BVA9502470 DOCKET NO. 93-08 961 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Entitlement to service connection for a right knee disorder with arthritis. 2. Entitlement to service connection for a left knee disorder with arthritis. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD C. Chaplin, Associate Counsel INTRODUCTION The veteran had active service from January 1952 until August 1955 and from February 1956 until July 1972. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of October 1991, from the Seattle, Washington, regional office (RO) which denied service connection for residuals of residuals of right knee bursitis and for residuals of left knee strain. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO erred in not granting service connection for a bilateral knee disorder. He contends that while on board ship he was exposed to wet, cold conditions while kneeling on cold steel which caused the bursitis of his knees. He states that while stationed at a land base, he did not have trouble with his knees, which is why there is no mention of it in his medical records. He claims that as he becomes older, the problem that started aboard ship has recurred and is a painful condition which affects his walking. He also claims that at the discharge examination he was not properly evaluated. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against service connection for a right knee disorder with arthritis and for a left knee disorder with arthritis. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained by the agency of original jurisdiction. 2. Bursitis of the knees and a minor strain of the left knee treated during service involved acute and transitory symptoms which resolved without residuals. 3. Arthritis of the knees was not shown during service or in the one year presumptive period and did not result from any incident of service. CONCLUSIONS OF LAW 1. Service connection for a right knee disorder with arthritis is not warranted. 38 U.S.C.A. § 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. § 3.303, 3.307, 3.309 (1993). 2. Service connection for a left knee disorder with arthritis is not warranted. 38 U.S.C.A. § 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. § 3.303, 3.307, 3.309 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant's claim is "well grounded" within the meaning of 38 U.S.C.A. 5107(a) (West 1991); that is, he has presented a claim that is plausible. Murphy v. Derwinski, 1 Vet.App. 78 (1990). Furthermore, he has not indicated that any probative evidence not already associated with the claims folder is available; therefore the duty to assist him has been satisfied. Id. The veteran filed a claim in May 1991, seeking service connection for a bilateral knee disorder, claiming the disorder initially presented as bursitis of both knees, and now is degenerative arthritis of both knees. By a rating action in October 1991, the RO denied service connection for residuals of right knee bursitis and for residuals of left knee strain. The veteran was so notified by letter dated in October 1991. He disagreed with the determination and initiated an appeal. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service and not the result of the veteran's own willful misconduct. 38 C.F.R. §§ 3.301, 3.303(b) (1994). 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." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1994). To establish service connection for a condition, symptoms during service must be identifiable as manifestations of a chronic disease or permanent effects of any injury. Further, a present disability must exist and it must be shown that the present disability is the same disease or injury, or is the result of disease or injury incurred in or made worse by the veteran's military service. In addition, where a veteran served 90 days or more during a period of war 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.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). Evidence reviewed included service medical records, a Department of Veterans Affairs (VA) examination report and a letter from a private physician. The service medical records show complaints of swelling and pain of the right knee on several occasions from November 1952 until March 1954. No history of injury to the knee was given. In March 1954, an examination of the right knee showed no limitation of motion, intact ligaments, negative cartilage tests and "subjective complaints of pain." An x-ray in April 1954 was described as within normal limits. The diagnosis was pre-patellar bursitis. The medical examination report in February 1956 gave a history of the veteran being informed by a doctor in the Navy that he had a mild case of bursitis in both knees. No clinical abnormalities were noted on that examination. A sick call record for April 1959 showed bursitis of the left knee with complaints of pain of the left knee on bending or standing too long. The examiner noted good mobility of the knee and a strong joint. The veteran's knee was treated with heat and an Ace bandage, and he was put on light duty. Reenlistment examinations in January 1964 and in January 1968 noted no complaints, findings or history of knee problems. An entry in July 1969 noted that the veteran fell and injured his left leg. An x-ray of the left knee and foot was negative for a fracture. The knee was stable, not swollen, and not very tender, with only a slight decrease in range of flexion. The impression was a minor strain of the knee. The service medical records show no other complaints, treatment or diagnosis for either knee. A medical examination, in December 1971, for an extension of enlistment, evaluated the lower extremities as "normal." The medical examination in June 1972, six months later, for transfer to fleet reserve, also evaluated as "normal" the lower extremities. With his claim submitted in May 1991, the veteran included a letter dated in May 1991 from Martin L. Proudfoot, M.D., who wrote "he also has degenerative arthritis bilaterally, mostly effecting his knees." A VA medical examination in June 1991 recorded the history as related by the veteran that bursitis of the knees began in about 1953. He had arthroscopic surgery of the right knee in 1987. His walking is limited because of the knee pain and the knees are swollen about once a week. The examiner diagnosed "[d]egenerative joint changes in the knees bilaterally with recurrent bursitis as noted above; status post apparent meniscectomy per arthroscope in 1987 in the left knee; physical findings suggestive of degenerative joint disease mild to moderate, well managed on Ecotrin daily, . . .with some limitations in the activities as described; . . . . X-ray findings indicated "rather severe bilateral degenerative arthritis in the knees, principally involving the medial joint compartments but also involving the patella-femoral compartment on the right." In March 1992, the veteran was afforded a personal hearing at which he testified that his knee problems began in January 1953 as a result of kneeling on the ship's deck in rain and cold weather. His knees would swell and he was told he had bursitis of the patella. He claimed he was not properly medically evaluated at the discharge examination. He alleged that the examination had been a "rush, rush deal" as the base was closing and the Navy was just interested in getting out. He stated that he has had a continuing problem with his knees during and after service and has treated the pain with aspirin. He further stated that he had continuous ongoing treatment for his knees since leaving service in 1972. He has had cartilage removed from the left knee and in the future, might need knee replacement surgery. He described having trouble walking, that his knees swell up about every other day and that his knees give way on him. Thomas J. Degan, M.D., wrote in February 1992, that the veteran "has been followed since 1987 for knee problems while working as a plumber." He was seen in March 1987 and felt to have early degenerative arthrosis of the medial compartment. An arthroscopy was performed. Dr. Martin Proudfoot wrote in June 1992 that the veteran has arthritis of the knees. "His knee problems began while he was in the service in 1952. He has had symptoms intermittently. In 1987, Thomas Degan, M.D., Orthopedist, operated on his left knee. He has symptoms in the right knee as well." We note the veteran's contention that he was not properly medically evaluated at the discharge examination claiming that the examination had been a "rush, rush deal." The medical examination in June 1972, for transfer to fleet reserve, evaluated as "normal" the lower extremities. However, findings at a medical examination, six months earlier, in December 1971, for an extension of enlistment, had also evaluated the lower extremities as "normal." The findings of the discharge examination, which included vision, hearing, blood pressure, indicate that more than just a cursory examination was performed. While service medical records indicate that the veteran sought occasional treatment during service in the early 1950's for painful knees and in July 1969 for a strain of the left knee, there is no evidence that a chronic bilateral knee disorder was manifested in 1972 at the time of his discharge from his active duty. Thus it is reasonable to conclude that any inservice bilateral knee pain was acute and transitory, leaving no residuals. Even if a chronic knee disorder was not manifest during service, chronicity may be shown if there is a continuity of symptomatology and treatment from shortly after discharge until the disorder is noted to be chronic. However, in this case, the first post service medical reference to a knee disorder dates from 1987, many years after service. In the absence of evidence showing continuity of symptomatology, service connection for a bilateral knee disorder must be denied. We note that Dr. Proudfoot wrote that the veteran's knee problems began in service in 1952 and had symptoms intermittently with arthroscopic surgery performed in 1987. This is outweighed, however, by the contemporaneous 18 years of service medical records which do not show a bilateral knee disorder. Moreover, the letter does not indicate that Dr. Proudfoot treated the veteran at a time proximate with his discharge from service or in the years immediately following discharge and prior to 1987, nor does the record indicate that the physician reviewed the service medical records to obtain an accurate medical history. The veteran also contends that he incurred arthritis of the knees as a result of service and that he should be entitled to service connection for this disability. There was no evidence of degenerative joint disease of either knee in service. In addition, a review of the evidence fails to demonstrate that arthritis was manifested within the one year presumptive period following the veteran's discharge from military service such that presumptive service connection benefits would be warranted. Accordingly, we conclude that service connection for a right knee disorder, and for a left knee disorder is not warranted. ORDER The benefit sought on appeal is denied. BETTINA S. CALLAWAY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.