Citation Nr: 18159933 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 15-20 892 Date: December 20, 2018 ORDER Service connection for a right knee disability, to include as secondary to a service-connected left toe disability is denied. Service connection for a right hip disability, to include as secondary to a service-connected left toe disability is denied. Service connection for a left hip disability, to include as secondary to a service-connected left toe disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has right knee disability due to a disease or injury in service, or to his service connected left toe. 2. The preponderance of the evidence is against finding that the Veteran has right hip disability due to a disease or injury in service, or to his service connected left toe. 3. The preponderance of the evidence is against finding that the Veteran has left hip disability due to a disease or injury in service, or to his service connected left toe. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 3. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1943 to December 1945. The Veteran received the Purple Heart, among other decorations. These matters come before the Board of Veterans Appeals (Board) from June 2014 and September 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded these issues in November 2017 for further development. The RO was instructed to schedule the Veteran for a VA examination to determine whether the Veteran’s claimed right hip, left hip, and right knee disabilities were proximately due to or aggravated by the Veteran’s service-connected left great toe disability. The Veteran subsequently attended VA examinations in December 2017, and the examination results are associated with the claims file. The Board is therefore satisfied that there has been substantial compliance with the remands’ directives and will proceed with review. See Stegall v. West, 11 Vet. App. 268 (1998). In August 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ) and a transcript of the hearing is associated with the claims file. 1. Entitlement to service connection for a right knee disability, to include as secondary to a service-connected left toe disability The Veteran contends that his right knee disability is secondary to his service-connected left toe disability. The Veteran claimed that he had an altered gait caused by having to use an orthotic insert due to his service-connected left toe disability, which then caused a right knee disability. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated beyond its natural progress by the Veteran’s service-connected left toe disability. The Board concludes that, while the Veteran has a current diagnosis of right iliotibial band syndrome and right knee arthritis, the preponderance of the evidence is against finding that the Veteran’s right knee arthritis is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). In December 2017, a VA examiner opined that the Veteran’s right knee disability is less likely than not proximately due to the Veteran’s service-connected left foot condition; nor was it aggravated by the Veteran’s foot condition. To support his rationale, he noted that arthritis is common with age and is often bilateral. Therefore, the onset of the Veteran’s arthritis in his right knee, along with other joints, is appropriate for a Veteran his age; and appropriate that its onset is six decades after the Veteran left service. Furthermore, the examiner reported that there was no evidence of a chronic ongoing biomechanical gait alteration caused by the Veteran’s left foot condition or use of orthotic insert in his shoe. Also in December 2017, another VA physician opined that that there is a very low chance that any knee, hip, or back problems are related to the service-connected toe disability, and opined that patients that are 90 years of age or greater all have some degree of knee, hip, or back arthritis without having had a foot injury. Similarly, a June 2014 VA examiner opined that it was less likely than not that the Veteran’s mild arthritis of his right knee was caused by his left great toe disability. To support her position, the examiner noted that there wasn’t an obvious gross disturbance of gait that would indicate an undue strain on the Veteran’s right knee. The examiner also noted that an X-ray from June 2013 indicated that the Veteran only had mild degenerative changes of his right knee which the examiner rationalized would be an expected finding due to the natural aging process. While the Veteran believes his right knee disability is due to or the result of his service-connected left toe disability, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinion of the June 2014 and December 2017 VA examiners. Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s right knee disability is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran is competent to report that he injured his great toe during service and that he has pain in his right knee, and his reports are credible and entitled to probative weight. His reports have been internally consistent, and are consistent with other evidence of record, including the Veteran’s December 1945 separation examination. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the June 2014 and December 2017 VA examiners opined that the Veteran’s right knee disability is not at least as likely as not related to an in-service injury, event, or disease, including his left toe disability. The rationale was that his current right knee disability is more likely related to his age. While the Veteran believes his right knee disability is related to an in-service injury, event, or disease, including his service-connected left toe disability, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing]. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinion of the June 2014 and December 2017 VA examiners. 2. Entitlement to service connection for a right hip disability, to include as secondary to a service-connected left toe disability 3. Entitlement to service connection for a right hip disability, to include as secondary to a service-connected left toe disability The Veteran also contends that his right and left hip disabilities are secondary to his service-connected left toe disability. The Veteran has a current diagnosis of arthritis in his bilateral hips. The Veteran underwent VA examinations in February 2016 and December 2017 related to his claim that his right hip disability is secondary to his service connected left toe disability. While the VA examiners diagnosed the Veteran with arthritis, the February 2016 VA examiner opined that the Veteran’s current right and left hip disabilities were less likely than not related to his left toe disability. Instead, the VA examiner opined that it was likely that the Veteran had idiopathic osteoarthritis. The February 2016 VA examiner further noted that there are no medical studies that support the development of degenerative arthritis in a contralateral limb due to favoring that limb. The December 2017 VA examiner further opined that the Veteran’s right and left hip disability is less likely than not incurred in or caused by the Veteran’s service or aggravated by his service-connected left toe disability, and that the Veteran’s right hip arthritis is more likely age related. While the Veteran believes his right and left hip disabilities are related to an in-service injury, event, or disease, including his service-connected left toe disability, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing]. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinion of the February 2016 and December 2017 VA examiners. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Boal, Associate Counsel