KNEE IMPAIRMENT OF

Summary

The Veteran served from August 1984 to August 1988. This case comes before the Board of Veterans' Appeals (Board) following a July 2021 rating decision, based on evidence of record at that time. The Veteran sought service connection for right knee pain, high cholesterol, high blood pressure, enlarged prostate, dizzy spells, and headaches. The Board granted service connection for right knee pain, finding that the Veteran's reported pain, stiffness, and swelling constituted a functional impairment, satisfying the elements for service connection. The service treatment records confirmed an in-service meniscus tear, and the Board found the Veteran credible regarding the onset and persistence of pain since service. Service connection for high cholesterol was denied because it is a laboratory finding and not a disability for VA purposes, and no present disability was established. The Board remanded claims for high blood pressure, enlarged prostate, dizzy spells, and headaches. The Veteran reported these symptoms and noted service at Camp Lejeune, North Carolina, with presumed exposure to contaminated water. The Board found an indication of a causal link to this exposure but remanded for VA examinations to determine the nature and etiology of these conditions and their relationship to service and Camp Lejeune exposure, citing a duty to assist error.

Rationale

Service treatment records indicate in-service meniscus tear.; Veteran credible regarding onset and persistence of pain.; Pain constitutes functional impairment.

Full Decision Text

Citation Nr: A24086512
Decision Date: 12/30/24	Archive Date: 12/30/24

DOCKET NO. 221024-302892
DATE: December 30, 2024

ORDER

Service connection for right knee pain is granted.

Service connection for high cholesterol is denied.

REMANDED

Service connection for high blood pressure is remanded.

Service connection for enlarged prostate is remanded.

Service connection for dizzy spells is remanded.

Service connection for headaches is remanded.

FINDINGS OF FACT

1. The probative evidence of record supports a finding that the Veteran incurred a right knee injury during service and that the corresponding symptoms have persisted since exiting from service. 

2. The Veteran's high cholesterol is a laboratory finding and is not considered a disability for VA purposes. 

CONCLUSIONS OF LAW

1.  The criteria for service connection for right knee pain are met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 

2.  The criteria for service connection for high cholesterol are not met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1984 to August 1988.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In July 2021, the Veteran submitted a VA Form 10182 Decision Review Request form opting into AMA and selecting the Direct Review Lane. "Direct review" means that the Board's decision must be based upon the evidence of record at the time of the prior decision, with no evidence submission or hearing request. As such, the Board has considered only the evidence of record at the time of the July 2021 decision.

1. Service connection for right knee pain is granted.

Legal Criteria

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303.

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Factual Background

The Veteran reports that he injured his right knee during service when he landed awkwardly during a physical training exercise. The Veteran's service treatment records indicate that he tore his right meniscus during service. The Veteran underwent a right knee arthroscopy in November 1985. 

The Veteran indicated that he currently experiences right knee pain, stiffness, and swelling in the right knee due to the injury he sustained during service. See May 2021 correspondence.

Analysis

At the onset, there is evidence of record that suggests that the Veteran does not have a right knee condition?diagnosis, which is essential?for?establishing a current disability. However, despite the lack of a formal diagnosis,?pain?alone may constitute disability, even without an identifiable underlying pathology, if the?pain?reaches the level of a functional impairment. See Saunders v. Wilkie,?886 F.3d 1356?(Fed. Cir. 2018).? 

Here, the Veteran has reported that he experiences right knee pain, stiffness and swelling. The Board finds that the persuasive evidence of record supports that there is functional impairment from the Veteran's right knee?pain, which constitutes a disability as consistent with Saunders. Thus, the first element for establishing service connection has been satisfied. 

The Veteran's service treatment records indicate that he tore his right meniscus during service. Accordingly, the second element of service connection has been met.

What remains for consideration is whether the Veteran's right knee pain is causally related to his in-service knee injury.

The Board finds the Veteran competent and credible to report that his right knee pain started during service which has persisted since exiting from service. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

2. Service connection for high cholesterol is denied.

The Board notes that the record does not indicate that the Veteran had high cholesterol at the time of the July 2021 rating decision. In the absence of a present disability, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 223,
What remains for consideration is whether the Veteran's right knee pain is causally related to his in-service knee injury.

The Board finds the Veteran competent and credible to report that his right knee pain started during service which has persisted since exiting from service. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

2. Service connection for high cholesterol is denied.

The Board notes that the record does not indicate that the Veteran had high cholesterol at the time of the July 2021 rating decision. In the absence of a present disability, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 

Moreover, high cholesterol is a laboratory finding and not, in and of itself, a disability for which VA compensation benefits are payable. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) ("Diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities. They are, therefore, not appropriate entities for the rating schedule.").

Accordingly, service connection for high cholesterol must be denied as a matter of law, and the benefit of the doubt doctrine is therefore not for application. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994); 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 

REASONS FOR REMAND

1. Service connection for high blood pressure is remanded.

2. Service connection for enlarged prostate is remanded.

3. Service connection for dizzy spells is remanded.

4. Service connection for headaches is remanded.

The Veteran reports having high blood pressure, an enlarged prostate, dizzy spells, and headaches. See July 2017 correspondence. The Board finds the Veteran to be competent and credible to report these symptoms because they are readily observable. See Jandreau supra. 

The record shows that the Veteran was stationed at Camp Lejeune, North Carolina, during active service. Thus, his in-service exposure to contaminated water at Camp Lejeune is presumed. See 38 C.F.R. § 3.307 (a)(7)(iii). The Veteran reports that these symptoms are related to his exposure to contaminated water at Camp Lejeune. 

The Board finds that there is at least an indication that the Veteran's described conditions are causally related to his in-service exposure to contaminated water. The Veteran has not been afforded a VA examination to evaluate this contention, and the Board is prohibited from exercising its own independent judgment to resolve medical questions. The Board finds this to be a pre-decision duty to assist error. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, remand is necessary to obtain a VA opinion to determine the nature and etiology of the Veteran's high blood pressure, enlarged prostate, dizzy spells, and headaches.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his high blood pressure. The examiner must respond to the following questions: 

(a.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's high blood pressure began in active service or is otherwise related to active service?

(b.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's high blood pressure is related to his exposure to contaminants in the water during his service at Camp Lejeune? 

2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his enlarged prostate. The examiner must respond to the following questions: 

(a.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's enlarged prostate began in active service or is otherwise related to active service?

(b.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's enlarged prostate is related to his exposure to contaminants in the water during his service at Camp Lejeune? 

3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his dizzy spells. The examiner must respond to the following questions: 

(a.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's dizzy spells began in active service or is otherwise related to active service?

(b.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the
 active service?

(b.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's enlarged prostate is related to his exposure to contaminants in the water during his service at Camp Lejeune? 

3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his dizzy spells. The examiner must respond to the following questions: 

(a.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's dizzy spells began in active service or is otherwise related to active service?

(b.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's dizzy spells are related to his exposure to contaminants in the water during his service at Camp Lejeune? 

4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his headaches. The examiner must respond to the following questions: 

(a.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's headaches began in active service or is otherwise related to active service?

(b.) Whether it is approximately at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran's headaches are related to his exposure to contaminants in the water during his service at Camp Lejeune? 

A complete rationale should be given for any opinion rendered.

Thereafter, readjudicate the remanded claims on appeal.

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Bahus, Alexander

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.