Citation Nr: 21067151 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 15-27 440A DATE: November 3, 2021 ORDER Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. FINDING OF FACT The Veteran's bilateral knee degenerative arthritis was not caused or aggravated by service-connected bilateral peripheral neuropathy of the lower extremities and did not have its onset within one year of military separation. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from July 1970 to July 1974. This matter is before the Board of Veterans' Appeal (Board) on appeal from an August 2013 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). The Board notes that the Veteran's appeal originally included the issue of entitlement to service connection for a right and left ankle sprains. However, a February 2021 rating decision awarded service connection for the Veteran's right and left ankle sprains and assigned a 10 percent disability evaluation effective June 26, 2013, for each disability. As this represents a full grant of the benefit sought, those issues are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in July 2019. A transcript of the hearing is in the Veteran's file. The Board previously remanded the appeal in October 2019 and December 2020, and the matter has been returned for appellate consideration. The development ordered by the Board having been completed (namely, obtaining additional treatment records and adequate examinations and opinions), the Board finds substantial compliance with its remand instructions. SERVICE CONNECTION 1. Entitlement to service connection for a right knee disability. 2. Entitlement to service connection for a left knee disability. The Veteran is pursuing secondary service connection for a bilateral knee disability. The Board will limit its analysis accordingly. The Veteran contends that his bilateral knee disability is due to his service-connected bilateral peripheral neuropathy of the lower extremities. 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 disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to 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(b). As to the first element of secondary service connection, current disability, the record indicates that the Veteran has been diagnosed with degenerative arthritis of his knees. Therefore, this element is met. Review of the record indicates that the Veteran is service connected for bilateral peripheral neuropathy of the lower extremities. Therefore, the question for the Board is whether the Veteran's bilateral knee disability is proximately due to or the result of service-connected bilateral peripheral neuropathy. The February 2020 VA examination report found that the Veteran's bilateral knee disability was unrelated to his active service, however, did not address the Veteran's primary contention of secondary service connection for his bilateral knee disability. As such, the December 2020 decision remanded the claim for a bilateral knee disability for an opinion addressing secondary service connection. The Veteran was afforded the January 2021 VA examination to determine the natural and etiology of the Veteran's bilateral knee disability. The VA examiner held that the Veteran's bilateral knee disability is less likely than not proximately due to or the result of his service-connected bilateral peripheral neuropathy of the lower extremities. The VA examiner highlighted that the Veteran's medical records documented the presence of tricompartmental degenerative arthritis as condition to be most likely to be responsible for the Veteran's current bilateral knee condition. The examiner noted that the Veteran's particular form of arthritis has a strong association with obesity. The VA examiner pointed out that the Veteran has had progressive weight gain since his military service. Moreover, the VA examiner opined that the Veteran's bilateral knee arthritis is not a documented complication of his peripheral neuropathy of the lower extremities. As such, the VA examiner held due to the absence of an association between these two conditions and likely association with obesity, it is less likely as not that degenerative arthritis is due to his service-connected bilateral peripheral neuropathy. The VA examiner also opined that the Veteran's peripheral neuropathy has not aggravated the Veteran's bilateral knee condition beyond its natural progression. The VA examiner highlighted that the Veteran's peripheral neuropathy does not extend above the lower legs and feet. Therefore, his peripheral neuropathy would likely not impact the functions, mechanics, or pressure to the joints of knees and aggravate his degenerative arthritis beyond its natural progression. The April 2021VA examiner also found the Veteran's bilateral knee disability to be unrelated to his active service, due to the length of time (46 years) between diagnosis and discharge from service. In this case, as to the issue of whether the Veteran's bilateral knee disability is proximately due to, caused by, or aggravated by his service-connected bilateral peripheral neuropathy, the Board finds that the January 2021 VA examination report is adequate and the most probative evidence of record as it was definitive, based upon a complete review of the Veteran's entire claims file, in consideration of the Veteran's reported history, prior physical evaluation of the Veteran, and pursuant to Board's remand instructions the January 2021 VA examiner provided a complete and thorough rationale in support of his opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Service connection is also not warranted on a presumptive basis, as there is no evidence that the Veteran's bilateral knee degenerative arthritis was manifest to a compensable degree within one year of his separation. The earliest evidence of objective evidence is 2020, more than four decades after his separation from service. Accordingly, the most probative evidence does not support the finding of a causal link between the Veteran's bilateral knee disability and his service-connected bilateral peripheral neuropathy, such that the final element of secondary service connection has not been met. The preponderance of the evidence is against the claim such that the benefit-of-the-doubt rule is not applicable, and secondary service connection for a bilateral knee disability is hereby denied. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.R. Higgins 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.