Citation Nr: 21000552 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 11-20 155A DATE: January 5, 2021 ORDER Service connection for a left knee disability (other than the service-connected left knee psoriatic arthritis), diagnosed as enthesopathy and strain, is granted. FINDINGS OF FACT 1. The Veteran has a current disability of left knee enthesopathy (pain with overuse or stress on the knees) and left knee strain. 2. The left knee disability was caused by the service-connected psoriatic arthritis. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for service connection for left knee strain and left knee enthesopathy, as secondary to service-connected psoriatic arthritis, have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1989 to March 1995. The instant issue on appeal – service connection for a left knee disability (other than the service-connected left knee psoriatic arthritis disability) that is diagnosed as a enthesopathy (pain with overuse or stress on the knees) and strain – was recently before the Board in April 2019. In April 2019 Board, the Board remanded the instant left knee service connection issue in order to obtain a VA examination addendum opinion, which was rendered in February 2020. Legal Authority for Service Connection Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). Service Connection for a Left Knee Strain and Enthesopathy After review of all the evidence, lay and medical, the evidence shows a current disability of left knee strain and left knee enthesopathy (pain with overuse or stress on the knees). See October 2018 VA Examination (diagnosing left knee strain); February 2020 VA Examination (diagnosing bilateral knee enthesopathy). The Veteran is already service connected for left knee psoriatic arthritis, which is rated at 10 percent under DC 5002-5260 for symptomatic pain on use with noncompensable limitation of motion, effective from March 4, 2009. The Veteran submitted to a VA examination in February 2020, which, although using some direct service connection language, essentially resulted in a secondary nexus opinion (38 C.F.R. § 3.310) that the current left knee strain and enthesopathy were caused by the service-connected psoriatic arthritis. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for secondary service connection for left knee enthesopathy and left knee strain have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. (Continued on the next page)   While enthesopathy and strain are different diagnoses than arthritis, the Board notes there is much overlapping symptomatology (such as knee pain) and functional limitation (noncompensable limitations of motion) that have already been contemplated in the 10 percent rating assigned for the service-connected psoriatic arthritis (under Diagnostic Code 5002); therefore, these secondary diagnoses will be rated together with the left knee psoriatic arthritis as one left knee disability, so as to avoid pyramiding of compensation by paying compensation for the same symptoms or functional limitation under different diagnoses. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (noting that the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions be duplicative or overlapping with the symptomatology of the other condition); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Costantino, 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.