Citation Nr: 18145958 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 14-43 488 DATE: October 30, 2018 ORDER Service connection for right knee disability secondary to left knee disability is granted. Service connection for right heel disability secondary to left knee disability is granted. FINDINGS OF FACT 1. The competent and probative evidence is at least in equipoise as to whether the Veteran’s current right knee disability is proximately due to or the result of his service-connected left knee disability. 2. The competent and probative evidence is at least in equipoise as to whether the Veteran’s current right heel disability is proximately due to or the result of his service-connected left knee disability. CONCLUSIONS OF LAW 1. The criteria for service connection for right knee disability are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 2. The criteria for service connection for right heel disability are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1967 to May 1968. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). All three elements must be established by competent and credible evidence in order that service connection may be granted. 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). A disability which is proximately due to or the result of a service-connected injury or disease shall be service connected. 38 C.F.R. § 3.310. Further, a disability which is aggravated by a service-connected disorder may be service connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 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. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. 1. Service connection for right knee disability secondary to left knee disability. The Veteran contends that his right knee disability is secondary to his left knee disability. The Board acknowledges that there are competing nexus opinions. The Board resolves the benefit of the doubt in the Veteran’s favor and concludes that the Veteran has a current diagnosis of right knee degenerative joint disease (DJD) that is proximately due to his left knee disability. 38 C.F.R. § 3.310. The March 2012 VA examination shows the Veteran has a current diagnosis of DJD and strain of the right knee. The VA examiner opined that it was less likely than not caused by or related to the left knee disability. The rationale was that although an abnormal gait might cause some temporary pain in the contralateral knee, after searching, no medical literature was found that confirms that prior surgery of one knee causes DJD in the other knee. In May 2015, two independent examiners opined that there was sufficient substantive evidence to substantiate the claim that the right knee pathology resulted via a secondary consequence of his left knee pathology. The rationale was based on current medical research that was included with their opinion. It was explained that years of abnormal gait, stance, and weight-bearing in his right leg was required to tolerate and compensate for the dysfunction in his service connected left leg injuries. This provided the impetus for right knee pathology. The load bearing skeleton is woven together and maintained in a specific alignment by a mesh of muscles, ligaments, and tendons. Derangements in posture and gait generated mechanical stresses in and on areas of the bones that were not intended to carry the strain. This eventually created permanent pathologic changes in areas of the body distant to the original injury. Additionally, the right knee disorder did not manifest until many years after the left knee injury occurred. It would conceivably take many years of wear and tear from compensating his left knee to produce weakened joints in his right knee. Accordingly, the Board finds that the weight of the competent and probative evidence is at least in equipoise as to whether the Veteran’s right knee disorder was caused by his service-connected left knee disability. See 38 C.F.R. §§ 3.102, 3.310(a). As set forth above, under the benefit-of-the-doubt rule, for the Veteran to prevail, there need not be a preponderance of the evidence in his favor, but only an approximate balance of the positive and negative evidence. Given the evidence set forth above, including the positive opinion by the independent examiners, and resolving doubt in favor of the Veteran, the Board finds that the Veteran’s currently diagnosed right knee disability is proximately due to or the result of his service-connected left knee disability. Therefore, the criteria for secondary service connection have been met. 2. Service connection for right heel disability secondary to left knee disability. The Veteran contends that his right heel disability is secondary to his left knee disability. The Board acknowledges that there are competing nexus opinions. The Board resolves the benefit of the doubt in the Veteran’s favor and concludes that the Veteran has a current diagnosis of right foot heel spur and plantar fasciitis that is proximately due to his left knee disability. 38 C.F.R. § 3.310. In a March 2012 VA examination, the Veteran was not found to have a right foot disability. The examiner opined that despite subjective complaints of right foot pain, there was no objective findings on examination to support a diagnosis for claimed symptoms and therefore not caused by or related to the left knee disability. VA treatment records show that the Veteran received treatment and orthotics for his right plantar heel spur. He has also been diagnosed with plantar fasciitis in his right foot. Accordingly, the Board finds competent evidence of a current disability. In May 2015, two independent examiners opined that the Veteran’s right foot disorder occurred as a consequence of his already service-connected left knee. The rationale was that as a result of his left knee disorder, he was forced to shift much of his weight bearing over to his contralateral right leg. The extra weight bearing, abnormal gait and stance provided the impetus for the right foot disorder. Accordingly, the Board finds that the weight of the competent and probative evidence is at least in equipoise as to whether the Veteran’s right foot disorder was caused by his service-connected left knee disability. See 38 C.F.R. §§ 3.102, 3.310(a). Given the evidence set forth above, including the positive opinion by the independent examiners, and resolving doubt in favor of the Veteran, the Board finds that the Veteran’s currently diagnosed right foot disability is proximately due to or the result of his service-connected left knee disability. Therefore, the criteria for secondary service connection have been met. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Cruz, Associate Counsel