Citation Nr: 18154170
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 16-55 985
DATE:	November 29, 2018
REMANDED
Entitlement to service connection for left knee degenerative joint disease is remanded.
Entitlement to service connection for right knee degenerative joint disease is remanded.
REASONS FOR REMAND
The Veteran served on active duty from July 1990 to August 1992.
This case comes before the Board of Veterans’ Appeals (Board) on appeal of a December 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona which denied service connection for a right knee condition and a left knee condition.
In May 2015 the Veteran filed his notice of disagreement, was issued a statement of the case in October 2016, and in November 2016 perfected his appeal to the Board.
Entitlement to service connection for a bilateral knee degenerative joint disease is remanded.
The Veteran contends that his bilateral knee degenerative joint disease was caused by an in-service injury.
The Veteran’s November 1989 medical examination report upon entry into service is normal with no reported knee issues except for a left knee scar.  Likewise, the Veteran’s November 1989 medical history report did not indicate the Veteran had suffered from any issues concerning his knees.
March 1992 service treatment records note left knee treatment wherein the Veteran indicated his left knee felt “100 percent better” with normal gait, ligaments and tendon intact, and patella stable. 
The Veteran’s August 1992 medical examination report upon discharge does not note any issues regarding his knees, and while his August 1992 medical history report upon discharge notes the Veteran is in good health, it also notes a “trick” or “locked knee”, and knee surgery in 1987 prior to service.
July 2002 VA post-service treatment notes indicate the Veteran suffered from left knee pain stemming from an injury he sustained in 1985 prior to service. 
October 2007 VA post-service treatment records note a diagnosis for degenerative joint disease of the left knee.
August 2012 VA post-service treatment records indicate the Veteran stated that the pain in his knees is due to a birth defect.
December 2013 VA post-service treatment notes indicate the Veteran was treated for right knee pain which according to the Veteran had a duration of 20 years, and left knee pain which had a duration of 30 years.  The Veteran indicated he suffered injuries to both knees which caused the pain.
October 2014 VA post-service treatment records note the Veteran was treated for bilateral knee degenerative joint disease and indicated he has had chronic pain since he was very young.
The Veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service.  38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b).  In other words, “[w]hen no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry.” Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004).  The Veteran’s November 1989 medical examination report upon entry into service does not note a left or right knee disability.  While post-service treatment records note evidence of a “trick” or “locked” knee prior to service, and knee pain and surgery prior to service, there is no clear and unmistakable evidence within his claims file which indicates the Veteran had a knee disability prior to service that was not aggravated by service.  Therefore, the Veteran is presumed to have been sound upon entry into active service.
The Veteran has also indicated that his knee pain is the result of a birth defect.  While the Veteran is competent to provide testimony or statements relating to symptoms or facts of events that he has observed and is within the realm of his personal knowledge, he is not competent to establish that which would require specialized knowledge or training, such as medical expertise.  Layno v. Brown, 6 Vet. App. 465, 469-70 (1994).  The record does not show, nor does the Veteran contend, that he has specialized education, training, or experience that would qualify him to render a diagnosis or render a medical opinion on the nature of his knee pain.
The Board cannot make a fully-informed decision on the issue of service connection for right knee degenerative joint disease and a left knee degenerative joint disease because no VA examiner has opined whether the Veteran’s current bilateral knee degenerative joint disease is etiologically related to service.  VA is required to provide an examination or obtain a medical opinion in a claim for service connection when the record contains competent evidence that the claimant has a current disability or persistent or recurrent symptoms of disability, the record indicates that the disability or symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79 (2006).  The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83.
As previously noted, the Veteran’s October 2007 VA treatment notes provide a diagnosis for left knee degenerative joint disease, and October 2014 VA treatment notes provide a diagnosis for bilateral degenerative joint disease, thus competent evidence of a current disability has been demonstrated.  Additionally, the Veteran’s lay statements of sustaining injuries to both knees 20 and 30 years prior to his December 2014 VA treatment provides competent evidence that his bilateral degenerative joint disease may be associated with service as the estimated time elapsed since the injuries may have included the Veteran’s time in service.  However, there is insufficient evidence of a nexus between the Veteran’s in-service symptoms and his current diagnosis to decide the claim, thus the VA’s duty to obtain an examination is triggered.  See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159.  An examination is needed to obtain a medical opinion as to the nature and etiology of the Veteran’s current right knee and left knee degenerative joint disease.
The matters are REMANDED for the following action:
Schedule the Veteran for a VA examination as to the etiology of his right and left knee disabilities.  The claims file must be sent to the examiner for review.
The examiner should indicate whether it is as least as likely as not (50 percent probability or more) that the Veteran’s knee disabilities are related to his military service.
A complete rationale should accompany any opinion provided.
The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. 


 
Jonathan Hager
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Maddox, Associate Counsel 

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

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