Citation Nr: 20021601 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 17-37 149 DATE: March 26, 2020 ORDER Service connection for a left knee disability is denied. FINDING OF FACT The Veteran’s left knee disability is not secondary to his service-connected right knee disability and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a left knee disability have not been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1968 to June 1972, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of this testimony is associated with the claims file. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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. The is referred to as “direct” service connection. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. This is commonly referred to as “secondary” service connection as the claimed disability has been caused or aggravated secondary to a service-connected disability. As an initial matter, the evidence shows that the Veteran has a current left knee disability. The Veteran initially filed his claim for service connection in July 2012. Medical evidence revealed that he had arthritis of both knees, as shown by a June 2013 x-ray examination report. During the pendency of the claim the Veteran required total left knee replacement surgery to treat his left knee arthritis in April 2015. Accordingly, the Veteran has a current left knee disability. The Veteran is service connected for a right knee disability. Service treatment records reveal that the Veteran incurred a right knee injury which resulted in a torn medial meniscus which required surgical treatment. When he filed his claim in 2012, the Veteran specifically claimed service connection for a left knee disability secondary to the right knee disability. Service treatment records show no complaints, diagnosis, or treatment related to any left knee injury or disability during service. During the May 1972 separation examination, evaluation of the lower extremities was normal. All records referring to knee symptoms in service relate to the right knee. A left knee disability is not shown by medical evidence until approximately June 2013, four decades after the Veteran’s separation from service. These records show that the Veteran had bilateral knee arthritis which required treatment with medication injection. In September 2013, a VA examination of the Veteran was conducted. The examiner reviewed the evidence of record and indicated a diagnosis of bilateral knee arthritis. According to the Veteran, his left knee had been bothering him for the past 10 years. The examiner’s medical opinion was that the Veteran’s claimed left knee arthritis was less likely than not proximately due to or the result of the service-connected right knee disability. The examiner specifically indicated that the evidence showed that the Veteran had severe tricompartmental arthritis in both knees and the left knee arthritis was likely a natural process of aging. In May 2017, another VA examination of the Veteran was conducted. The examiner noted the prior diagnoses of bilateral knee arthritis and the right knee meniscus tear as well as the subsequent bilateral knee replacement surgeries. The examiner’s medical opinion was that it was less likely than not that the Veteran’s claimed left knee disability was caused or aggravated by the service-connected right knee disorder. The examiner specifically stated that arthrotomy in one knee would not cause arthritis in the other. Moreover, despite the Veteran’s assertion of favoring his right knee, the examiner indicated the medical evidence, including medical studies referenced by the Veteran, do not support the worsening of arthritis on the contralateral knee absent major muscle or nerve damage, partial or complete paralysis of the damaged leg, and/or shortening of the injured lower extremity resulting in a limb length discrepancy of more than 4 or 5 cm so that the individual’s gait pattern has been altered to the extent that clinically there is an obvious lurch type gait (a significant limp). In addition, the examiner indicated such a gait would need to be present for an extended period to have an impact on the opposite leg. The examiner noted a normal gait pattern at the examination. A copy of the medical study referenced by the examiner was placed in the record by the Veteran as an attachment to his substantive appeal. At the January 2020 hearing, the representative asserted that the examiner who conducted the most recent Compensation and Pension examination may not have reviewed the record because they were a member of the Veteran’s primary care team. The Board has rarely, if ever, heard the assertion that a treating medical professional’s examination report is inferior to one conducted by a medical professional solely for Compensation and Pension purposes. By virtue of treating the Veteran, the treating physician would be somewhat aware of the medical history. Moreover, the assertion that the examiner did not review the relevant information is baseless and unsupported by the evidence as the examination report specifically indicates that the examiner who conducted the 2017 Compensation and Pension examination reviewed all the evidence of record, and the examiner referenced specific pieces of the evidence in the examination report and medical opinion. The Veteran’s claim for service connection on a secondary basis must be denied. The VA medical opinions of record indicate that the Veteran’s service-connected right knee disorder did not cause or aggravate his left knee disability. The Board finds the opinions highly probative as they were made by medical professionals with consideration of the specific facts in this case and after examination of the Veteran. In addition, a rationale is provided to support the conclusions reached. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. The Board has considered the Veteran’s statements, to include his assertions that that the right knee disability caused or aggravated his left knee. However, as the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., pain; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. Accordingly service connection on a secondary basis must be denied. During the pendency of the appeal the Veteran also asserted his claim for service connection for a left knee disability on a direct basis. In written statements, and his 2020 hearing the Veteran made the same basic assertion the he injured both knees during service in Vietnam when he fell during a rocket attack in 1969. He asserts that both knees were injured but that his right knee was injured worse and required surgery. The objective evidence of record contradicts the Veteran’s assertions made in his written statements and at the hearing. Service records establish that the Veteran served in Vietnam from July 1970 to May 1971. Service treatment records dated February 1971 indicate that the Veteran “injured his right knee 2 weeks ago playing football” and that he was now being seen because he reported twisting the right knee again jumping off a truck. No mention of any injury to the left knee is indicated, nor is the claimed rocket attack. Treatment records in August and September 1971, after his return from Vietnam, note ongoing problems with the right knee associated with the February 1971 injury. Moreover, despite assertions made at the hearing, there is no evidence to establish that the Veteran served directly in combat during his period of service in Vietnam. Examination of the lower extremities at separation, performed in May 1972, revealed no left knee abnormalities. At the September 2013 Compensation and Pension examination the Veteran reported having a 10-year history of bilateral knee pain and again injuring his knee “in a rocket attack when he twisted his right knee getting into a bunker.” Again, no mention of any left knee injury during service was made. The Board also notes that the 2013 Compensation and Pension examination indicated that the Veteran had bilateral knee arthritis which was age related. The Veteran’s assertions of injuring his left knee during service have been considered and the Board does not find them credible in light of the documented records in the service treatment records and the Veteran’s initial reports of the length and extent of his history of knee pain. There is no evidence in the service treatment records that the Veteran injured his left knee in service, and his assertions of such an injury are not credible. In 2013 he specifically reported a 10-year history of knee pain, which contradicts and possible assertions of a continuity of symptomatology dating to service. The 2013 medical opinion specifically indicated that the Veteran’s left knee arthritis was age related. With no credible evidence of a left knee injury or disability during service and no evidence of a link to service, the claim on a direct basis must be denied. For the above reasons, the preponderance of the evidence is against the claim and service connection for a left knee disability is denied. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Havelka, Counsel 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.