Citation Nr: 18155072 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 11-09 731 DATE: December 4, 2018 ORDER Entitlement to service connection for a right knee disorder is denied. FINDING OF FACT The Veteran’s right knee disorder is neither proximately due to nor aggravated beyond its natural progression by his service-connected left knee arthritis, and is not otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW A right knee disorder was not incurred or aggravated inservice, right knee arthritis may not be presumed to have been so incurred, and a right knee disorder is not caused or aggravated by a service connected disorder. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1987 to September 1995 and from January to November 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In November 2016, a hearing was held before the undersigned in Washington D.C.; a transcript of the hearing is associated with the record. This case was initially before the Board in May 2017, at which time the appeal was remanded for additional development. With respect to the Veteran’s claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. In order to establish service connection for a present disability the 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability that is proximately due to a service-connected disorder. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Service connection for arthritis may be established on a presumptive basis by showing that arthritis manifested itself to a degree of 10 percent or more within one year from the date of separation from active duty. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The Veteran asserts that his right knee disorder is caused by service or related to his other service connected disabilities. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of right knee arthritis, and while the evidence shows that bruising of the right knee occurred during service, the preponderance of the evidence weighs against finding that the Veteran’s right knee arthritis began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131. As such, the claim will be denied. The Veteran filed a claim of entitlement to service connection for right knee pain in 2009. His service treatment records do not reveal a diagnosed right knee disability, but in September 1988 the Veteran was seen for a stiff right knee, and cramping during a road march. Physical examination revealed no deformity and no sign of pain at the time of examination. The assessment was a possible knee bruise. The Veteran’s lower extremities were clinically evaluated as normal at his September 1995 separation examination. The Veteran denied a history of swollen, stiff or painful joints at a November 2004 post deployment physical. The Veteran is service connected, in pertinent part, for left knee degenerative arthritis. At an October 2009 QTC examination for a left knee disorder the Veteran’s right knee demonstrated evidence of tenderness, guarding of movement, locking pain and crepitus. The examiner opined that these symptoms were more likely than not the result of the Veteran’s left knee disorder and diagnosed right knee degenerative joint disease. The examiner, however, failed to provide any rationale explaining how the left knee disorder was causing the right knee disorder. A June 2016 VA examination noted osteoarthritis of both knees and reviewed the evidence listed above. The examiner was asked if any right knee disorder was at least as likely as not incurred in service, or caused by a disease, injury or other event that occurred during the Veteran’s periods of active duty. The examiner answered that the right knee disorder was less likely than not incurred in or caused by service. The examiner’s rationale was there was “no evidence connecting [a right] knee disorder to event in service. Service event was without objective signs of injury, long interval without evaluation or imaging.” The Veteran testified before the undersigned in November 2016. He stated that he had pain during service, and repeatedly referenced how left knee pain would flare up and give out on him. The appellant testified that during his military exit examination he told the examiner and they noted the left knee disability. The Veteran did not bring up his right knee pain at this time. He testified that he began favoring the left knee as that joint hurt more and more. This habit in turn reportedly affected his right knee over time. The Veteran denied receiving treatment for a right knee disorder during his 2004 deployment. He also could not remember if he received any treatment for the right knee within a year of separation. Following a September 2017 knee examination the Veteran was diagnosed with arthritis of both knees. The VA contract examiner reviewed the claimant’s service and post-service records and noted there was no medical evidence to support that the right knee arthritis was aggravated by his left knee disability. In addition, the examiner noted that there is no medical literature to support arthritis of one joint as the cause for arthritis in the opposite joint. VA treatment records show the Veteran was not diagnosed with right knee arthritis until October 2009, i.e., five years after his separation from active duty. While the Veteran is competent to report that he has experienced intermittent pain and instability since service, he is not competent to provide a diagnosis or opine that these symptoms were caused by his service connected left knee arthritis. The etiology of the claimant’s right knee disorder is medically complex, and requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The record contains conflicting medical opinions regarding whether the Veteran’s right knee arthritis is at least as likely as not related to an in-service injury, event, or disease, including secondarily to his left knee arthritis. Taken together, the June 2016 and September 2017 VA examiners’ opinions establish that the Veteran’s right knee arthritis is not at least as likely as not related to an in-service injury, event, or disease, including his service connected left knee arthritis. The June 2016 VA examiner opined that the Veteran’s right knee arthritis was not at least as likely as not related to his right knee bruise in 1988, while the September 2017 VA examiner opined that the Veteran’s right knee arthritis was not at least as likely as not related to his service connected left knee disability. The combined rationale was that, due to the length of time between his in-service injury and any complaint of right knee disability, and because medical literature does not support the premise that arthritis in one joint causes it in another, there is no nexus between the two disabilities. The examiners’ combined 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 October 2009 QTC examiner opined that the Veteran’s right knee arthritis was more likely than not due to his service connected left knee arthritis. However, there was no rationale provided. Consequently, the Board gives more probative weight to the September 2017 VA examiner’s opinion. Consequently, the Board gives more probative weight to the recent VA medical examinations. In sum, the preponderance of the most probative evidence is against finding that the Veteran’s right knee disorder was demonstrated inservice, against finding that right knee arthritis was compensably disabling within one year of separation from active duty, and against finding that any right knee disorder is caused or aggravated by a service connected disorder to include a right knee disability or combination of service-connected disabilities. Hence, the claim is denied.   As the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Joseph Montanye, Associate Counsel