Citation Nr: 21001505 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 16-45 099 DATE: January 8, 2021 ORDER Entitlement to service connection for a right knee disability is granted. Entitlement to service connection for a left knee disability is granted. Entitlement to service connection for a back disability is granted. FINDINGS OF FACT 1. The Veteran’s right knee disability is proximately due to his service-connected bilateral foot disability. 2. The Veteran’s left knee disability is proximately due to his service-connected bilateral foot disability. 3. The Veteran’s back disability is aggravated beyond its natural progression by his service-connected bilateral hip disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for a left knee disability are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for a back disability are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1975 to July 1979. These matters come before the Board of Veterans’ Appeals on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned at a Travel Board hearing in March 2019; a transcript is of record. The appeal was before the Board in November 2019, when it was decided in part and remanded in part. In a rating decision since issued in July 2020, the RO granted service connection for a bilateral hip disability and bilateral lower extremity neuralgia (claimed as nerve damage). Consequently, these issues are no longer on appeal and are not addressed in this decision. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Additionally, service connection may be granted on a secondary basis for a disability which is proximately due to or the result of an established service-connected disability. 38 C.F.R. § 3.310. Similarly, any increase in severity of a non-service-connected disease or injury that is proximately due to or the result of a service-connected disability will be service-connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the non-service-connected disease or injury is said to have been aggravated by the service-connected disability. 38 C.F.R. § 3.310. In cases of aggravation of a Veteran’s non-service-connected disability by a service-connected disability, the Veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.322. 1. Entitlement to service connection for a right knee disability 2. Entitlement to service connection for a left knee disability Issues 1-2: The Veteran contends he has a bilateral knee disability related to service. Alternatively, he contends that his bilateral knee disability is related to his service-connected bilateral foot disability. Medical records show the Veteran has a current disability of bilateral patellofemoral pain syndrome status post bilateral ACL reconstruction and post left meniscus repair, alternatively diagnosed as bilateral knee degenerative arthritis. The December 2019 VA examiner opined that a knee disability was not incurred in service or caused or aggravated by a foot disability. The examiner’s rationale was that the Veteran’s bilateral knee disability was due to his post-service torn ACL and meniscus, and that his knee disability began several years after his foot disability. The examiner stated medical literature did not support a relationship between his knee and foot disabilities. A March 2020 private medical examiner opined that the Veteran’s bilateral knee disability was caused by his service-connected bilateral foot disability. The examiner noted medical records reflected that the Veteran had an abnormal gait, and stated it resulted in hyperextension of the knees, worsening his knee disability. The examiner also stated the Veteran’s bilateral foot disability, hallux rigidus, is commonly known to increase knee pain due to altered stride. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current bilateral knee disability is proximately due to or aggravated beyond its natural progression by his service-connected bilateral foot disability. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for right and left knee disabilities are warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for a back disability The Veteran contends he has a back disability related to service. Alternatively, he contends that his back disability is related to his service-connected bilateral foot or hip disabilities. Medical records show the Veteran has a current disability of lumbosacral strain and degenerative arthritis of the spine, also diagnosed as thoracolumbar spine degenerative disc disease. The December 2019 VA examiner opined that a back disability was not incurred in service or caused or aggravated by a foot disability. The examiner’s rationale was that the separation examination was negative for a spine condition, his post-service records first showed back complaints following a 2007 motorcycle accident, and there is no nexus between a back disability and a foot disability. The examiner did not provide an opinion about a relationship between the Veteran’s back disability and his service-connected bilateral hip disability. A March 2020 private medical examiner opined that the Veteran’s back disability was caused by his service-connected bilateral hip disability. The examiner noted medical records reflected that the Veteran had an abnormal gait from his bilateral foot disability, which led to his bilateral hip disability. The examiner stated that the bilateral hip disability, iliopsoas tendonitis, led to the Veteran’s back disability. The examiner acknowledged the Veteran’s post-service 2007 motorcycle accident, but he opined that the bilateral hip disability nonetheless aggravated the Veteran’s back disability. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current back disability is proximately due to or aggravated beyond its natural progression by his service-connected bilateral hip disability. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a back disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Dean, 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.