Citation Nr: 0002511 Decision Date: 02/01/00 Archive Date: 02/10/00 DOCKET NO. 98-11 485 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for a left knee disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michelle L. Nelsen, Associate Counsel INTRODUCTION The veteran had active duty from September 1950 to June 1952. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. FINDING OF FACT There is no competent medical evidence of a nexus between the veteran's current left knee disorder and his period of active duty service. CONCLUSION OF LAW The veteran's claim of entitlement to service connection for a left knee disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.102 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(a) (1999). Service connection may be demonstrated either by showing direct service incurrence or aggravation or by using applicable presumptions, if available. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994) (specifically addressing claims based ionizing radiation exposure). Direct service connection requires a finding that there is a current disability that has a definite relationship with an injury or disease or some other manifestation of the disability during service. Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). A disorder may be service connected if the evidence of record reveals that the veteran currently has a disorder that was chronic in service or, if not chronic, that was seen in service with continuity of symptomatology demonstrated thereafter. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 494-97 (1997). Evidence that relates the current disorder to service must be medical unless it relates to a disorder that may be competently demonstrated by lay observation. Savage, 10 Vet. App. at 495-97. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). Disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establish that the disorder was incurred in-service. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). Some chronic diseases are presumed to have been incurred in service, although not otherwise established as such, if manifested to a degree of ten percent or more within one year of the date of separation from service. 38 U.S.C.A. § 1112(a)(1); 38 C.F.R. § 3.307(a)(3); see 38 U.S.C.A. § 1101(3) and 38 C.F.R. § 3.309(a) (listing applicable chronic diseases, including arthritis). If an injury or disease was alleged to have been incurred or aggravated in combat, such incurrence or aggravation may be shown by satisfactory lay evidence, consistent with the circumstances, conditions, or hardships of combat, even if there is no official record of the incident. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). "Satisfactory evidence" is credible evidence. Collette v. Brown, 82 F.3d 389, 392 (1996). Such credible, consistent evidence may be rebutted only by clear and convincing evidence to the contrary. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter "the Court") has repeatedly held that this provision does not establish a presumption of service connection, but eases the combat veteran's burden of demonstrating the occurrence of some inservice incident to which the current disability may be connected. See Clyburn v. West, 12 Vet. App. 296, 303 (1999); Arms v. West, 12 Vet. App. 188, 194-95 (1999); Wade v. West, 11 Vet. App. 302, 304- 305 (1998); Russo v. Brown, 9 Vet. App. 46, 50 (1996); Caluza v. Brown, 7 Vet. App. 498, 507 (1995). Therefore, "[s]ection 1154(b) provides a factual basis upon which a determination can be made that a particular . . . injury was incurred . . . in service but not a basis to link etiologically the [injury] in service to the current condition." Cohen v. Brown, 10 Vet. App. 128, 138 (1997) (citing Libertine v. Brown, 9 Vet. App. 521, 524 (1996); Caluza, supra). However, a person claiming VA benefits must meet the initial burden of submitting evidence "sufficient to justify a belief in a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 91 (1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). A claim that is well grounded is plausible, meritorious on its own, or capable of substantiation. Murphy, 1 Vet. App. at 81; Moreau v. Brown, 9 Vet. App. 389, 393 (1996). For purposes of determining whether a claim is well grounded, the Board presumes the truthfulness of the supporting evidence. Arms v. West, 12 Vet. App. 188, 193 (1999); Robinette v. Brown, 8 Vet. App. 69, 75 (1995); King v. Brown, 5 Vet. App. 19, 21 (1993). In order for a claim to be well grounded, there must be competent evidence of a current disability (a medical diagnosis); of incurrence or aggravation of a disease or injury in service (lay or medical evidence); and of a nexus between the in-service injury or disease and the current disability (medical evidence). Epps v. Gober, 126 F.3d 1464, 1468 (1997); Caluza, 7 Vet. App. 498, 504 (1995). Where the determinative issue involves a medical diagnosis, there must be competent medical evidence to the effect that the claim is plausible; lay assertions of medical status do not constitute competent medical evidence. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). VA's duty to assist a veteran in developing facts pertinent to his claim is not triggered until and unless the veteran submits a well grounded claim. Morton v. West, 12 Vet. App. 477, 486 (1999). In this case, the April 1998 VA examination report reveals a diagnosis of degenerative joint disease in the left knee with probable tears of the anterior cruciate ligament, posterior cruciate ligament, and medial meniscus. Therefore, the first criterion of a well grounded claim is met. The veteran generally claims that the knee disorder is related to service. Specifically, he relates that he suffered a knee infection, carbuncles on either side of the knee, in service. Notes on the veteran's June 1952 separation examination indicate that, following infection over the knee in July 1951, he had had trick knee. Thus, there is evidence of the in-service incurrence of some knee injury or disease in service. On this issue, the Board offers two observations. First, although there is a current diagnosis of degenerative joint disease, there is no evidence that the arthritis was present to a compensable degree within one year of the veteran's separation from service. Thus, the presumption of in-service incurrence is not applicable. 38 U.S.C.A. § 1112(a)(1); 38 C.F.R. § 3.307(a)(3). Second, the veteran served in Korea, and service records indicate that he was awarded the Combat Infantryman Badge, which denotes combat status. However, the veteran does not allege here that the left knee disorder at issue was incurred in combat. Therefore, there is no presumption of in-service incurrence of the knee disorder based on the veteran's general combat status. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). However, the Board finds that the veteran's claim is not well grounded because there is no competent medical evidence of a nexus between service and the currently diagnosed left knee problems. Although the veteran related the pertinent in- service knee history to the VA examiner, the examiner did not relate the current disorder to service. It is not enough that the examiner recorded the veteran's statements. Medical history provided by a veteran and recorded by an examiner without additional enhancement or analysis is not competent medical evidence. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). A review of the claims folder reveals only that the veteran himself has opined that the left knee infection in service is related to his current left knee problems. As a lay person, the veteran is competent to report his symptoms. However, he is not competent to offer an opinion on a matter that requires medical knowledge, such as a determination of etiology. Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494. Absent competent medical evidence showing a relationship between the infection shown in service and the veteran's current left knee disorder, the claim is not well grounded. Epps v. Gober, 126 F.3d 1464, 1468 (1997). Under these circumstances, the Board finds that the veteran has not submitted a well grounded claim for service connection for a left knee disorder. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.102; Epps, 126 F.3d at 1468. Therefore, the duty to assist is not triggered and VA has no obligation to further develop the veteran's claim. Epps, 126 F.3d at 1469; Morton, 12 Vet. App. at 486; Grivois v. Brown, 5 Vet. App. 136, 140 (1994). The Board recognizes that this appeal is being disposed of in a manner that differs from that used by the RO. The RO denied the veteran's claim on the merits, while the Board has concluded that the claim is not well grounded. However, the Court has held that "when an RO does not specifically address the question whether a claim is well grounded but rather, as here, proceeds to adjudication on the merits, there is no prejudice to the veteran solely from the omission of the well-grounded analysis." Meyer v. Brown, 9 Vet. App. 425, 432 (1996). If the veteran wishes to complete his application for service connection for a left knee disorder, he should submit medical evidence that relates his current knee problems to service. 38 U.S.C.A. § 5103(a); Robinette, 8 Vet. App. at 77-80. The Board notes that, during the January 1999 hearing, the hearing officer advised the veteran to seek out and submit any past private medical records he believed would support his claim. Although the veteran did not produce any such evidence, he is again advised that previous medical records may be useful in supporting his claim. ORDER Entitlement to service connection for a left knee disorder is denied. RENÉE M. PELLETIER Member, Board of Veterans' Appeals