BVA9505173 DOCKET NO. 92-11 321 ) DATE ) ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUE Entitlement to service connection for residuals of an injury of the left knee. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C. R. Olson, Counsel INTRODUCTION The veteran's active military service extended from September 1967 to September 1969. He had subsequent service in the Reserves from September 1969 to September 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 1972 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas which denied service connection for residuals of a left knee injury. In a February 1974 decision, the Board allowed a 10 percent rating for the veteran's skin disorder and remanded the knee issue for VA medical records. Some were obtained. The RO made a rating decision which effectuated the allowance. Thereafter, the RO took no further action, despite an October 1974 letter from the veteran. The case was again before the Board in November 1992 on the issue of service connection for residuals of an injury to the left knee, when it was remanded for records and examination of the veteran. The veteran was examined and attempts were made to secure additional information from the service department. It appears that all possible development has been accomplished and the Board proceeds with its review of the appeal. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO committed error in denying service connection for residuals of an injury of the left knee. In his original April 1972 claim, the veteran asserted that he sustained a knee injury in March 1968 and that he had stiffness, swelling and locking of the left knee since September 1969. In his April 1991 claim, the veteran asserted that his left knee injury was incurred in 1969, while serving in Wyoming. There have also been statements to the effect that the left knee injury was incurred during active duty for training, in Wyoming, in 1970. 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 grant of service connection for residuals of a left knee injury. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. Any left knee injury the veteran may have had during active duty or active duty for training was transitory in nature and resolved without identifiable residual disability. 3. The veteran's current chronic left knee disorder was not present during active duty or active duty for training and is not shown to be the result of disease or injury during his active military service. CONCLUSION OF LAW A chronic left knee disability was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran'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 which is plausible. All relevant facts have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). The service medical records do not show any knee injury, complaints, findings, or diagnoses. When the veteran was examined for separation from service, in August 1969, there were no medical complaints pertaining to the left knee. His lower extremities were reported to be normal. In the report of medical history the veteran denied having had "trick" or locked knee. The service department has verified that the veteran served in the Reserves from September 1969 to September 1973. The veteran has submitted a copy of a form dated in November 1970 which shows active duty for training from August 18 to 29, 1970. He also submitted a copy of a sick slip, dated August 19, 1970. Remarks list "knee injury, torn cartilage" and show he was referred to an aid station. A summary of VA hospitalization, in April 1972, shows that the veteran reported injuring his left knee in 1968 and of having recurrent symptoms since that time. He told of reinjuring his knee a week before admission and experiencing locking. A arthrotomy disclosed a bucket handle tear of the left medical meniscus. A meniscectomy was performed. In his original claim, received in April 1972, the veteran reported that the left knee injury occurred in March 1968 and that he had stiffness, swelling, and locking since September 1969. The injury was allegedly treated at Ft. Lewis, Washington, in March 1968. However, there is no independent medical evidence to corroborate that this alleged injury actually occurred. All records covering the veteran's military service, in particular, those pertaining to his separation examination in 1969 have been obtained and they contain no references to a knee injury. In October 1972, the RO asked the veteran for information on how, when and where the injury occurred and what branch of service was involved. The report of the November 1972 VA examination shows that the veteran told of injuring his knee two times during service. On the orthopedic examination, the veteran stated that he sustained an injury to his left knee in June 1969, when he fell on his knee. The diagnosis was postoperative residuals of a left knee medial meniscectomy with limitation of motion, and chronic mild symptoms. In his January 1973 appeal, the veteran responded to the request for additional information by noting that he had submitted a copy of a sick slip. He explained that his knee was affected by episodes of locking and instability at the time of the examination for separation from service; however, the examiner did not go that far down and the veteran wanted to get the examination done so he could leave service. In February 1974, the Board remanded the issue for VA medical records. The RO was to request records from the VA facility at Alexandria, Louisiana for September or October 1969 and records from Houston, Texas for March or April 1970 and since April 1972. The Alexandria, Louisiana, VA Medical Center responded that it had no record of the veteran ever being treated at that facility. The Houston, Texas, VA Medical Center submitted copies of records from April and May 1972 and December 1973. An April 1974 rating decision continued the denial of service connection for the left knee medial meniscectomy. The Board was informed that further development had been resolved, the veteran had been granted a compensable rating, and that no further disagreement had been received from the veteran In an October 1974 letter, the veteran stated that he was not given any medication for his knee injury while in summer training at Camp Gernsey, Wyoming. He said he was seen by a medical officer and dismissed. He stated that the next problem with his knee was in April 1972. He also discussed his other disabilities. Another claim was received in April 1991. The veteran stated that he had sustained a knee injury in 1969 at a fort in Wyoming. Additional development was undertaken. Private medical records dated from 1989 to 1991 reveled cardiovascular disease and a right knee injury with internal derangement. Additional VA records through August 1983 were also received. There were no records pertaining to the left knee earlier than the April 1972 records, which had previously been considered. A search for additional service medical records conducted at the Board's request in 1992, produced a copy of the separation examination report and records which did not contain any information about the knee. On the January 1993 VA examination, the veteran reported sustaining a left knee injury in 1971, while on training exercises at a camp in Wyoming. He stated that he tripped while running on an exercise, twisting and falling on his left knee. He told of persistent medial joint line pain following that episode. He reported his April 1972 meniscectomy and described his subsequent symptoms. Examination findings were negative. It was the impression that the veteran had patellofemoral chondromalacia. The radiologist reported bilateral medial joint space narrowing in both knees with small patellar osteophytes on the right. The orthopedic examiner felt the x-rays showed no significant degenerative changes. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110 (West 1991). In this case, the veteran has variously reported a knee injury during his initial period of active duty and during later active duty for training. He may well have had knee injuries at those times; however, they are not confirmed by the medical records contemporaneous with the periods involving the alleged injury. Further, the evidence does not show that, if any injury did in fact occurr, that it resulted in any chronic left knee disability. As indicated above, the records for the initial period of service which ended in 1969 do not show any chronic left knee disability. The veteran has attempted to discount the separation examination as inadequate. Nevertheless, it was an examination conducted by a physician just before the veteran left service. The timing of the examination and the physician's medical expertise make this the most probative evidence as to absence of a left knee disorder during the veteran's initial period of service. It is persuasive that if any left knee injury was sustained in service it was transitory in nature and had resolved without residual disability by the time of service separation examination in 1969. The record shows that the veteran had active duty for training in 1970 and that he got a sick slip the day after this period of active duty for training began. He has stated that he was seen by a medical officer and dismissed without treatment. The record shows that he continued on his active duty for training for another 10 days. It appears that the notation on the sick slip, as to a knee injury and torn cartilage was made by an enlisted man and not a medical officer. It is not persuasive as to the correct diagnosis at that time because it was not rendered by a qualified medical official. Moreover, the sick slip does not indicate when the alleged injury occurred and there is no evidence showing continuity of manifestations either from the VA or private sources. The best evidence as to the onset of a chronic knee disorder is the report of the April 1972 hospitalization which shows that the veteran injured his knee one week before his admission to the hospital. At that time, the veteran also reported injuring his left knee in service, in 1968, and having recurrent symptoms since then, but the veteran is not a medical expert. His opinion as to whether he previously sustained a chronic injury and as to whether subsequent aches and pains in his knees were manifestations of the earlier injury are no competent or credible. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992), Grottveit v. Brown, 5 Vet.App. 91 (1993). The hospital report shows that, a week before admission, he sustained a left knee injury an had locking of the knee. The treating physicians felt that he had a tear of the left medial meniscus and this required surgery. While the veteran reported having sustained an injury in 1968, there is no competent medical evidence to relate the tear of the medial meniscus to the alleged 1968 injury, particularly in the absence of documented medical treatment prior to the 1972 injury. Weighing the evidence in this case, the Board finds that the best evidence is not in equipoise. There is no approximate balance between positive and negative evidence. Therefore, there is no issue of reasonable doubt raised. The preponderance of the evidence establishes that even in an injury did occur, which has not been established by competent credible evidence, it was at best transitory in nature and that the chronic left knee injury was sustained after the veteran's periods of military service. Consequently, service connection for a left knee disorder must be denied. ORDER Service connection for residuals of a left knee injury is denied. JOAQUIN AGUAYO-PERELES 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.