Citation Nr: 0007478 Decision Date: 03/20/00 Archive Date: 03/23/00 DOCKET NO. 96-19 616 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for a left knee disorder. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Hancock, Counsel INTRODUCTION The veteran served on active duty from April 1969 to October 1970. The veteran also had verified inactive duty training from July 11, 1993, to July 14, 1993, and active duty for training (ACTDUTRA) from June 2, 1995, to September 19, 1995. The issue currently on appeal arises before the Board of Veterans' Appeals (Board) from a rating decision dated in February 1996 by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The veteran was afforded a personal hearing, conducted by a local hearing officer, at the RO in November 1997. The Board notes that the veteran failed to report for a hearing scheduled to be held before a member of the Board at the RO in April 1999. FINDING OF FACT The left knee disorder is of service origin. CONCLUSION OF LAW A left knee disability was incurred during active duty for training. 38 U.S.C.A. §§ 101(24), 106, 11310, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran and his representative contend, in essence, that service connection for a left knee disability is warranted. The veteran, during his hearing at the RO in November 1997, asserted that he injured his left knee during active duty for training (ACTDUTRA) while stationed at Fort Belvoir, Virginia in 1994 or 1995. He added that he was treated during that time in sick bay for left knee problems. Initially, the Board has found that the veteran's claim for service connection for a left knee disorder is well grounded pursuant to 38 U.S.C.A. § 5107 (West 1991) in that his claim is plausible, that is meritorious on its own and capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78 (1990). Once it has been determined that a claim is well grounded, VA has the statutory duty to assist the appellant in the development of evidence pertinent to that claim. The Board is satisfied that all relevant evidence is of record, and the statutory duty to assist the veteran in the development of evidence pertinent to his claim has been met. Service connection may be granted, in part, for "disability resulting from personal injury suffered or disease contracted in the line of duty...." 38 U.S.C.A. § 1110 (West 1991). Service connection may also be granted for a disability resulting from a disease or injury incurred in or aggravated while performing active duty for training, or for an injury incurred or aggravated while performing inactive duty for training. 38 U.S.C.A. §§ 101(24), 106 (West 1991). A veteran is presumed to be in sound condition when accepted for service except for defects noted at the time of examination, acceptance and enrollment, or where clear and unmistakable evidence demonstrates that the disability existed prior to service. 38 C.F.R. § 3.304 (1999). Service connection may also be granted for aggravation of a preexisting disability. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306 (1999). In determining whether service connection is warranted for a disability, the VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107 (West 1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The service medical records for the veteran's period of active duty, to include the September 1970separation examination, reflect no complaint or finding relative to a left knee disorder. As noted above, the veteran had ACTDUTRA from June 2, 1995, to September 19, 1995. Review of the evidence of record shows that the veteran was treated for complaints concerning his left knee on several occasions in June 1995 and also in July 1995. A June 1995 sports medicine clinic report shows that the veteran presented with an acute complaint of left medial knee pain, which began about three weeks previously after he came onto active duty. Examination showed soft tissue swelling and normal range of motion. The diagnosis was left knee pes anserine bursitis. A sick slip, also dated in June 1995, shows that the veteran was not to run for 7 days. A VA examination was conducted in September 1995. The clinical history indicated that the veteran injured his left knee during summer camp in 1984 while running during physical training exercises, at which time it became swollen. He also reported re-injuring his knee in 1995 while running, at which time he again experienced swelling. No history of locking was reported but swelling and intermittent pain was noted. Examination showed no swelling or instability with flexion to 100 degrees and extension to 0 degrees. No meniscal injury was noted. Osteoporosis was diagnosed. In a letter, December 1995, the veteran indicated that he had checked with his guard unit and that they did not have his medical records. Subsequent efforts by VA to obtain additional service medical records have been unsuccessful. As indicated above, the veteran testified at a hearing in November 1997. He noted that he injured his left knee during ACTDUTRA while stationed at Fort Belvoir, Virginia in 1994 or 1995. He added that he was treated during that time in sick bay for left knee problems. He further stated that he was not given a brace or a cane and that he never received a diagnosis concerning his left knee. He noted that he had been treated by a private physician for his knee since that time. The veteran also testified that his knee was occasionally unstable, and sometimes swelled and locked up. A VA examination was conducted in December 1997. At that time the veteran again complained of left knee pain and swelling. Examination revealed no tenderness, deformity, or edema. Stability was described as good. X-rays of the left knee showed osteoporosis. The diagnosis was chronic pain in the left knee of unknown etiology and osteoporosis of the left knee. The examiner commented that the veteran had functional loss, described as moderate, due to left knee pain. A VA orthopedic examination was conducted in October 1999. At that time the veteran reported initially injuring his knee while performing physical training in 1985. He also reported re-injuring his knee in 1995. The veteran indicated that he was currently being treated by a private physician, an orthopedist, with anti-inflammatory medications, and that he had been informed by this physician that he had osteoporosis. He complained of left knee stiffness, swelling, and occasional locking which were precipitated by prolonged standing and walking. Examination revealed that the veteran ambulated with a moderate limp. Left knee examination showed mild soft tissue swelling, but no effusion. Tenderness was noted around the patella and along the joint lines. Range of motion testing showed flexion only to 90 degrees, with moderate to severe pain shown with flexion and extension of the knee. Extension was to 0 degrees, and no instability was shown to be manifested. The veteran could not perform deep knee bends. The examiner indicated that significant functional loss due to pain of the left knee was manifested. X-rays were noted to show osteoporosis of the left knee, with no evidence of fracture or other osseous, articular, or soft tissue abnormalities. X-rays showed osteoporosis, of a moderate degree. The diagnosis was chronic left knee pain with moderate degree of osteoporosis. To summarize, the veteran's statements and testimony describing his left knee symptoms and the inservice injury are considered to be competent evidence. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The first aspect of the veteran's claim to be discussed is whether the veteran had a left knee disability prior to his June 1995 ACTDUTRA. In this regard, he indicated that he injured his left knee in 1984 or 1985 while on duty in the Reserve. The VA has been unable to locate these records. Regardless, the Board is satisfied that the left knee problems the veteran experienced beginning in June 1995 are unrelated to the knee injury ten years earlier. The next aspect of the veteran's claim to be determined is whether any current left knee disorder is related to his military service. In this regard, the service medical records show that the veteran was treated on several occasions for left knee pain in June and July 1995. Complaints of left knee pain and swelling were recorded during the VA examinations in September 1995 with a diagnosis of osteoporosis. In addition, the December 1997 and October 1999 VA examinations confirmed the continued presence of left knee pain. Also, the October 1999 examination showed soft tissue swelling, limitation of motion and tenderness. There is some question as to the exact etiology of the left knee pain. In December 1997 the diagnosis was chronic pain in the left knee of unknown etiology and osteoporosis of the left knee. In October 1999 the diagnosis was chronic left knee pain with moderate degree of osteoporosis. Regardless, the Board is satisfied that the veteran has a chronic left knee disability, which was initially clinically manifested in June 1995 during ACDUTRA. Accordingly, service connection for a left knee disorder is warranted. ORDER Service connection for a left knee disorder is granted. ROBERT P. REGAN Member, Board of Veterans' Appeals