Citation Nr: 18144091 Decision Date: 10/23/18 Archive Date: 10/23/18 DOCKET NO. 14-34 242 DATE: October 23, 2018 ORDER Entitlement to service connection for a lumbar spine disorder, diagnosed as osteoarthritis, is granted. Entitlement to service connection for a left knee disorder, diagnosed as degenerative arthritis, is granted. FINDINGS OF FACT 1. The Veteran has a lumbar spine disorder, diagnosed as osteoarthritis, that is related to his military service. 2. The Veteran has a left knee disorder, diagnosed as degenerative arthritis, that is related to his service-connected right knee disability. CONCLUSIONS OF LAW 1. A lumbar spine disorder, diagnosed as osteoarthritis, was incurred in active service. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 2. A left knee disorder, diagnosed as degenerative arthritis, is proximately due to o the result of Veteran’s service-connected right knee disability. 38 U.S.C. § 1110 (West 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1966 to August 1968 and from March 1985 to February 1989. He also had service in the Ohio Army National Guard. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a video hearing before the undersigned Veterans Law Judge in October 2016. A transcript is of record. In May 2018, the Board requested from the Veterans Health Administration (VHA) an advisory medical opinion regarding the lumbar spine disorder. Because the Board is granting the benefit sought on appeal in full, there is no prejudice to the Veteran in proceeding with adjudication of the claim at this time, i.e., without first sending a copy of the opinion to the Veteran and his representative to allow them a 60-day period to submit responsive evidence or argument. See 38 C.F.R. §§ 20.901, 20.903 (2017). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); 38 C.F.R. § 3.310. 1. Entitlement to service connection for a lumbar spine disorder In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to service connection for a lumbar spine disorder. The Veteran’s service treatment records documented recurrent back pain with episodes of arthritis in a January 1988 periodic examination. It was noted that he was seen by a physician for his back in February 1988 and for complaints of a back ache in October 1988. The Veteran was afforded a VA examination in October 2011 at which time he was diagnosed with osteoarthritis involving the spine. The examiner opined that degenerative arthritis of the spine is part of the aging process and not related to the Veteran’s military service. In so doing, he noted that, although there is subjective documentation of arthritis, there is no objective documentation reflecting arthritis being diagnosed during active duty. However, the examiner did not specifically address the service treatment records documenting back problems in 1988 or whether any subsequent diagnosis could be related to such symptomatology during a period of active duty. Thus, the opinion has limited probative value. The Veteran was also provided a VA examination in June 2014. He was diagnosed with degenerative arthritis of the spine, and it was noted that the Veteran had reported that he had chronic episodic low back pain that started about 20 years earlier. The examiner reiterated that degenerative arthritis of the spine is part of the aging process and not related to the Veteran’s military service. He also stated that the disorder is not related to any right or left knee condition. However, the examiner did not address the back problems documented in the service treatment records dated in 1988. Thus, the opinion also has limited probative value. The Board requested an advisory VHA medical opinion, which was provided by Dr. M.B. (initials used to protect privacy) in May 2018. Significantly, the examiner opined that it is at least as likely as not that the Veteran’s current lumbar spine disorder manifested in or is otherwise related to his military service. In so doing, Dr. M.B. noted the service treatment records documenting the Veteran’s back problems and indication of arthritis during a period of active duty in 1988, as well as the Veteran’s own reports regarding the onset of the disorder and the lack of any post-service injury. He also explained that back pain related to a lumbar strain and osteoarthritis can be episodic with symptoms ranging from minimal to none and then quite severe. The Board finds the October 2018 VHA opinion has significant probative value because the examiner thoroughly reviewed the claims file and supported the conclusion with a complete rationale that was based on an accurate factual premise. Accordingly, the Board concludes that service connection for the Veteran’s lumbar spine disorder is granted. 2. Entitlement to service connection for a left knee disorder In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to service connection for his left knee disorder. The evidence of record reflects the Veteran has been diagnosed with bilateral degenerative arthritis of the knees and underwent total knee replacement surgeries. He is currently service-connected for right knee traumatic arthritis status post total right knee replacement. The service treatment records do not document any complaints, treatment, or diagnosis of a left knee disorder. The Veteran testified during an October 2016 hearing that he walked with a cane and favored his “good side,” which caused it to become arthritic. He indicated that he began having problems in 2006 and denied having any post-service injuries to the left knee. A June 2014 VA examiner opined that the Veteran’s degenerative arthritis of the left knee is part of the normal aging process and not related to any right knee condition. However, the VA examiner did not provide a rationale for the opinion. Therefore, the opinion has limited probative value. The Veteran has submitted an opinion from his private physician in October 2016. He stated that, because of the Veteran’s severe injury to his right knee which became progressively more arthritic to the point of needing arthroplasty to control the pain, the left knee was favored over the years. He indicated that the unusual stress to the left knee caused the Veteran to experience pain over the medial aspect of that knee as well. He noted that radiographs confirm severe arthritis to the left knee and that the Veteran underwent left knee surgery. He concluded that, even though there is no way of absolutely proving that the left knee disorder is due to the right knee, the Veteran’s altered gait of a number of years very well may have led to the deterioration of the favored left knee. The Board finds the October 2016 private opinion to be more probative that the VA examination report. The examiner provided rationale and explained why the Veteran’s altered gait would have cause his current left knee disorder. Based on the foregoing, the Board finds that the Veteran’s left knee disorder is the result of his service-connected right knee disability. Therefore, service connection is warranted for the Veteran’s left knee disorder. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Kuczynski