BVA9505636 DOCKET NO. 93-11 777 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona THE ISSUE Entitlement to service connection for a right knee disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD W. Pope, Counsel INTRODUCTION The veteran had more than six years and eight months of active service from December 1974 to August 1981. Her records also indicate periods of active duty for training with the U.S. Air Force Reserve. Rating decisions in February 1982 and November 1985 denied service connection for a right knee disability incurred during the veteran's active service ending in August 1981. As the current claim is based on a period of active duty for training in March 1984, this decision will be de novo in nature. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1991 rating decision. The veteran was present for a hearing before a hearing officer at the RO in June 1992. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for a right knee disability which was incurred on March 12, 1984 during a period of active duty for training. She asserts that she has continued to require and receive treatment for a right knee problem since that injury. 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 the claim of service connection for a right knee disability. FINDINGS OF FACT 1. All relevant evidence referable to the current appeal has been requested by the RO. 2. The veteran received a "contusion/mild sprain" of the right knee during active duty for training on March 12, 1984. 3. A chronic disability of the right knee was not shown during the veteran's active duty for training in March 1984 and no current right knee pathology is shown to be a residual of the March 1984 injury. CONCLUSION OF LAW A chronic disability of the right knee did not result from a disease or injury incurred in or aggravated by the veteran's active duty for training in March 1984. 38 U.S.C.A. §§ 101(24), 106, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107, and that all relevant facts have been properly developed for this appeal. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated while performing active duty for training or injury incurred or aggravated while performing inactive duty for training. 38 U.S.C.A. §§ 101(24), 106, 1131. For the showing of a 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." A continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic. When the fact of chronicity in service is not adequately supported, then a showing of continuity after service discharge is required to support the claim. 38 C.F.R. § 3.303(b). When a disease was not initially manifested during service or within the applicable presumption period, the appellant may establish the "required nexus" for service connection by evidence demonstrating a medical relationship between the current disability and the service. 38 C.F.R. § 3.303(d); Godfrey v. Derwinski, 2 Vet.App. 352, 356 (1992). Medical records from Travis Air Force Base in California disclose that the veteran was seen at approximately 3:15 P.M. on March 12, 1984 for complaints of right knee pain after stepping in a hole while running It was noted that she had transported herself to the medical facility. A physical examination of the knee disclosed erythema. There was coldness over the proximal aspect of the knee due to an ice pack, and "mild tenderness" of the patella on motion. The knee was stable bilaterally. Drawer and McMurray's tests were negative. X-ray studies were reported as showing no evidence of fracture. The assessment was "contusion/mild sprain" of the right knee. A U.S. Air Force Medical Certificate (AF Form 1971) dated March 13, 1984, discloses that the veteran was able to return to normal military duty after treatment for traumatic subluxation of the right patella. A U.S. Air Force Physical Profile Serial Report (AF Form 422) states that the veteran was to remain on temporary restricted duty without running, squatting, aerobics or pushing until March 16, 1984, due to acute subluxation of the right patella. Medical records from Luke Air Force Base in Arizona disclose that the veteran was seen in May 1984 for complaints of knee pain. She reported an injury in March 1984 and stated that she was "still unable to kneel" on her right knee. It was noted that she had been seen by a physician's assistant on approximately March 19, 1984, but that the treatment records were not available. A physical examination of the right knee revealed no swelling, effusion or deformity. There was diffuse anterior lateral and medial tenderness, and pain on compression of the patella. The examiner noted that the right patella tracked normally. X-ray studies of the right knee were reported as within normal limits. A report of a September 1984 "periodic...flying" examination for the U.S. Air Force Reserves was negative for complaints or findings of a right knee problem. On an accompanying medical history questionnaire, completed and signed by the veteran, she indicated that she did not have any swollen or painful joints, any joint deformity or a "trick" or locked knee. VA outpatient treatment records disclose that the veteran was seen for neurological complaints concerning her right leg in March 1990. A report of July 1990 X-ray studies of the right knee showed degenerative joint disease. In November 1990 the veteran reported right knee pain, swelling, clicking and "giving way." Crepitus with motion was noted in both knees. A McMurray's test of the right knee was positive. The impression was probable lateral meniscus tear of the right knee. An April 1991 VA social worker's notation revealed that the veteran had worked for "the Immigration Dept., was hurt on the job, was under Workman's Comp. until Dec. 1990 then she was terminated....She now has problems [with right] leg that is disabling...." In October 1991 the veteran reported a "1 1/2 yr." history of right knee pain, and a history of a "fall" in 1985. She also reported "giving out", locking and swelling of the knee. A McMurray's test was positive. The assessment was lateral meniscus tear. An arthroscopic examination was planned, but subsequently canceled by the veteran. During a June 1992 VA hearing the veteran testified that at the time of her injury in March 1984 her right knee had swollen to "the size of a small watermelon," and that the only reason she was not hospitalized was "because [she] was a reservist." (See pages two and three of the transcript of the June 24, 1992 VA hearing.) She indicated that she had sought treatment for the knee at Luke Air Force Base shortly after the injury, had subsequently received treatment from a private physician, and had begun receiving treatment from the VA in approximately November 1985. She asserted that she would supply information to obtain medical records of the aforementioned treatment within 30 days. Information necessary to obtain private medical reports was not provided. Attempts to obtain additional VA and service treatment records dated prior to 1990 have not been successful. Upon review of the evidence the Board finds that the contemporaneous medical records show a March 1984 injury of the right knee which was much less severe than recalled by the veteran. In fact, the treating physician noted only a "contusion" or "mild sprain" of the knee, and released her to normal duty after a few days. There was no suggestion, at any time, of a need for hospitalization. Based on this evidence, it cannot be concluded that a chronic right knee disability was present during active duty. Further, contrary to her recent testimony that she had recurrent problems with her right knee following this incident, the contemporaneous medical records also disclose that the veteran specifically denied any problems related to her right knee in September 1984. The complaints concerning her current right knee difficulties did not appear until 1990, more than five years after the noted injury. In addition, the veteran has never provided the information, promised during her June 1992 hearing, which could substantiate complaints or treatment for right knee problems between 1984 and 1990, or medical evidence attributing her current right knee pathology, a torn lateral meniscus and degenerative joint disease, to the March 1984 injury. As noted by the United States Court of Veterans Appeals, unsupported lay assertions presented by the veteran concerning such questions of medical diagnosis or causation are not competent evidence. See Grottveit v. Brown, 5 Vet.App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet.App. 492, 494-95 (1992). Accordingly, in the absence of competent evidence substantiating a chronic disability of the right knee as a result of the injury during the veteran's active duty for training in March 1984, the Board finds that the preponderance of the evidence is against the claim of service connection for a right knee disability. 38 U.S.C.A. §§ 101(24), 106, 1131; 38 C.F.R. § 3.303. ORDER Service connection for a right knee disability is denied. ______________________________ WAYNE M. BRAEUER 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.