Citation Nr: 0004965 Decision Date: 02/25/00 Archive Date: 03/07/00 DOCKET NO. 98-09 758 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUE Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for residuals of a sprain of the left knee. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD K.L. Salas, Associate Counsel INTRODUCTION The veteran had active military service from March 1951 to March 1953. This appeal arose from an April 1998 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. The RO determined that new and material evidence had not been submitted to reopen the claim of entitlement to service connection for residuals of a sprain of the left knee. The appellant provided testimony before a Member of the Board of Veterans' Appeals (Board) at a hearing at the RO in October 1999, a transcript of which has been associated with the claims file. The case has been forwarded to the Board for appellate review. FINDINGS OF FACT 1. The RO denied the claim of entitlement to service connection for residuals of a sprain of the left knee when it issued an unappealed rating decision in January 1956. 2. The evidence submitted since the January 1956 rating decision is neither wholly duplicative nor cumulative, and is so significant that it must be considered in order to fairly decide the merits of the claim. 3. The claim of entitlement to service connection for a sprain of the left knee is supported by cognizable evidence showing that the claim is plausible or capable of substantiation. 4. Competent medical evidence of record has identified a current left knee disability as a residual of a knee sprain in service. CONCLUSIONS OF LAW 1. Evidence received since the final January 1956 determination wherein the RO denied the claim of entitlement to service connection for residuals of a sprain of the left knee is new and material, and the veteran's claim for that benefit has been reopened. 38 U.S.C.A. §§ 5104, 5108, 7105(c) (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a), 20.1103 (1999). 2. The claim of entitlement to service connection for residuals of a sprain of the left knee is well grounded. 38 U.S.C.A. § 5107 (West 1991). 3. Residuals of a sprain of the left knee were incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.102, 4.3, 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background The evidence at the time of the January 1956 rating decision wherein the RO denied entitlement to service connection for residuals of a sprain of the left knee (claimed as a left knee condition) is reported in pertinent part below. At the time of the veteran's induction examination, no knee disorder was noted. In October 1952 he was treated for a sprain of the left knee secondary to stopping suddenly while playing touch ball. Treatment appears to have lasted about two days. The separation examination recorded no defect of the knee. In January 1956 the RO denied the veteran's claim of entitlement to service connection for residuals of a sprain of the left knee on the basis that no residuals were found. The veteran was notified of the decision by letter dated in January 1956 and informed of his right of appeal. In July 1956 the veteran submitted a private medical report. He told his physician that he had injured his left knee playing football in service in 1952, and had symptoms after discharge including occasional soreness, pain and some giving out when stopping suddenly while running. An examination was performed. The physician wrote that his feeling was that the veteran presented definite and cohesive symptoms of a tear of the posterior portion of the internal semilunar cartilage of the left knee. The doctor acknowledged that this conclusion was not supported by any definite findings in the examination. Slight retropatellar crepitus indicated the presence of chondromalacia of the patella, which was felt to be conceivably attributable to the injury of 1952. A VA examination of the knee was conducted in September 1956. The veteran reported that his left knee was injured in the Army in about August of 1952. An examination of the knee was negative except for some mild crepitation of both knees. The diagnosis was no evidence of internal derangement of either the right or the left knee joint. X-rays showed no abnormal skeletal changes. It was noted on the x-ray report that the clinical history or provisional diagnosis was a possible tear of the medial meniscus and chondromalacia patella. A confirmed rating decision was issued in September 1956. The veteran was informed of the confirmed decision by letter dated in October 1956 and he was notified that the action did not extend his right of appeal beyond one year from January 31, 1956. The veteran submitted a letter dated in May 1957, received by the RO in June 1957, asking for a reexamination. He stated that that he did not think he had been treated fairly and suggested that if he was not reexamined he wished to appeal. In June 1957 the RO notified the veteran that his appeal period was expired. In February 1998 the veteran filed a claim of entitlement to service connection for an injury to the left knee in service in 1952. In a statement accompanying his claim, the veteran stated that he was experiencing discomfort of the left knee with symptoms of pain and soreness. He was of the opinion that he suffered an anterior cruciate ligament (ACL) tear in service, noting that an ACL tear usually occurs following a sudden valgus impact. He also added that knees that are unstable as a result of an ACL tear put a person at risk of early degenerative joint disease as well as subsequent damage to other structures of the knee. The veteran felt that he had all of the symptoms of an ACL tear. He stated that he heard or felt a pop and the knee, which then swelled immediately, indicated a hemarthrosis. He stated that his knee was swollen for several weeks and continued to give way even years after he returned to civilian life. He cited several medical references for the symptoms of an ACL tear. Additional private treatment records from 1976 and 1977 pertaining to the left knee were received. A report from July 1976 noted a history by the veteran of intermittent pain in the left knee for several years that had grown progressively worse. He reported an old football injury, and related at the time of the examination that he was a mail carrier. The examiner's opinion was that he was probably starting to develop some symptoms of a mild arthritis or arthralgia that "may well be due to his type of employment." X-rays from July 1976 showed mild degenerative changes with osteophytes. There was also an appearance of a small fragment that could represent partial avulsion from previous trauma. Another private medical report from August 1977 noted that the veteran had pain in the medial thigh referred to the inguinal area after walking for some time on his mail route and subsiding with rest. An arthrogram of the left knee dated in August 1977 was suggestive of a tear in the lateral meniscus. The veteran then submitted a July 1998 orthopedic evaluation report from Dr. MSW. There was a history of left knee pain and it was noted that he had an initial injury to the left knee playing football in service. He had been running and planted his foot; his knee gave way, and he felt and heard a popping after which there was significant swelling. By history there were multiple episodes of giving way of the knee while walking and being active. There was increasing pain in 1977 and an arthrogram showed a probable meniscus tear. Current complaints included pain and some catching. After an examination and review of radiographs showing minimal scattered degenerative changes, Dr. MSW's impression was ongoing sequelae related to the initial injury, which probably was a lateral meniscus tear. The veteran testified at a hearing before a member of the Board in October 1999. He submitted an October 1999 orthopedic report at the hearing along with a copy of the previously submitted 1998 report, and waived RO consideration of the evidence. He testified that he originally injured his knee jumping out of a window in service because of a feared imminent explosion and later injured the left knee while playing football. The veteran stated that the knee went out and swelled up, and that since the football injury he had had recurrent episodes of falling. Current symptoms included pain, swelling, and giving way of the knee about 10 times a year. He felt that his symptoms were exacerbated by walking in the course of his job as a postal carrier. In his October 1999 orthopedic report Dr. MSW noted that the veteran was experiencing recurrent pain. He had catching and popping of the knee. After an examination, the impression was probable lateral meniscus tear superimposed over degenerative changes and patellofemoral changes that may only be tracking in nature but which could also represent cartilaginous changes as well. Criteria If no notice of disagreement is filed within the prescribed period, the action or determination shall become final and the claim will not thereafter be reopened or allowed, except as otherwise provided by regulation. 38 U.S.C.A. § 7105(c); 38 C.F.R. § 20.1103. If new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C.A. § 5108. See Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). A decision of a duly constituted rating agency or other agency of original jurisdiction shall be final and binding on all field offices of VA as to conclusions based on the evidence on file at the time VA issues written notification in accordance with 38 U.S.C.A. § 5104. A final and binding agency decision shall not be subject to revision on the same factual basis except by duly constituted appellate authorities or except as provided in § 3.105 of this part. 38 C.F.R. § 3.104(a). Despite the finality of a prior final RO decision, a claim will be reopened and the former disposition reviewed if new and material evidence is presented or secured with respect to the claim which has been disallowed. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). The United States Court of Appeals for Veterans Claims (Court) has held that when "new and material evidence" is presented or secured with respect to a previously and finally disallowed claim, VA must reopen the claim. Manio, 1 Vet. App. 140, 145. The Court has held that VA is required to review for its newness and materiality only the evidence submitted by an appellant since the last final disallowance of a claim on any basis in order to determine whether a claim should be reopened and readjudicated on the merits. Evans v. Brown, 9 Vet. App. 273 (1996). In order to reopen a claim by providing new and material evidence, the appellant must submit evidence not previously submitted to agency decision makers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a). New evidence is evidence that (1) was not in the record at the time of the final disallowance of the claim, and (2) is not merely cumulative of other evidence in the record. Smith v. West, 12 Vet. App. 312 (1999); Evans, 9 Vet. App. 273, 283. New evidence is considered to be material where such evidence provides a more complete picture of the circumstances surrounding the origin of the veteran's injury or disability, even where it will not eventually convince the Board to alter its decision. Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998). If the Board determines that new and material evidence has been presented under 38 C.F.R. § 3.156(a), the claim is reopened, and it must next be determined whether the appellant's claim, as then reopened, is well grounded in terms of all the evidence in support of the claim, generally presuming the credibility of that evidence. Elkins v. West, 12 Vet. App. 209, 218-219 (1999). If the claim is well grounded, the case will be decided on the merits, but only after the Board has determined that VA's duty to assist under 38 U.S.C.A. § 5107 has been fulfilled. The Court noted in Elkins and Winters v. West, 12 Vet. App. 203 (1999) that by the ruling in Hodge, 155 F.3d 1356, the Federal Circuit Court "effectively decoupled" the determinations of new and material evidence and well groundedness. Thus, if the Board determines that additionally submitted evidence is "new and material," it must reopen the claim and perform the second and third steps in the three-step analysis, evaluating the claim for well groundedness in view of all the evidence, both new and old, and if appropriate, evaluating the claim on the merits. Elkins, 12 Vet. App. 209; Winters, 12 Vet. App. 203. The Board does not have jurisdiction to consider a previously adjudicated claim unless new and material evidence is presented. Barnett v. Brown, 83 F. 3d 1380, 1384 (Fed. Cir. 1996). When new and material evidence has not been submitted in a previously denied claim "[f]urther analysis...is neither required, not permitted." Butler v. Brown, 9 Vet. App. 167, 171 (1996) (finding in a case where new and material evidence had not been submitted that the Board's analysis of whether the claims were well grounded constituted a legal nullity). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. This may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions. Each disabling condition shown by a veteran's service records, or for which service connection is sought must be considered on the basis of the places, types and circumstances of the veteran's service as shown by service records, the official history of each organization in which the veteran served, medical records and all pertinent medical and lay evidence. Determinations as to service connection will be based on review of the entire evidence of record, with due consideration to the policy of VA to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 C.F.R. § 3.303(a) (1999). With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clear-cut clinical entity, at some later date. 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." When the disease identity is established there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) 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) (1999). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the claimant to produce evidence that his claim is well grounded; that is, that his claim is plausible. Grivois v. Brown, 6 Vet. App. 136, 139 (1994); Grottveit v. Brown, 5 Vet. App. 91, 92 (1993). For a claim for service connection to be well grounded, there must be competent evidence of a current disability in the form of a medical diagnosis, of incurrence or aggravation of disease or injury in service in the form of lay or medical evidence, and of a nexus between in service injury or disease and current disability in the form of medical evidence. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). In addition, in the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The second and third elements of the Caluza test can also be satisfied by evidence that a condition was "noted" in service or during an applicable presumptive period; evidence showing post service continuity of symptomatology; and medical or, in certain circumstances, lay evidence between the present disability and the post service symptomatology. Savage v. Gober, 10 Vet. App. 488 (1997). In Clyburn v. West, 12 Vet. App. 296 (1999), the Court found that while there was evidence of both a current diagnosis and in-service incurrence, no medical nexus evidence had been submitted. The Court rejected the appellant's contention that his continued complaints of knee pain since service, coupled with his diagnosis of chondromalacia patellae just six months after his discharge, were sufficient to satisfy the nexus prong. The issue was one of etiology and therefore the case did not present an issue that could be satisfied by lay testimony. There was no competent medical evidence that the appellant's current condition, whether chondromalacia patellae or degenerative joint disease, was the same condition or related to the knee problems he experienced while on active duty. Although the veteran was deemed competent to testify to the pain he experienced since his tour of duty, he was found to not be competent to testify to the fact that what he experienced in service and since service was the same condition with which he was currently diagnosed. Even under 38 C.F.R. § 3.303(b), medical evidence is required to demonstrate a relationship between a present disability and the continuity of symptomatology demonstrated if the condition is not one where a lay person's observations would be competent. Where the determinative issue involves causation or a medical diagnosis, competent medical evidence to the effect that the claim is possible or plausible is required. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The claimant does not meet this burden by merely presenting his lay opinion because he is not a medical health professional and does not constitute competent medical authority. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Lay assertions cannot constitute cognizable evidence, and as cognizable evidence is necessary for a well grounded claim, Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992), a claim based only on the veteran's lay opinion is not well grounded. In determining whether a claim is well grounded, the claimant's evidentiary assertions are presumed true unless inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19, 21 (1993). The Court has held that if the veteran fails to submit a well grounded claim, VA is under no duty to assist in any further development of the claim. 38 U.S.C.A. § 5107(a); Gilbert v. Brown, 5 Vet. App. 91, 93 (1993); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997); 38 C.F.R. § 3.159(a) (1998). See also McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997). In Morton v. West, 12 Vet. App. 477 (1999), the Court concluded that the Secretary, by regulation, Manual, and/or Compensation and Pension (C&P) policy cannot eliminate the condition precedent placed by Congress upon the inception of his duty to assist. Absent the submission and establishment of a well grounded claim, the Court held that the Secretary cannot undertake to assist a veteran in developing facts pertinent to his or her claim. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after consideration of all of the evidence and material of record in an appropriate case before VA, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1999). I. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for residuals of a left knee sprain. Analysis The veteran seeks to reopen his claim of entitlement to service connection for residuals of a left knee sprain, which the RO denied in January 1956. When a claim is finally denied by the RO, the claim may not thereafter be reopened and allowed, unless new and material evidence has been presented. 38 U.S.C.A. § 7105; 38 C.F.R. § 3.104. When an appellant seeks to reopen a finally denied claim, the Board must review all of the evidence submitted since that action to determine whether the claim should be reopened and readjudicated on a de novo basis. Glynn v. Brown, 6 Vet. App. 523, 529 (1994). In order to reopen a finally denied claim there must be new and material evidence presented since the claim was last finally disallowed on any basis, not only since the claim was last denied on the merits. Evans, 9 Vet. App. 273. Under Evans, evidence is new if not only previously of record and is not merely cumulative of evidence previously of record. The evidence submitted in connection with the veteran's 1998 claim to reopen the prior final January 1956 rating decision includes private medical records from 1976 and 1977, the veteran's statements, including citations to medical treatises, his hearing testimony, and private medical records from 1998 and 1999. The Board concludes that this evidence is new and material. The basis of the prior final denial was that the veteran had no current disability. The medical records submitted by the veteran show treatment of a left knee disability in the 1970s. In 1998 and 1999 a private orthopedist not only concluded that a current disability existed, but offered his opinion that the disability was a residual of the veteran's knee injury in service. This evidence serves to create a more complete picture of the circumstances surrounding the origin of the injury or disability. The veteran's testimony and medical records are also material in that they show continuity of left knee symptomatology after service. The new evidence submitted by him is credible and competent, and bears directly and substantially on the issue at hand. Therefore the appellant's claim is reopened. As the Board noted above, the Court previously announced a three-step test with respect to new and material cases. Under the Elkins test, VA must first determine whether the veteran has submitted new and material evidence under 38 C.F.R. § 3.156 to reopen the claim; and if so, VA must determine whether the claim is well grounded based on the review of all the evidence of record; and lastly, if the claim is well grounded, VA must proceed to evaluate the merits of the claim but only after ensuring that the duty to assist has been fulfilled. Winters v. West, 12 Vet. App. 203 (1999); Elkins v. West, 12 Vet. App. 209 (1999). As new and material evidence has been submitted to reopen the appellant's claim of entitlement to service connection for residuals of a left knee sprain, the first element has been met. Accordingly, the Board's analysis must proceed to a determination of whether the appellant's reopened claim is well grounded; and if so, to an evaluation of the claim on the merits. II. Whether the claim of entitlement to service connection for residuals of a left knee sprain is well grounded. Analysis Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the veteran to produce evidence that his claim is well grounded; that is, that his claim is plausible. Grivois, 6 Vet. App. 136, 139; Grottveit, 5 Vet. App. 91, 92. The Board reiterates the three requirements for a well grounded claim: (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 inservice injury or disease and a current disability. See Caluza, supra. The Board's review of the evidentiary record discloses that there is competent post service medical evidence of a current disabling condition of the left knee - namely, a probable lateral meniscal tear superimposed over degenerative changes and patellofemoral changes - and of a nexus between that current disability and the veteran's in service left knee injury (diagnosed as a sprain at the time). The private medical opinions well ground the veteran's claim under 38 C.F.R. § 3.303(d). The opinions also well ground the claim under 38 C.F.R. § 3.303(b) and Savage. The examiner has linked the condition "noted" in service, the post service medical evidence, the veteran's post service symptomatology, and his current diagnosis. The RO found that the 1998 medical opinion was based entirely on history. Although a restatement of medical history by a medical examiner un-enhanced by any additional medical comment by that examiner, does not constitute "competent medical evidence," LeShore v. Brown, 8 Vet. App. 406, 409 (1995), the Board disagrees that the opinion offered was simply a recitation of history. The examiner's report did not clearly state that medical records were reviewed or that they were not. However, the examiner did make reference to the arthrogram performed in 1977. This suggests that the examiner may well have reviewed the veteran's medical records. Medical evidence is not presumptively credible if based on an inaccurate factual premise or history. Reonal v. Brown, 5 Vet. App. 458 (1993). However, it does not appear that the factual predicates of the examiner's opinion were incorrect. The veteran has provided consistent and credible testimony and statements over the years regarding his football injury to the left knee in service. As the Board noted earlier, the Court announced a three-step test with respect to new and material cases. Under the Elkins test, VA must first determine whether the veteran has submitted new and material evidence under 38 C.F.R. § 3.156 to reopen the claim. The Board has determined that new and material evidence was submitted to reopen the veteran's claim of entitlement to service connection for residuals of a left knee sprain. Under the Elkins test, VA must next determine whether the reopen claim is well grounded. The Board has just determined that the veteran's claim is well grounded. The final step is to evaluate the merits of claim but only after ensuring that the duty to assist has been fulfilled. Winters v. West, 12 Vet. App. 203 (1999); Elkins v. West, 12 Vet. App. 209 (1999). Having accomplished the first two steps, the Board must proceed to evaluate the merits of the claim. III. Entitlement to service connection for residuals of a left knee sprain. Analysis Upon review of all of the evidence of record, including the service medical records, the July 1956 medical report, the August 1956 VA examination report, 1976 and 1977 treatment records, orthopedic reports from 1998 and the veteran's statements and testimony, the Board concludes that the preponderance of the evidence does not weigh against the claim of entitlement to service connection. The evidence is at least in equipoise and therefore the claim is granted, resolving any reasonable doubt in the veteran's favor, as is his right under the applicable laws and regulations. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. The veteran did not have a lot in the way of physical findings in service or shortly after service, but his doctor at the time felt that he had a knee injury and warned that the knee injury could worsen. The evidence submitted over the intervening years shows that that is exactly what happened. He has had ongoing knee complaints and has received treatment for the left knee. There is also competent expert medical opinion that the currently diagnosed left knee disability has an etiological relationship or nexus to the knee injury in service. There is no recent competent medical evidence weighing against the medical reports submitted by the veteran, which are supportive of establishment of service connection under 38 C.F.R. § 3.303(b) or 38 C.F.R. § 3.303(d). While in 1976 there was some suggestion that the veteran's complaints at that time could have some relationship to his employment, the Board concludes that although his work as a postal carrier may have had some effect on his left knee condition given the extensive walking required by the job, there is no clear evidence of an intervening injury breaking the chain of causation between the inservice injury and the veteran's current disability. The Court has held that before the Board addresses a question that has not been considered by the RO, it must consider whether the veteran has been given adequate notice of the need to submit evidence or argument, an opportunity to submit such evidence or argument and an opportunity to address the question at a hearing, and if not, whether or not the claimant has been prejudiced by being denied those opportunities. Bernard v. Brown, 4 Vet. App. 384 (1993). Given that the Board is granting the claim of entitlement to service connection for residuals of a left knee sprain, the Board sees no prejudice to the veteran in making a decision on the merits without remanding the appeal for a medical examination or other development, and for de novo consideration by the RO. ORDER The veteran having submitted new and material evidence to reopen a claim of entitlement to service connection for residuals of a left knee sprain, the appeal is granted. The veteran has submitted a well grounded claim of entitlement to service connection for residuals of a left knee sprain. Entitlement to service connection for residuals of a left knee sprain is granted. RONALD R. BOSCH Member, Board of Veterans' Appeals