Citation Nr: 18146609 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 13-08 305 DATE: October 31, 2018 ORDER Service connection for degenerative arthritis of the right knee secondary to left knee replacement is granted. FINDING OF FACT The most probative evidence of record demonstrates that the Veteran’s degenerative arthritis of the right knee was caused or related to his left knee disability, status-post left knee replacement. CONCLUSION OF LAW The criteria for service connection for degenerative arthritis of the right knee secondary to left knee replacement have been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from February 1956 to July 1959. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2011 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned in February 2016. In March 2016, the Board reopened this issue and remanded it for additional development, to include a VA examination. After an August 2017 Board decision denied service connection for this issue, the Veteran subsequently appealed the decision to the Court of Appeals Veterans Claims (CAVC). In May 2018, CAVC issued an order granting the amended motion to remand this appeal to the Board of Veterans’ Appeals. Entitlement to service connection for degenerative arthritis of the right knee secondary to left knee replacement Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to successfully establish service connection, there must be competent and credible evidence showing (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the current disability and the disease or injury incurred in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a condition that is not directly caused by the Veteran’s service. 38 C.F.R. § 3.310. In order to prevail under a theory of secondary service connection, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities and (2) the condition said to be proximately due to the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998); see also Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition, secondary service connection may also be found in certain instances when a service-connected disability aggravates another condition. See Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310 (b). Thus, service connection may be established either by showing (1) direct service incurrence or aggravation, (2) an etiological relationship between the claimed condition and a service-connected disability, or (3) using applicable presumptions, if available. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In determining whether service connection is warranted for a disability, 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 (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. The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a); Baldwin v. West, 13 Vet. App. 1 (1999); see 38 C.F.R. § 3.303 (a). A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, supra. As noted above, service connection may be granted on a secondary basis for a condition that is not directly caused by the Veteran’s service, if it is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. For these claims, establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310 (b). Analysis Here, the Veteran is seeking service connection for a right knee disability, which he contends is attributable to his service-connected total left knee replacement. Specifically, the Veteran asserts that his service-connected left knee disability caused him to overload where he shifted his weight to the right side of his body to compensate for his left knee condition. See February 2016 Hr’g Transcript at 4. The Veteran’s March 1999 VA examiner opined that the 30 percent of the Veteran’s right knee pain represented increased symptoms from favoring the left knee. However, the VA examiner opined that the Veteran would probably have developed some degenerative joint changes by that point and that the right knee problems were not caused by the left knee. In December 1998, a private examiner opined that he was certain that the Veteran had to overuse his right knee when his left knee was severely symptomatic prior to his left knee replacement approximately two years prior and also during his rehabilitation. He further opined that he did not think this was the cause of the Veteran’s degenerative arthritis of his right knee, but certainly over use of the right knee probably aggravated it and caused it to progress more rapidly. The Veteran’s March 2009 examination report showed moderate degenerative changes in the lateral compartment and mild DJD in the medial patellofemoral compartments. The September 2009 physical therapy consultation notes the Veteran had right knee pain as he was coming off medication from his most recent total knee replacement The May 2016 C&P examiner opined that the Veteran’s right knee is not at least as likely as not aggravated by the left knee as he had degenerative changes and this was consistent with decades of physical labor work as there was no evidence of instability or injury that was caused by the left knee per patient. The examiner further opined that the left knee is not the cause of the right knee as he has no injury from the left knee that caused any compensation as the pain started when the left pain was treated and this is consistent with the degenerative pain coming from the employment activity and there was no mechanical symptoms or instability symptoms from service time to 1991. In February 2016, the Veteran competently and credible testified that he first made complaints regarding his right knee after he stopped taking his pain medication following a left knee replacement in December 1996. See February 2016 Hr’g Transcript at 4. The Veteran stated that he had been taking pain medication for 4-5 years prior to his left knee replacement surgery. Id. Given the favorable evidence of record, the Board finds that the establishment of service connection for right knee condition as secondary to the service-connected total left knee replacement is warranted. 38 C.F.R. § 3.310. Service connection for status-post total right knee replacement with traumatic arthritis as secondary to a service-connected disability is granted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jacquelynn M. Jordan, Associate Counsel