Citation Nr: 0003519 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 98-20 311 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for the residuals of a right knee injury. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. P. Kennedy, Associate Counsel INTRODUCTION The veteran served on active duty from November 1977 to February 1980. This case comes before the Board of Veterans' Appeals (Board) from an appeal of a rating decision by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veteran Affairs (VA), in which the RO denied service connection for residuals of laceration of the right patella and strained right gastrocnemius muscle, and for status post repair of ruptured right quadriceps tendon and right knee arthritis. The Board notes that the RO addressed the veteran's right knee service connection claim as two separate issues. However, the Board finds that the two issues are addressing the same claim -- the veteran's claim for service connection for the residuals of an inservice right knee injury. Therefore, these issues can be consolidated and addressed together as one issue. FINDING OF FACT The record does not show competent medical evidence of a nexus between a current right knee disability and a disease or injury incurred or aggravated during active military service. CONCLUSION OF LAW The veteran's claim for service connection for the residuals of a right knee injury is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION The threshold question that must be resolved regarding any given claim is whether the appellant has presented evidence that the claim is well grounded; that is, that the claim is plausible. If he or she has not, the appeal fails as to that claim, and the Board is under no duty to assist him or her in any further development of that claim, since such development would be futile. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78 (1990). The United States Court of Veterans Appeals (now the United States Court of Appeals for Veterans Claims, hereinafter the Court) has held that a well grounded claim is comprised of three specific elements: (1) evidence of a current disability as provided by a medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, (3) a nexus, or link, between the inservice disease or injury and the current disability, as provided by competent medical evidence. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd 78 F.3d 604 (Fed. Cir. 1996) (table). In the absence of any one of these three elements, the claim is not plausible, and the Board must find that the claim for service connection is not well grounded and therefore must be denied, pursuant to the decision of the Court in Edenfield v. Brown, 8 Vet. App. 384 (1995). The Board first looks to evidence of a current right knee disability. The Board finds that, for purposes of a well grounded claim, the veteran has submitted sufficient evidence of a current disability. The most recent VA examination, from January 1998, revealed that the veteran complained of right knee pain requiring medication, ever since a June 1996 right knee injury while playing basketball. He described the pain as anterior knee pain that increases with activity and affects his daily living. The examination revealed that he has some patellar crepitus, and X-rays showed moderate to severe patellofemoral degenerative joint disease with mild medial and lateral compartment degenerative changes and a loose body versus myositis ossificans in the suprapatellar pouch. The examiner's diagnosis was chronic right knee pain with moderate to severe patellofemoral arthritis with mild medial and lateral compartment arthritis status post operative repair of a probable ruptured quadriceps tendon in August 1986. The Board relies on this diagnosis as a credible basis for finding that the veteran does have a current disability. As for evidence of the incurrence or aggravation of an injury or disease inservice, the Board finds sufficient evidence of an inservice right knee injury. The veteran's service medical records reveal that in May 1978, the veteran complained of a contusion and slight laceration of the right patella that was painful when he walked. The examiner found full range of motion of the knee, with pain on walking, and slight tenderness and swelling on the patella. The diagnostic assessment was laceration on the patella from trauma, with a prescription of an Ace wrap and use of a cane for 7 days. Additionally, the service medical records show that in July 1979 the veteran complained of a painful knee that started while playing basketball the previous evening. The examiner observed that the veteran had a tender gastrocnemius muscle, and assessed the condition as a strained gastrocnemius muscle. The examiner prescribed heat and ice, and no physical training for 4 days. The Board finds that this is sufficient evidence of an inservice right knee injury for purposes of a well grounded claim. See Caluza, supra. The critical issue for the veteran's case is whether the record contains adequate nexus evidence, as provided by a competent medical authority, between the veteran's current right knee condition and his active military service. After reviewing the evidence, the Board finds that the veteran's claim fails on this count. The Board first points out that, as part of the veteran's January 1980 separation physical, he completed a Report of Medical History that made no mention of a right knee problem, nor was one detected during his examination. The record does not show evidence of a right knee condition until 1996, approximately 16 years following service discharge. An August 1996 VA inpatient treatment report reveals that the veteran injured his right knee while playing basketball approximately 7 weeks prior to the August 1996 hospitalization. The reported history of the injury and treatment is that the veteran complained of right knee pain and swelling from the basketball incident, he then received physical therapy that did not improve his knee condition, and subsequently was seen by the VA Orthopedic Clinic, where he was diagnosed with a ruptured right quadriceps tendon. The August 1996 inpatient report indicates that his right quadriceps tendon was repaired. Follow-on VA outpatient treatment records from October 1996 indicate that the veteran was using a knee brace and prescribed physical therapy. There is no evidence in these treatment records that connects the veteran's August 1996 basketball injury to his inservice strained gastrocnemius muscle or the laceration of his patella. There is no reference at all in these 1996 records to any inservice knee problem. The medical evidence from 1996 clearly indicates that the veteran's right knee problems for which he was operated on were due to an injury incurred in a basketball game 16 years after service discharge. The Board also considers the report from the January 1998 VA examination that was previously discussed. The report refers to a medical history of a June 1996 basketball injury incurred "in service". The report then goes on to describe the extent of the veteran's knee disability and, in the diagnosis, attributes the knee disability to the injury sustained "in service". However, the evidence clearly shows that this June 1996 basketball injury took place many years after service discharge. Whether the examiner is mistaken in his account of the veteran's reported medical history or the veteran reported that he was still inservice at the time of his June 1996 basketball injury, is of little concern to the Board. The VA examiner in January 1998 clearly attributes the veteran's current knee disability to the residuals of the ruptured quadriceps tendon injury sustained in 1996. There is no question that the veteran had long since been off of active military duty by this time. Therefore, the nexus evidence that this report presents is not between the veteran's current knee disability and his active military service, but rather between the current knee condition and the 1996 post service knee injury. The Board also acknowledges the statements submitted by the veteran with his July 1998 Notice of Disagreement concerning the extent of his right knee disability. First, the Board in no way downplays the extent of the veteran's current knee disability. However, we do note that the veteran's assertions that his sharp knee pains and inability to bend his knee very much or make quick movements because he would easily fall, all dating back to an inservice knee injury, appear inconsistent with the fact that his 1996 knee injury took place while playing basketball. In weighing the veteran's statements against the documented medical evidence of record, the Board is swayed by the definitive conclusions of the 1998 VA examiner attributing the current knee condition to the 1996 basketball injury. The Board does not find any competent medical evidence on record that provides a causal nexus between the veteran's right knee injury in service and his current right knee condition. There is no opinion from a competent medical authority that the veteran's current knee disability is related to his inservice patella laceration or his strained right gastrocnemius muscle, which are the only two knee conditions documented in service. The veteran essentially relies on his own opinion that his current right knee disability was caused by an inservice knee injury. The medical evidence does not support this conclusion. The record does not show that the veteran is a medical professional or has the training and expertise to be qualified to provide opinions on clinical findings. Consequently, his statements do not constitute competent medical evidence of causation. Such a claim must be based on a diagnosis by a qualified physician and supported by a physical examination. Green v. Derwinski, 1 Vet. App. 121, 124 (1991). A review of the record does not reveal any competent medical evidence from a qualified physician to support this claim. Evidence of causation requires competent medical knowledge, which is not present in this case. See Espiritu, supra, at 494. As the veteran has presented no evidence, other than his own allegations, to establish a nexus between his current right knee condition and any inservice injury or disease, his claim for service connection for the residuals of a right knee injury is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Caluza, 7 Vet. App. at 506. The Court has held that, when a claimant fails to submit a well grounded claim under 38 U.S.C.A. § 5107(a) (West 1991), VA has a duty under 38 U.S.C.A. § 5103(a) (West 1991) to advise the claimant of the evidence required to complete his or her application, in circumstances in which the claimant has referenced other known and existing evidence. Robinette v. Brown, 8 Vet. App. 69 (1995); see also Epps v. Brown, 9 Vet. App. 341 (1996). In this case, the Board finds that this procedural consideration has been satisfied. In particular, the Board notes that the rating decision and statement of the case advises the veteran that there is no competent medical evidence that his current left knee condition either occurred in or was caused by active service. Moreover, unlike the situation in Robinette, he has not put VA on notice of the existence of any specific, particular piece of evidence that, if submitted, could make any of his claims well grounded. ORDER Entitlement to service connection for the residuals of a right knee injury is denied. MARY GALLAGHER Member, Board of Veterans' Appeals