Citation Nr: 20031682 Decision Date: 05/05/20 Archive Date: 05/05/20 DOCKET NO. 11-31 195 DATE: May 5, 2020 ORDER Entitlement to service connection for left knee condition, to include as secondary to service-connected right knee disability, is denied. FINDING OF FACT The preponderance of the evidence is against finding that left knee condition began during active service, is otherwise related to service, or caused or aggravated by the Veteran’s service-connected right knee disability. CONCLUSION OF LAW The criteria for entitlement to service connection for left knee condition have not been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from January 2006 to January 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was last before the Board in December 2018 and was remanded for further development. The development was completed and has been returned to the Board for further appellate action. Service Connection Service connection may be established 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. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Moreover, where a veteran served continuously for 90 days or more during a period of active service during a period of war, or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. §§ 3.307, 3.309. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disability, or for the degree of disability resulting from aggravation of a nonservice-connected disability. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995). Entitlement to service connection for left knee condition, to include as secondary to service-connected right knee disability. The Veteran’s main contention on appeal is that he developed a left knee disability that has been caused by or aggravated by the service-connected right knee disability. The Veteran reports that does to overuse of his left knee to compensate for his right knee, he began to develop left knee pain while still in the service. As an initial matter, the Board finds that the Veteran has a current disability, diagnosed as left knee strain and degenerative arthritis of the left knee. Accordingly, the first criterion for establishing service connection has been met. The question therefore becomes whether the Veteran’s disability is related to service. The Veteran’s service treatment records are silent with regard to a diagnosis of, or treatment for the Veteran’s left knee. The Veteran’s separation exam from the Marine Corps is negative regarding complaints of left knee pain. The Veteran’s post-service treatment records show the Veteran was seen for his left knee during an October 2010 VA examination. The examiner stated that the Veteran had active movement against full resistance and full range of motion of the left knee. That is, shortly after service, the left knee examination was thoroughly examined by VA and no disability, to include one manifested by functional impairment without a formal diagnosed, was indicated. The Veteran had full range of motion in the left knee without pain. This evidence weighs against a finding that the Veteran had a chronic left knee disability near in time to his separation from service. This finding also weighs against the Veteran’s contention that a left knee disability began during service, as this examination was provide nine months after separation from service and did not document evidence of left knee disability. In March 2012, the Veteran filed a claim for his left knee condition and was afforded a new examination in February 2017. The Board has previously found this opinion inadequate; for this reason, the Board does not rely on it. Further, although this report further makes contradictory statements regarding a pre-existing left knee disability, read as a whole it is clear that this examination did not accurately document such a finding and it is not otherwise supported by the record. As noted, the service medical records do not document a left knee disability, and likewise, do not document a pre-service injury. Following the December 2018 Board remand, the Veteran was afforded another VA knee examination in November 2019. The examiner opined that the Veteran’s left knee condition was not related to service. The examiner stated that a service treatment note in October 2009 showed the Veteran had a right knee injury while running, but that no left knee pain was reported. The examiner further reasoned that there were no clinical studies available to support a nexus. The examiner further opined that the Veteran’s left knee disability was not caused by the Veteran’s service-connected right knee disability. The examiner reasoned that the Veteran’s left knee disability was not a factor in the development of osteoarthritis. The examiner also referenced a Mayo Clinic article regarding osteoarthritis which stated that osteoarthritis involves wear-and-tear damage to joint cartilage, and the hard, slick coating on the ends of bones where they form a joint. The article further noted that cartilage cushions the ends of the bones and allows nearly frictionless join motion, but that enough damage can result in bone grinding directly on the bone, which causes pain and restricted movement. The article also noted that wear and tear can occur over many years, or it can be hastened by a joint injury or infection, and that osteoarthritis affects the entire joint, causing changes in the bone and deterioration of the connective tissues that attach muscle to bone and hold the joint together. Lastly, the article noted, it also causes inflammation of the joint lining. With regarding to secondary service connection based on aggravation, the examiner opined that the Veteran’s left knee disability was not aggravated beyond its natural progression by the Veteran’s service-connected right knee disability. The examiner reasoned that arthritis was not a factor in the development of osteoarthritis of the knees. Upon review of the record, the Board finds the November 2019 VA examiner’s opinion regarding direct service connection is probative and entitled to weight. The opinion reflected consideration of the Veteran’s medical history, and medical records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board similarly finds the November 2019 VA examiner’s opinion regarding causation and aggravation probative and entitled to weight. The opinion reflected consideration of the Veteran’s medical history, medical records, and was supported with medical literature that was consistent with the evidence. See Nieves-Rodriguez, 22 Vet. App. at 304. There are no medical opinions to the contrary. This opinion considers the relevant medical evidence and considers the Veteran’s contentions. The rationale is based on the examiner’s specific reference to the disease processes involved and the examiner provides reasons that the disease process involved in unrelated to service and is not secondary to the service-connected right knee disability. While the Veteran believes that his current disability is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. In this regard, the etiology of a knee condition, such as left knee strain and degenerative arthritis of the left knee, is a matter that requires medical training and expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his current disability is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Thus, the Board finds the opinions of the of the November 2019 VA examiner to be significantly more probative than the Veteran’s lay assertions. In sum, the Board concludes that the most probative evidence of record is against finding that the Veteran’s left knee condition arose in service, was manifested in the year following discharge from service, or is otherwise related to service. Accordingly, the claim for service connection is denied. The evidence of record also weighs against a finding of secondary service connection by causation or aggravation.   In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine does not apply and service connection must be denied. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Perez, Associate 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.