, failed to address the MOS's potential contribution, did not address post-service treatment, and relied on the absence of complaints in the medical records. Based on the Veteran's credible testimony, the post-service diagnosis of knee injury residuals, and subsequent treatment, the Board found the disability manifested to a compensable degree immediately after service and is presumed related due to continuity of symptomatology. Service connection for the right knee disability is granted.

Rationale

Inadequate VA examination; Credible testimony; Post-service diagnosis and treatment; Presumed related due to continuity of symptomatology

Full Decision Text

Citation Nr: 23068213
Decision Date: 12/29/23	Archive Date: 12/29/23

DOCKET NO. 20-23 528
DATE: December 29, 2023

ORDER

Entitlement to service connection for a right knee disability is granted.

FINDING OF FACT

The Veteran's right knee disability manifested to a compensable degree within one year of his separation from service and is not attributable to intercurrent causes.

CONCLUSION OF LAW

The criteria for service connection for a right knee disability have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the U.S. Marine Corps Reserve from June 1981 to September 1981 and from June 1985 to August 1985 and in the Navy from July 1987 to April 1991. The matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2023, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. 

Entitlement to service connection for a right knee disability.

The Veteran contends that he is entitled to service connection for a right knee disability.

Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain chronic diseases, including arthritis, will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Concerning a current diagnosis, the record reflects an April 2015 diagnosis of joint knee osteoarthritis.

With regard to an in-service event, the Veteran testified at the February 2023 hearing that his military occupation specialty (MOS) was a tanker crewman and Navy avionics technician. He contends that as a tank crewman his job involved a great deal of heavy lifting. Further, the Veteran testified that he suffered direct trauma to his knee in August 1985 in Fort Knox, Kentucky while at tank school. He contends that due to this direct trauma he went to the sick bay but only received crutches. Further, he contends that after service he sought treatment at a Naval Hospital where the clinicians concluded that he had torn ligaments in the knee and possibly a meniscus tear.

Concerning a nexus between the diagnosis and the Veteran's service, at the March 2020 informal hearing conference, the Veteran contends through his representative that he received treatment for his right knee disability in service. At the March 1991 separation examination, the Veteran reported a scar across his right knee.

The Veteran's Navy outpatient medical records reflect that the Veteran reported on a May 1986 Report of Medical History that he had a strained knee from an August 1985 football game. He also reported receiving two months of disability pay from the Marine Corps due to the strained knee. Further, a May 1986 medical record consultation sheet reflects that the Veteran was diagnosed with injury residuals of the right knee due to an injury occurring during an active-duty football game. The clinician requested an evaluation of the right knee as the Veteran was no longer able to perform orthopedic exercises as
 through his representative that he received treatment for his right knee disability in service. At the March 1991 separation examination, the Veteran reported a scar across his right knee.

The Veteran's Navy outpatient medical records reflect that the Veteran reported on a May 1986 Report of Medical History that he had a strained knee from an August 1985 football game. He also reported receiving two months of disability pay from the Marine Corps due to the strained knee. Further, a May 1986 medical record consultation sheet reflects that the Veteran was diagnosed with injury residuals of the right knee due to an injury occurring during an active-duty football game. The clinician requested an evaluation of the right knee as the Veteran was no longer able to perform orthopedic exercises as treatment for the knee strain.

The Veteran's VA medical records reflect that the Veteran has received treatment for his knee disability since 2014.

The Veteran underwent a July 2018 VA examination where the examiner concluded that the Veteran's right knee disability is not related to his service. The examiner provides as rationale that there is no evidence of a knee injury occurring in 1985 and continuing into 1986 and that the injury is not noted in further record review until about 2014 when he resumes VA care for knee pain. The examiner notes that the Veteran's 2015 x-rays demonstrated tricompartmental arthritis whereas the 1985 x-rays were normal. Finally, the examiner concludes that there is not enough evidence to create a nexus for this disability.

The Board finds the July 2018 VA examination regarding direct service connection is inadequate as the examiner offered conclusory opinions without sufficient rationale and relied on the absence of complaints in the Veteran's medical records. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that it is incumbent on the examiner to consider all of the relevant evidence before forming an opinion). Further, the examiner does not address whether the Veteran's MOS could have caused his right knee disability or whether there is a connection between the knee strain in service and the Veteran's joint osteoarthritis. Also, the examiner does not address the Veteran's post-service treatment in 1986 for a strained knee. Accordingly, the Board finds the examination is inadequate for adjudication purposes.

Based on the Veteran's credible testimony, the diagnosis of right knee injury residuals 9 months post-service, along with post-service treatment, the Board finds that the Veteran's right knee disability manifested to a compensable degree immediately after service. Additionally, the Veteran underwent post-service treatment to treat the right knee disability.

The Veteran's right knee disability is presumed related to service because pain and right knee injury residuals are shown as chronic nine months post-service and manifested to a compensable degree within a presumptive period following separation from service. Symptoms attributable to the chronic disease are further shown to have continued since service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Given the foregoing, the Board finds that all elements of service connection have been met. Therefore, service connection for a right ankle disability is granted. See 38 U.S.C. § 5107 (b). 

 

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Metoyer, D'Audra I.

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.