Citation Nr: 18150225 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-25 626 DATE: November 14, 2018 ORDER Service connection for a left knee disorder including as secondary to service-connected low back disorder is denied. Service connection for a right knee disorder including as secondary to service-connected low back disorder is denied. FINDINGS OF FACT 1. The Veteran's right knee disability did not manifest in service nor was there arthritis within one year of separation. The disability is not otherwise related to service. It is not proximately due to nor aggravated by her service-connected low back disability. 2. The Veteran's left knee disability did not manifest in service nor was there arthritis within one year of separation. The disability is not otherwise related to service. It is not proximately due to nor aggravated by her service-connected low back disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disorder are not met, to include on a direct, presumptive or secondary basis. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a), 3.310(a). 2. The criteria for service connection for a left knee disorder are not met, to include on a direct, presumptive or secondary basis. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a), 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from May 1982 to June 1992 and August 1993 to April 2007. In June 2018, the Veteran and her husband testified during a Board hearing before the undersigned Veterans Law Judge (VLJ). At the hearing, the undersigned clarified the issues on appeal and made inquiry as to the existence of outstanding evidence as to the issues being decided. The actions of the VLJ comply with 38 C.F.R. § 3.103. Also at the hearing, the Veteran submitted medical records with a waiver of Agency of Original Jurisdiction (AOJ) review. Service Connection The Veteran primarily contends she has left and right knee disabilities due to her service-connected low back disability. She testified that they became apparent about 3 years after her low back disability was service-connected in 2007. Right and left knee condition included secondary to low back disorder Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §1110, 1131. In general, to establish a right to compensation for a present disability, a Veteran 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 - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). The first question for the Board is whether the Veteran has a current right or left knee disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran has current right and left knee disability; the May 2014 VA examination reflects diagnosis of bilateral knee strain. However, she does not argue with any specificity, nor does the record suggest, that the current knee disabilities began during service or are otherwise related to service. Service treatment records show complaints of right and left knee problems during her over 20-year career which have been reviewed by a 2014 VA examiner and assessed as not representative of chronicity. Post-service treatment records do not contain any medical opinion indicating that the knee problems are related to service. The May 2014 VA examination contains the examiner’s opinion that the bilateral knee condition is less likely than not incurred in or caused by an event, injury or illness in active military service. The examiner explained that there is no evidence to support chronicity of pain while in service to endorse service connection. The examiner considered the Veteran’s assertion that she thought her knee pain was due to running in service. To the extent that the current treatment records reflect an October 2017 finding of mild degenerative joint disease of the right knee, the finding is outside of the initial one-year presumptive period to allow for presumptive service connection for a chronic disease such as arthritis. See 38 U.S.C. § 1101 (3);38 C.F.R. § 3.309 (a). Arthritis did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101 (3), 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a). The May 2014 and May 2015 examinations note that imaging studies did not show arthritis but instead showed normal knees bilaterally. The 2014 VA examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board adopts the opinion for its reasons and bases, noting that the examiner has fairly considered the material evidence of record. Wray v. Brown, 7 Vet. App. 488 (1995). To the extent the Veteran believes she has current right and left knee disability due to service, and is competent to report pain, the medical evidence indicating no relationship between current disability and service is far more extensive, reliable and credible than statements from a lay informant. The weight of the evidence is against concluding that any knee disease was incurred in service. 38 C.F.R. § 3.303 (d). Thus, the preponderance of the evidence is against the claim on this basis. Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability, and not due to the natural progress of the nonservice-connected disease. 38 C.F.R. § 3.310 (b). The question for the Board is whether the Veteran has right or left knee disorder that is proximately due to or the result of, or was aggravated beyond the natural progress by service-connected low back disability. The Board concludes that, while the Veteran has the aforementioned right and left knee disorders, the preponderance of the evidence is against finding that any such disability is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310 (a). The May 2015 VA examiner opined that the Veteran’s bilateral knee pain is less likely than not related to service-connected back disability. The rationale was the low back condition would not contribute to the bilateral knee pain due to the fact that the Veteran did not have improper gait to cause misalignment. Instead, the knee condition could be related to her BMI of 30.1 from strenuous weight bearing on bilateral knees. There is no medical opinion indicating that any current knee disorder is related to the service-connected low back disease or injury. Ongoing treatment from Tripler Army Base show that the Veteran continues to complain of knee pain. However, no medical professional has opined there is a relationship between the back and the knees. Moreover, gait continues to be observed as not abnormal. See, e.g., August 2018 VA back examination and May 2018 Tripler treatment record. This is significant because the 2015 VA examiner cited to lack of gait issues to support the conclusion that the back did not cause any knee issues. While the Veteran believes her knee disorders are proximately due to or the result of/aggravated beyond its natural progression by service-connected disability, her lay theory is of significantly less probative weight when compared with the objective record, and the findings by the neutral VA examiner. In weighing the evidence, the Board finds that the medical evidence of record, and the lack of competent support for the Veteran’s theory, preponderates against the claim. The 2015 examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board adopts the opinion for its reasons and bases, noting that the examiner has fairly considered the material evidence of record. Wray v. Brown, 7 Vet. App. 488 (1995). (Continued on the next page)   The preponderance of the evidence weighs against finding that any such disorder is related to the low back disability. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. RIPPEL