Citation Nr: 18149408 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 12-02 487 DATE: November 9, 2018 ORDER Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability is granted. FINDING OF FACT The persuasive evidence demonstrates the Veteran’s left knee disability developed as a result of an injury during active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability, have been met. 38 U.S.C. § 1110, 1131 (2012); 38 C.F.R. § 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from September 1974 to September 1977. This matter comes before the Board of Veterans' Appeals (Board) by order of the United States Court of Appeals for Veterans Claims (hereinafter “the Court”) in May 2018, which granted an amended joint motion for remand (JMR) vacating a July 2017 Board decision and remanding the issue on appeal for additional development. The issue initially arose from a May 2011 rating decision by the Columbia, South Carolina, Regional Office (RO) of the Department of Veterans Affairs (VA). In April 2016, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A copy of the transcript of that hearing is of record. 1. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2018). Generally, the evidence must show: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). VA may favor one medical opinion over another, provided an adequate basis is provided. Owens v. Brown, 7 Vet. App. 429 (1995). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102 (2018). The pertinent evidence of record shows that the Veteran was evaluated in service for an injury in May 1977 and that he had knee problems related to that injury. The diagnosis as to the knees was chondromalacia or possibly subluxing patellae. On his November 1977 VA examination form the Veteran noted pain in the knees. The examiner noted a normal gait and configuration of both knee joints with normal range of active and passive motion. The joints were stable with no swelling, synovial edema or articular effusion. There was no evidence of bursitis. No diagnosis specific to the left knee was provided. In a September 1997 admission evaluation, the Veteran reported that his left knee had started bothering him again. A June 2002 X-ray study report noted a history of bilateral knee pain and instability that was worsening. No arthritic changes, malalignment, or fracture was seen in either knee. Joint spaces were maintained. An April 2004 report noted ongoing bilateral knee pain. In October 2009, the Veteran reported worsening knee discomfort and occasional giving way of his knees. X-ray studies in October 2009 were negative for the knees with no evidence of degenerative osteoarthritis. A November 2009 physical therapy report noted bilateral knee pain and that the Veteran reported problems since 1974, with increased pain and buckling for the past seven to eight years. A December 2009 physical therapy note reported he stated he wore bilateral hinged knee braces. On VA examination in May 2011 the Veteran reported that he had fallen from a truck in 1975 and injured his knees. He reported having had intermittent left knee pain since that time, occurring monthly for two to seven days at a time. The examiner reviewed the Veteran’s medical history, but was unable to provide a diagnosis due to the lack of objective findings for the Veteran’s left knee. The examiner opined that it was less likely than not that the Veteran’s left knee condition was related to active duty. The rationale for the opinion was that there was only a single reported incident in service, that there was no significant evidence of chronicity, and that there was no objective evidence of chronic injury on the examination. The Veteran submitted a March 2012 private medical opinion in support of his claim noting that the Veteran’s medical records had been reviewed and that he injured both knees during his military duty in 1976. It was concluded that the pain in the knees was felt to be secondary to his military injury in 1976. A November 2012 VA examiner found that the Veteran’s left knee condition was not due to his right knee condition. The medical literature reviewed did not support a contention that an isolated joint on an uninvolved limb would be affected by a condition in the opposite limb unless the affected limb had lost portions (i.e. had been amputated) or was immobilized. It was noted the Veteran did not meet these criteria. In April 2015, the Veteran reported pain in the left knee for two weeks. The examiner’s assessment was patellofemoral pain with anserine bursitis. X-ray studies in April 2015 noted the bones were well mineralized and in normal alignment. There was no loss of cartilage and no fractures, destructive processes, or joint infusions. The overall impression was a normal study. A July 2016 VA opinion found the Veteran’s pain in service was “intermittent” and not chronic. The examiner opined that the in-service pain had no sequela, or subsequent effect on the Veteran’s left knee. The examiner also doubted that the in-service diagnosis of chondromalacia was accurate as the condition required advanced imaging to diagnose which the provider did not have at that time. A July 2018 private medical opinion summarized the pertinent evidence of record and found that it was at least as likely as not that the Veteran’s left knee condition was caused by an in-service injury. It was noted that he had fallen out of a truck in service injuring both knees and had persistent complaints of bilateral knee pain after that time. The May 1977 evaluation during service was noted to have documented painful patellofemoral crepitans in the right and left knees with subluxation bilateral and greater on the left. In summary, the physician found the Veteran suffered an injury in service, had constant and persistent complaints consistent with chondromalacia, and as a result had developed osteoarthritis in both knees. Based upon the evidence of record, the Board finds the Veteran’s present left knee disability developed as a result of an injury during active service. The persuasive evidence demonstrates that he sustained injuries including to the left knee, that he subsequently experienced persistent complaints consistent with chondromalacia, and that his present left knee osteoarthritis developed as a result of his injury in service. The Veteran’s statements as to having had persistent left knee pain after service are found to credible. The July 2018 private medical opinion is supported by service treatment reports and by credible lay statements as to pertinent symptoms manifest after active service. The appeal is granted. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Douglas, Counsel