Citation Nr: 21004865 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 15-02 493 DATE: January 28, 2021 ORDER Service connection for a sinus disability is denied. Service connection for irritable bowel syndrome (IBS) is granted. Service connection for a right ankle disability is denied. New and material service treatment records have been obtained, and a claim of service connection for a right knee disability is reopened and reconsidered. New and material service treatment records have been obtained, and a claim of service connection for a left knee disability as secondary to a right knee disability is reopened and reconsidered. Service connection for a right knee disability is denied. Service connection for a left knee disability as secondary to a right knee disability is denied. FINDINGS OF FACT 1. There is no in-service event, disease, or injury related to sinusitis. 2. IBS qualifies as a medically unexplained chronic multi-symptom illness. 3. A right ankle disability is not related to service and did not manifest within one year of separation from service. 4. Service treatment records associated with the claims file since a final February 2006 rating decision relate to an unestablished fact, are not cumulative or redundant of the evidence previously of record, and are sufficient to raise a reasonable possibility of substantiating the claim of service connection for a right knee disability. 5. Service treatment records associated with the claims file since a final February 2006 rating decision relate to an unestablished fact, are not cumulative or redundant of the evidence previously of record, and are sufficient to raise a reasonable possibility of substantiating the claim of service connection for a left knee disability as secondary to a right knee disability. 6. Right knee arthritis is not related to service and did not manifest within one year of separation from service. 7. Left knee arthritis is not related to service, is not related to a service-connected disability, and did not manifest within one year of separation from service. CONCLUSIONS OF LAW 1. The criteria for service connection for sinusitis are not met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for service connection for IBS are met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.317 (2019). 3. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 4. Service treatment records associated with the claims file since a final February 2006 rating decision are new and material; therefore, the Veteran’s claim of entitlement to service connection for a right knee disability is reopened and reconsidered. 38 U.S.C. §§ 5108, 7105(c) (2012); 38 C.F.R. §§ 3.156(c), 20.1103 (2019). 5. Service treatment records associated with the claims file since a final February 2006 rating decision are new and material; therefore, the Veteran’s claim of entitlement to service connection for a left knee disability as secondary to a right knee disability is reopened and reconsidered. 38 U.S.C. §§ 5108, 7105(c) (2012); 38 C.F.R. §§ 3.156(c), 20.1103 (2019). 6. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 7. The criteria for service connection for a left knee disability as secondary to a right knee disability are not met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1987 to November 1990. This appeal is before the Board of Veterans’ Appeals (Board) from July 2013 and April 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In March 2018, the Veteran testified during a Board hearing in Atlanta, Georgia, before the undersigned Veterans Law Judge. A transcript is included in the claims file. In September 2018 the Board remanded the Veteran’s appeal with instructions to obtain current records and to readjudicate the appeal considering new evidence submitted. The appropriate records were obtained, and a supplemental statement of the case was issued in June 2020. The Board is therefore satisfied that the instructions in its September 2018 remand have been satisfactorily complied with. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted 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(a). Service connection requires: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). For certain chronic diseases, such as arthritis, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Unlike service connection on a direct basis, the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 do not require competent medical nexus of a link between the qualifying chronic disability and military service. Service connection is presumed unless there is affirmative evidence to the contrary, where the criteria are met. See 38 C.F.R. § 3.317(c); Gutierrez v. Principi, 19 Vet. App. 1 (2004). The term “Persian Gulf Veteran” means a Veteran who, during the Persian Gulf War, served on active military, naval, or air service in the Southwest Asia theater of operations. The Southwest Asia theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(2). The term “qualifying chronic disability” means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; (B) a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) functional gastrointestinal disorders (excluding structural gastrointestinal disorders). 38 C.F.R. § 3.317(a)(2)(i). A medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. See 38 C.F.R. § 3.317(a)(2). “Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). For the purposes of 38 C.F.R. § 3.317, disabilities that have existed for six months or more or that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 1. Entitlement to service connection for a sinus disability The Veteran claims service connection for a sinus disability. Service treatment records reflect multiple upper respiratory infections but no diagnosis of any sinus disability. No sinusitis abnormality was noted at the Veteran’s separation examinations in October 1990 or November 1990, and in the accompanying reports of medical history he explicitly denied having ever experienced sinusitis. (While the October 1990 examination noted a preauricular sinus, there was no abnormality noted in the paranasal sinuses.) VA treatment records reflect that in October 1995 the Veteran was diagnosed with sinusitis. In March 1996 he again was diagnosed with acute sinusitis. In December 1996 he was again diagnosed with sinusitis. In October 1997 he reported an 8-year history of sinus trouble. In June 1998 he was diagnosed with chronic sinusitis, and in July 1998 he underwent nasal polypectomy. At a November 2000 Persian Gulf registry examination, he reported sinus symptoms for one year. The Veteran submitted March 2013 disability benefits questionnaires for headaches and sinus conditions completed by his treating VA nurse practitioner. The practitioner diagnosed chronic sinusitis and nonmigraine headaches related to sinus problems. Attached was a February 2013 CT scan showing mild chronic nonspecific inflammatory changes within the sinuses. No etiology opinion was given regarding sinusitis. In his August 2013 notice of disagreement, the Veteran stated that he was treated for his sinus disability in service. VA obtained a December 2014 medical opinion from a VA medical examiner based on review of the record. The examiner opined that sinusitis was less likely than not related to service. This opinion was based on the rationale that service records did not document chronic, ongoing treatment for sinusitis, and it is therefore less likely than not that current sinusitis is related to service 24 years prior. VA treatment records reflect that in September 2015 the Veteran reported sinus congestion. His treating physician advised that smoking tobacco aggravated his sinuses and encouraged him to stop. At his March 2018 hearing, the Veteran reported that in service he was on a ship and worked with a lot of dust. He stated that he had sinus problems that were operated on when he got out of the military. In a June 2020 statement, the Veteran reported that his sinusitis was treated in service. The Board finds that the evidence weighs against a finding of an in-service event, disease, or injury related to sinusitis. Service treatment records do not indicate any sinus symptoms or diagnoses beyond the preauricular sinus, which have no apparent relationship to paranasal sinuses. VA treatment records show initial treatment for sinus troubles in 1995, nearly five years after separation. He was treated for sinusitis extensively in the 1990s, but he reported no link to service until August 2013 when he stated that the disability began in service. He explicitly denied having ever experienced sinusitis at separation, and this contemporaneous statement is more probative than recollections decades later. At his hearing, he stated that he attributed his sinus trouble to dust he inhaled in service, but this theory appears to be wild speculation unsupported by any evidence, medical or otherwise. For these reasons, the Board finds that the evidence weighs against a finding of an in-service event, disease, or injury related to sinusitis. Service connection is therefore denied. 2. Entitlement to service connection for a gastrointestinal disability The Veteran claims service connection for a gastrointestinal disability. Service treatment records reflect that in February 1988 the Veteran was treated for diarrhea and vomiting. He was diagnosed with diarrhea. In June 1988 he reported tightness in his stomach and was diagnosed with abdominal pain. In August 1989 he reported abdominal pain and two days without bowel movements. He was diagnosed with constipation. In October 1990 he reported diarrhea after drinking apple juice earlier that morning. He was diagnosed with a possible viral syndrome. No such abnormality was noted at his separation examinations three days later in October 1990 and several weeks later November 1990, and in the accompanying reports of medical history he explicitly denied having ever experienced frequent indigestion or stomach, liver, or intestinal trouble. VA treatment records reflect that at a November 2000 Persian Gulf registry examination the Veteran did not report any history or symptoms of gastrointestinal problems. In May 2004 he reported stomach pain, indigestion, nausea, and occasional vomiting. He associated his symptoms with stress and eating certain foods. He was diagnosed with reflux. In May 2012, he reported stomach pains, burping, gas, indigestion, loose bowel movements, and vomiting. He was diagnosed with abdominal pain and prescribed maalox. X-rays showed no hiatal hernia or abnormality but a large amount of stool. The Veteran underwent a VA examination in May 2013. He reported that he began experiencing abdominal pain in February 1988 with diarrhea and vomiting. He reported that he continued to have these symptoms intermittently since then. He reported that the symptoms are triggered by being emotionally upset or mentally stressed. He was diagnosed with IBS and H. pylori infection. The examiner opined that the disabilities were less likely than not related to service. This opinion was based on the rationale that service treatment records indicated a few unrelated acute gastrointestinal illnesses with no evidence of chronic symptoms such as those currently reported. The examiner explained that the in-service symptoms were not consistent with the current diagnoses of H. pylori or IBS. The examiner opined that the current disabilities did not have their onset until 2010. In his June 2014 notice of disagreement, the Veteran stated that he was treated for gastroesophageal reflux disease (GERD) in service. He also noted that at his separation examination an abnormality was noted in his “G-U system.” The Board notes that the G-U system is the genitourinary system, which indeed was marked abnormal at his October 1990 separation examination. His “abdomen and viscera,” however, was marked normal. At his March 2018 hearing, the Veteran reported that he was treated for his gastrointestinal symptoms a lot in service. As an initial matter, the Veteran was denied eligibility for service connection for a Gulf War illness by the RO based on a finding there was no evidence of qualifying service in Southwest Asia during the Persian Gulf War period, which began in August 1990, three months prior to his separation. His October 1990 separation examination, however, was conducted aboard the U.S.S. John F. Kennedy, which at the time was stationed in the Red Sea. This service, however brief, qualifies him for consideration under 38 C.F.R. § 3.317. The Board finds that the evidence is at least in equipoise that the Veteran’s diagnosed IBS is a qualifying disability under 38 C.F.R. § 3.317. He was diagnosed with IBS at his May 2013 VA examination. While the examiner opined that IBS was not related to service, the examiner did not address the Veteran’s contentions that his digestive symptoms were related to his service-connected mental health disability, nor did the examiner provide an opinion as to whether IBS was a medically unexplained chronic multi-symptom illness. As the record does not contain any other medical evidence identifying an explanation for the Veteran’s IBS, the Board finds that the evidence is at least in equipoise that the Veteran’s diagnosed IBS is a qualifying disability under 38 C.F.R. § 3.317. Service connection is therefore granted. 3. Entitlement to service connection for a right ankle disability The Veteran claims service connection for a right ankle disability. Service treatment records do not reflect any symptoms of or treatment for any right ankle disability, and no such abnormality was noted at the Veteran’s separation examinations in October 1990 and November 1990. VA treatment records reflect that at a November 2000 Persian Gulf registry examination the Veteran reported current knee symptoms but no history or symptoms of an ankle disability. In his August 2013 notice of disagreement, the Veteran stated that he was treated for his right ankle disability in service. VA treatment records reflect that in November 2014 the Veteran presented to the emergency room reporting right ankle pain that started in the 1980s after a traumatic injury. He reported chronic achy pain. He was given differential diagnoses of unilateral noninflammatory arthritis and osteoarthritis. X-rays showed that he either had an injured deltoid ligament or a previous small avulsion fracture. His podiatrist prescribed a brace. In May 2015 he reported to his podiatrist that his right ankle pain had resolved. In September 2015 he again denied right ankle pain or loss of motion. In a June 2020 statement, the Veteran reported that his ankle pain had worsened. The Board finds that the evidence weighs against a finding that the Veteran’s right ankle disability is related to service or manifested within one year of separation from service. There is no evidence of any ankle symptoms prior to his March 2012 claim. While he maintains that he was treated for this disability in service, he has not described where, when, or how he injured his right ankle. Rather, he vaguely describes a traumatic injury that occurred sometime in the 1980s. His service treatment records, showing no such treatment, are more probative than his current recollections. His ankle x-rays provide evidence that his symptoms are related to a remote injury but there is no evidence beyond the Veteran’s vague recollections to establish that this injury occurred in or before service. For these reasons, the Board finds that the evidence weighs against a finding that the Veteran’s right ankle disability is related to service or manifested within one year of separation from service. Service connection is therefore denied. 4. Whether new and material evidence has been received to reopen a claim of service connection for a right knee disability 5. Whether new and material evidence has been received to reopen a claim of service connection for a left knee disability as secondary to a right knee disability The Veteran seeks to reopen his claims of service connection for disabilities of the bilateral knees. VA may reopen a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). “New” evidence is evidence not previously submitted to agency decision makers and “material” evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether the evidence presented or secured since the prior final disallowance of the claim is new and material, the credibility of the evidence is generally presumed. Cox v. Brown, 5 Vet. App. 95, 98 (1993); Justus v. Principi, 3 Vet. App. 510, 513 (1992). VA is required to review for newness and materiality only the evidence submitted by a claimant since the last final disallowance of the claim on any basis, whether a decision on the underlying merits or, a petition to reopen. Evans v. Brown, 9 Vet. App. 273, 283 (1996). In Shade v. Shinseki, 24 Vet. App. 100 (2010), the United States Court of Appeals for Veterans Claims (Court) held that § 3.159(c)(4) does not require new and material evidence as to each previously unproven element of a claim for the claim to be reopened and the duty to provide an examination triggered. In a fact pattern where a prior denial was based on lack of current disability and nexus, the Court found that newly submitted evidence of a current disability was, in concert with evidence already of record establishing an injury in service, new and material and sufficient to reopen the claim and obtain an examination. Regardless of any RO determinations that new and material evidence has been submitted to reopen service connection, the Board must still determine whether new and material evidence has been submitted in this matter. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). When the new evidence consists of relevant service department records that existed and had not been associated with claims file at the time of the prior denial, the original claim will be reconsidered instead of reopened, and the date of the prior claim remains the date of the claim. 38 C.F.R. § 3.156(c). The Veteran’s bilateral knee claims were originally denied in a February 2006 rating decision based on a finding that there was no in-service event, disease, or injury related to a current disability. The rating decision noted that service treatment records were unavailable except for his June 1987 enlistment examination report. The Veteran neither appealed the denial nor submitted evidence within the one-year appeal period, and the decision therefore became final. Since the February 2006 final rating decision, the Veteran’s complete service treatment records have been associated with his claims file. These records include a January 1988 diagnosis of probable mild chondromalacia patella in the right knee. The Board finds that this evidence relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claims of service connection for a right knee disability and for a left knee disability secondary to a right knee disability. The Veteran’s claims are therefore reconsidered under 38 C.F.R. § 3.156(c) and are addressed on the merits below. 6. Entitlement to service connection for a right knee disability 7. Entitlement to service connection for a left knee disability as secondary to a right knee disability The Veteran claims service connection for bilateral knee disabilities. Service treatment records reflect that in January 1988 the Veteran reported right knee pain, especially after marching. He was diagnosed with probable mild chondromalacia patella. There was no followup treatment. No such abnormality was noted at his separation examinations in October 1990 and November 1990, and in the accompanying reports of medical history he explicitly denied having ever experienced arthritis or trick/locked knee. VA treatment records reflect that at a September 2000 Persian Gulf registry examination, the Veteran reported right knee pain that was interfering with his work as an electrician. He stated that he injured his right knee climbing stairs, though he did not say when. At a November 2000 followup he reported bilateral knee pain, worse on the right. In June 2005 he reported bilateral knee pain. He reported that his current braces do not provide enough support and that his knees buckle. He was provided with new braces. He attributed his pain to service, stating that he had to go up and down stairs on ships. The Veteran submitted a March 2013 disability benefits questionnaire completed by his treating VA nurse practitioner. The practitioner diagnosed arthritis of the bilateral knees. No etiology opinion was offered. The Veteran underwent a VA examination in May 2013. He reported that he first began having problems with his right knee in January 1988. He denied any injuries but stated that he began having pain with marches and running. He stated that he sought medical treatment and was given a permanent profile excusing him from extended standing. He reported knee symptoms since that time. He was diagnosed with degenerative joint disease of the right knee. The examiner opined that the disability was less likely than not related to service. This opinion was based on the rationale that there was only one instance of in-service treatment with no indication of any activity limitations. After this December 1988 treatment the next documented report of knee pain was in November 2000. The examiner explained that VA treatment records also indicate that he had been overweight since June 1995 when he weighed 250 pounds. His weight had steadily risen to its current level over 400 pounds. The examiner explained that his obesity is more likely the cause of his degenerative joint disease. VA treatment records reflect that in July 2013 the Veteran had a physical therapy consultation for his knees. He reported that pain and symptoms began with a football injury in high school that got progressively worse with activity in the military. In his August 2013 notice of disagreement, the Veteran stated that he was treated in service for his right knee and left knee secondary to his right knee. VA treatment records reflect that in September 2013 the Veteran reported bilateral knee pain among other joint pains. He requested a letter stating that he could not stand for long periods of time. In January 2014 he reported continued chronic problems with his knees. VA obtained a December 2014 medical opinion from a VA medical examiner based on review of the record. The examiner opined that degenerative joint disease of the right knee was less likely than not related to service. This opinion was based on the rationale that service records did not document chronic, ongoing treatment for degenerative joint disease of the right knee, and it is therefore less likely than not that the current disability is related to service 24 years prior. VA treatment records reflect that in October 2015, x-rays showed mild degenerative joint disease in the left knee and mild patellofemoral narrowing in the right knee. At his March 2018 hearing, the Veteran reported that he was first diagnosed with arthritis in his right knee in the early 2000s. He stated that when he was in the military, he was repeatedly prescribed Motrin because of his knee pain. He stated that he had knee pain when marching, doing physical training, and going up and down stairs and ladders. In a September 2018 letter, the Veteran’s treating VA nurse practitioner wrote that he had been treated for knee pain by VA since November 2004. VA treatment records reflect that in September 2018 the Veteran reported bilateral knee pain. X-rays revealed degenerative changes with no joint effusion in the right knee and mild degenerative changes with no joint effusion in the left knee. The Veteran submitted an August 2019 disability benefits questionnaire completed by his treating VA nurse practitioner. In the questionnaire, which focused on housebound status, the practitioner noted that the Veteran had chronic bilateral knee pain which interfered with his ability to walk or stand for periods of time. No etiology opinion was provided. The Board finds that the evidence weighs against a finding that the Veteran’s right knee arthritis is related to service or manifested within one year of separation from service. The May 2013 VA examiner provided a probative opinion explaining that the record showed no knee symptoms between December 1988 and November 2000. As such, the acute symptoms reported in December 1988 were likely unrelated to his current degenerative arthritis. There is no medical evidence in the record to contradict this opinion. While the Veteran reports that he has had symptoms since service, the 12-year gap in treatment records is more probative. To the extent that the Veteran vaguely attributes his knee disability to climbing steps in service, he is not competent to make such an opinion on etiology and there is no competent evidence of such a relationship in the record. For these reasons, the Board finds that the evidence weighs against a finding that the Veteran’s right knee arthritis is related to service or manifested within one year of separation from service. Service connection is therefore denied. The Board further finds that the evidence weighs against a finding that the Veteran’s left knee arthritis is related to service, manifested within one year of separation from service, or is related to a service-connected disability. There is no evidence of any left knee symptoms or treatment in service or at any time prior to November 2000. To the extent that the Veteran attributes his knee pain to climbing steps in service, as with his right knee this speculative theory is not supported by competent evidence. In addition, because the Board herein denies service connection for a right knee disability, service connection secondary to the right knee disability is unavailable. For these reasons, the Board finds that the evidence weighs against a finding that the Veteran’s left knee arthritis is related to service, manifested within one year of separation from service, or is related to a service-connected disability. Service connection is therefore denied. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Gallagher, 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.