Citation Nr: 18158893 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 11-18 513 DATE: December 19, 2018 ORDER Service connection for a left knee disorder, to include as secondary to a service-connected right knee disorder, is denied. FINDING OF FACT The Veteran’s left knee disorder is not shown to be etiologically related to any event, injury, or disease in service; nor is it shown to have been caused or aggravated by a service-connected disorder of the right knee. CONCLUSION OF LAW The criteria for an award of service connection for a left knee disorder, to include as secondary to a service-connected right knee disorder, have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from February 1989 to May 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. The RO declined to reopen the Veteran’s previously denied claim for service connection for a left knee disorder. In February 2014, the Board remanded the Veteran’s claim for additional development; in particular, to obtain further treatment records and provide the Veteran an examination. In December 2014, the Board reopened the Veteran’s claim and remanded it for further development on the merits; specifically, to obtain a medical opinion that addressed theories of both direct service connection and secondary service connection on the basis of aggravation. The requested development has been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service or when evidence establishes a disease diagnosed after discharge was incurred in service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). Certain chronic disabilities, are presumed to have been incurred in service if (a) manifest to compensable degree within one year of discharge from service; (b) there is evidence of the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and present manifestations of the same chronic disease; or (c) when a chronic disease is not present during service, evidence of continuity of symptomatology. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (2016). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In making all determinations, the Board must fully consider the lay assertions of record. 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. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (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 at 1376-77. The Board must also assess the credibility and weight of evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). The standard of proof to be applied in decisions on claims for Veterans’ benefits is set forth at 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran seeks to establish service connection for a left knee disorder. He maintains that a left knee disorder was incurred in, or is otherwise related to, service; or, in the alternative, that it was caused, or has been aggravated by, service-connected disability of the right knee. In the present case, there is no dispute that the Veteran has a left knee disorder. The record clearly reflects that the disorder was definitively diagnosed as early as March 2002. The examiner attributed the Veteran’s left knee condition to some ligamentous sprain. The Veteran’s MRI results revealed a partial tear of the medial retinaculum, associated with lateral subluxation of patella among other defects. See Medical treatment records, November 2003. The real question here is whether there is a nexus, or link, between the Veteran’s left knee disorder and any event, injury, or disease in service, and if not, whether the evidence otherwise establishes that a left knee disorder was caused, or has been aggravated by, a service-connected disability of the right knee. As to those matters, the Board’s finds that the preponderance of the evidence is against the Veteran’s claim. On April 2014, the Veteran was afforded a VA medical examination. After reviewing the record, the examiner opined as follows: It is less likely than not that the Veteran’s service[-]connected right knee is the cause of the Veteran’s left knee condition. While in service the Veteran was diagnosed with patellar tendonitis with calcification within the patellar tendon. He had an operation in 1991 to remove the calcification in the tendon. There was no other condition diagnosed or suspected by the orthopedic surgeon at the time. More than 10 years later, the Veteran had an MRI of the right and left knee which showed multiple internal problems with both knees. These problems were not diagnosed while in service and cannot be connected with the right patellar tendonitis and removal of calcification in service, as too much time had passed since service, during which these injuries/changes to the knees could have occurred. Pursuant to the December 2014 Board Remand, an addendum opinion was provided in May 2015 by the same examiner who provided the April 2014 opinion. The examiner opined that: It is less likely than not that the left knee disorder had its clinical onset during active service or is otherwise related to any in-service disease, event, or injury. Review of the STRs shows no evidence of a left knee complaint or condition during service. There is no evidence of an injury to the left knee during service that the examiner was able to locate. As requested, the March 2002 VA record showing “He feels that he may have mis-stepped and jammed his left knee about a week ago” was reviewed, as well as the surrounding records. This does not show that his left knee injury occurred secondary to service or secondary to his right knee, but rather from an individual incident that occurred more than 10 years after service. The examiner further stated: From a biomedical perspective there is no clear evidence to suggest that an injury to one knee can cause major problems with the opposite uninjured knee except for certain specific conditions, i.e. major leg length discrepancy where the injured leg becomes significantly shorter than the normal leg by 5cm or more, or when a severe Trendelenburg lurch develops because of injury or paralysis to one lower extremity creating extra stress in the uninjured limb. Gait studies on patients who had a paralytic and short-leg limp from old poliomyelitis confirmed that the force transmitted in the affected leg was reduced, but that in the opposite leg it was the same as in normal individuals (Harrington 1976, 1992). The findings were similar in patients with an antalgic gait resulting from arthritis (Harrington 1983, 1992). In summary, there is no hard data to support the belief that 'favoring' one leg adversely affects the other. Finally, based on the same principles, the examiner concluded that it was not likely that the Veteran’s right knee disorder was aggravating his left knee disorder. See C&P, exam May 2015. The AOJ obtained further opinions from a different examiner in September 2016. After examining the Veteran and reviewing the claims file, that examiner similarly opined that it was less likely than not that a left knee disorder had its clinical onset during active service or was otherwise related to any in-service disease, event, or injury. The examiner stated, in pertinent part: There is no documentation of any left knee injuries, complaints or conditions during active service in the available STRs. Furthermore, the medical records document that in March of 2002, the Veteran stated that he injured his left knee when he mis-stepped and jammed the knee about one week prior. The medical record also states that he injured the left knee while playing basketball in 1999. These events are unrelated to any existing right knee condition. There is no medical evidence that supports that his left knee condition was causally related to the right knee condition. Review of the medical literature does not show that an injury or condition of one knee adversely affects the other knee or causes any medical conditions to develop in the other knee. There is no medical evidence that supports the claim that the left knee was aggravated beyond its normal course by the right knee condition. The Veteran[] stated that his right knee condition improved after the right knee surgery in 2002. His gait was normal. He stated that the right knee pain was very mild and he did not have any pain on movement of the right knee. The Veteran’s representative contends that the latter medical examination is inadequate because it did not consider the Veteran’s lay statements aside from the “veteran states he developed pain in his left knee at the same time as he developed pain in his right knee while in active service.” Further, the representative contends that the examiner did not consider highly pertinent evidence. See Appellate Brief, November 2018. The representative does not identify the pertinent evidence he believes the examiner overlooked, nor the lay statements that were not addressed. As documented, the examiner reviewed the VBMS and CPRS files. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for left knee disorder. While the evidence of record shows that the Veteran has a current left knee disorder, the probative evidence of record demonstrates that such is not related to his service. The VA examiners opined that the Veteran’s current left knee disorder is less likely than not related to his in-service injury, or caused or aggravated by his service-connected right knee disorder. The opinions were provided following examination of the Veteran and review of the claims file, and an adequate rationale was provided for the conclusions reached. As such, the opinions are entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). There are no medical opinions to the contrary. To the extent the Veteran believes that his current left knee disorder is related to service or his service-connected right knee disability, as a lay person, the Veteran is not shown to have the specialized training necessary to render such an opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The medical opinions from the VA examiners are of greater weight. In summary, the Board finds that the left knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service. Nor is it shown to have been caused or aggravated by the service-connected right knee disability. Consequently, service connection on either a direct or secondary basis is not warranted. As the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Iglesias, Law Clerk