200309-69305
200309-69305
| Board of Vet. App. | Jun 29, 2021Background
- Veteran served on active duty Mar–Jul 1998 and Dec 2006–Sep 2011; reported a left-knee paintball injury while in service (reported Jan–Feb 2011).
- VA treatment/x-ray records during service (Feb 2011 x‑rays) were normal; intermittent complaints noted in 2011–2012; no joint-pain reports on periodic assessments from 2013–2015.
- First documented diagnosis of medial compartment osteoarthropathy with narrowing and osteophytes appears in January 2017 and was confirmed by a February 2018 VA examination.
- Veteran filed a legacy appeal (Apr 2018 rating decision → Feb 2020 SOC); she opted into AMA and selected the Direct Review docket, so the Board considered only evidence of record at the time of the Feb 2020 SOC.
- VA medical examiners (Feb 2018 and Jan 2020) concluded it is "less likely than not" the current knee condition is related to the in‑service event, citing a long interval without continuous treatment, imaging, or documented chronicity.
- Board denied service connection (both direct and presumptive chronic-disease theories), finding the preponderance of the evidence against a nexus and that continuity/chronicity requirements were not met; benefit of the doubt was not applied.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Veteran's left knee disability is service‑connected (direct nexus) | Left knee injury in service (paintball) caused current osteoarthropathy; symptoms worsened since then | No medical nexus: long gap, no continuous complaints, normal in‑service imaging; VA exam opined against service causation | Denied — preponderance against direct service connection |
| Whether arthritis qualifies for presumptive service connection as a chronic disease (chronic in service) | Arthritis is a listed chronic disease; service pain reports show condition began in service | Service records lack sufficient manifestations in service to establish chronic disease under §3.303(b) | Denied — not shown as chronic in service |
| Whether the disease manifested to a compensable degree or with continuity of symptoms within the presumptive period | Veteran reported in‑service knee pain and later diagnosed; continuity of symptomatology exists | First diagnosed in 2017 (>5 years after separation); no continuous symptoms documented after service or within one year | Denied — no manifestation to compensable degree within presumptive period; no continuity of symptoms |
| Competency of Veteran's lay statements to establish medical nexus | Veteran reports onset and persistence of knee problems from service | Lay testimony insufficient to establish causation for a medically complex diagnosis; requires medical expertise | Board gave lay statements weight for symptom report but found them not competent to prove medical causation; relied on VA medical opinions |
Key Cases Cited
- Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (continuity of symptomatology under §3.303(b) applies only to conditions listed as chronic under §3.309(a))
- Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (lay evidence can be competent for certain medical matters under defined circumstances)
- Kahana v. Shinseki, 24 Vet. App. 428 (Vet. App. 2011) (Board must assess whether a particular condition is the type for which lay evidence can be competent)
- King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012) (lay evidence may be insufficient to establish medical causation for complex conditions)
- Buchanan v. Nicholson, 451 F.3d 1336 (Fed. Cir. 2006) (absence of contemporaneous medical records is a factor to weigh against a claim)
- Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (long passage of time between discharge and complaint is a factor against service connection)