Citation Nr: 21004837 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 05-36 373 DATE: January 28, 2021 ORDER Entitlement to service connection for a left knee disability, to include as secondary to service-connected disabilities, is denied. FINDING OF FACT The Veteran’s left knee disability was not incurred in or due to his time in service and is not proximately due to any of his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for a left knee disability, to include as secondary to service-connected disabilities, are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from May 1962 to July 1966. The Veteran had a hearing in March 2011. A transcript has been associated with the file. The Veteran had previously had a hearing on other matters initially part of his appeal in September 2001. Those matters have since been adjudicated. In November 2015, the Veteran indicated he did not want a third hearing and wanted his appeals decided on the evidence of record. This matter has been remanded for further development multiple times in June 2012, April 2016, March 2019, and most recently in August 2020. The development has been completed and the matter is again before the Board. The Board’s apologies for the delay in the adjudication. As a preliminary matter, the Board notes the Veteran has been in receipt of a total disability rating based on individual unemployability (TDIU) since July 2006. Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016), Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends he has a left knee disability that was incurred in and due to his time in service or that it is proximately due to his service-connected disabilities. Specifically, the Veteran has said that the altered gait caused by his right knee disability aggravated his left knee disability. The Veteran reported while in service, he was hit by a boat and that conducting ship maintenance also contributed to his left knee condition. (See March 2011 hearing transcript.) The Veteran has been diagnosed with a left knee disability. The Veteran’s service treatment records (STRs) do not show he was seen in service for an ongoing left knee problem or a knee injury resulting from a boat accident. Indeed, his separation examination is negative for any continuing complaints of a left knee problem. The Veteran had an examination for his left knee in August 2012. The examiner reviewed the Veteran’s file and the examiner said the Veteran’s left knee disability was less likely than not incurred in or due to his time in service, stating that the Veteran’s record did not indicate any knee problems while in service. However, no additional rationale was offered. Thus, the Veteran had another examination for his left knee in January 2017. The examiner saw the Veteran in person, reviewed his file, and noted his left knee diagnosis. The examiner considered the Veteran’s statements about how his time in service caused his knee problem. The examiner opined the Veteran’s left knee disability was less likely than not incurred in and due to his time in service. The examiner explained that while the Veteran gave a history of a lot of bending, squatting, climbing, and stooping while in service, there was no documentation in service of any injury or significant trauma to the left knee. Additionally, the examination that day showed the Veteran’s knee condition was consistent with age. In August 2018, a medical expert opinion was submitted. The examiner reviewed the Veteran’s file, including the Veteran’s statements and testimony about his activities in service. The examiner opined that the Veteran’s left knee was not etiologically related to the Veteran’s time in service or within one year of his discharge. The examiner noted that x-rays obtained in January 2017 showed mild degenerative left knee changes, stable since 2011. This examiner noted that while the Veteran claimed that gait changes led to his left knee problems, “the medical literature is replete with studies that dispel this belief, in the absence of a major disorder in the contralateral extremity. The Veteran’s right knee condition is not of such severity that it would be consistent with causing impact on the contralateral extremity.” In September 2020, in an addendum opinion, the examiner noted the Veteran’s height, weight, and age, and opined that based on these factors, the Veteran’s left knee x-rays were better than most men of his age and height, showing his x-rays only show “mild degenerative changes of the left knee” consistent with aging, weight, genetics, nutritional, and hormonal factors. The examiner reviewed the Veteran’s file and opined it was less likely than not the Veteran’s left knee was proximately due to his right knee disability. The examiner explained there was no medical basis for such an assumption. Additionally, the examiner opined it was not at least as likely as not the Veteran’s left knee was aggravated by his service-connected right knee disability, saying there is insufficient medical evidence to support this assumption. The examiner considered the Veteran’s argument that his altered gait by his right knee led to his left knee disability. The examiner acknowledged this theory of etiology but said that this testimony did not “trump medical evidence which is clear that the left knee is essentially symptomatic due to osteo-arthritis.” After a thorough review of the Veteran’s treatment records, his in-service records, his examinations, and his contentions and statements, the Board finds that the most probative evidence shows that the Veteran’s left knee disability was not incurred in or due to his time in service. Additionally, multiple examiners have stated the Veteran’s left knee disability is consistent with his age, rather than due to his service-connected right knee disability. Regarding the above, the Board acknowledges the Veteran’s statements that his left knee bothers him and that he continues to seek treatment for his condition. The Board also recognizes the Veteran’s statements that he believes his left knee disability could have been secondary to his service-connected right knee disability. However, while the Veteran is competent to report the symptoms of his disabilities, he is not competent to opine on matters requiring medical knowledge, such as diagnosing or determining the nature and etiology of medical conditions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board places more probative weight on the objective medical evidence of record. The Board finds that while the August 2012 examination was inadequate due to a lack of supporting rationale, the other examinations of record, upon which the Board has relied to render its decision, are adequate because the Veteran was seen in person, his file was reviewed, his statements were considered, and the examiners formed opinions backed by detailed explanations. It is important for the Veteran to understand that the medical findings provide highly probative evidence against this claim that the Board cannot, unfortunately, ignore, outweighing the Veteran’s belief that his disability is the result of service, providing a highly clear basis for the opinion. Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Snoparsky 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.