Citation Nr: 20009947 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 19-09 346 DATE: February 6, 2020 ORDER Entitlement to service connection for left thigh atrophy is granted. FINDING OF FACT The Veteran’s left thigh atrophy is proximately due to his service-connected left knee disability. CONCLUSION OF LAW The criteria for entitlement to secondary service connection for left thigh atrophy have been met. 38 U.S.C. §§ 1110, 1131, 5107 (West 2014); 38 C.F.R. §§ 3.303, 3.304, 3.102 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2008 to September 2008. This appeal comes before the Board of Veterans’ Appeals (Board) from a November 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Neither the Veteran nor the representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Thus, the Board need not discuss any potential issues in this regard. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant, when rendering a decision on appeal. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. See Gilbert, 1 Vet. App. at 53. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 1131; 38 C.F.R. § 3.303 (a). Generally, service connection requires: (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may also be considered on a secondary basis pursuant to 38 C.F.R. § 3.310. The evidence must demonstrate an etiological relationship between a service-connected disability and the condition said to be proximately due to or the result of the service-connected disability. See Buckley v. West, 12 Vet. App. 76, 84 (1998). Secondary service-connection may also be warranted for a nonservice-connected disability when that disability is aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The Veteran seeks service connection for a left thigh condition, secondary to service-connected left knee disability. Specifically, he claims that his physiatrist has diagnosed atrophy in the left thigh, secondary to the service-connected left knee injury, and that he has been constantly receiving therapy for this condition. He also contends that his left thigh muscle atrophy is visible and measurable. Although the Veteran was not found to have any left thigh muscle atrophy condition during the most recent VA examination (and as a result, the VA examiner did not provide a medical opinion on the secondary service connection during that time), there is other competent and credible evidence, to include the January and February 2018 VA examinations/medical opinions, as well as contemporaneous VA treatment records, suggesting that the Veteran has current left thigh muscle atrophy (see November 2018, February 2018, and January 2018 VA examinations/medical opinions, see also e.g., November 2018 VA examination, December 2018 VA treatment records, February 2019 VA treatment records, documenting the Veteran’s complaints of his left thigh muscle atrophy, continued therapies provided for his muscle atrophy and strength impairment, as well as various medical findings for his left thigh muscle atrophy/weakness/VMO muscle atrophy). Thus, the Board finds that the evidence is in equipoise that the Veteran has current left thigh muscle atrophy. Turning to the medical etiology opinions in the file, the Board gives the most probative value to the January and February 2018 VA medical opinions and examinations that diagnosed the Veteran with a left quadricep atrophy and provided a positive etiology opinion. Although the Board acknowledges that the rationales for these positive secondary service connection could have been a bit more extensive (in its explaining the nexus), the Board still finds them to be adequate and highly probative, especially in light of the fact that these were, after all, provided after comprehensive review of all pertinent records, along with a thorough in-person examination, in addition to the fact that they were supported by concrete objective and subjective findings. There are no other secondary service connection medical opinions in this case. Again, the findings of these VA examiners that there is, in fact, left thigh atrophy is verified by the VA outpatient records. Thus, in summary, affording the Veteran the benefit of the doubt, service connection for left thigh atrophy is granted. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lee The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.