Citation Nr: 21069555 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 17-61 865 DATE: November 18, 2021 ORDER Service connection for a right knee disability, to include as due to a service-connected left knee disability, is denied. FINDING OF FACT The Veteran's right knee disability is not secondary to service-connected left knee disability and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for right knee condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1975 to February 1977. This case returns to the Board of Veterans' Appeals (Board) after a remand to the agency of original jurisdiction (AOJ) in February 2021. Entitlement to Service Connection for a Right Knee Disability Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 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). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran's right knee symptoms are related to service or to his service-connected left knee disability. Service treatment records are silent as to a right knee disability or injury. In June 1976, the Veteran is shown ot have had a bruised patellar tendon and ligament of the left knee following a fifteen-mile run. There were no right knee complaints. The Veteran's February 1977 report of medical examination for discharge included a normal evaluation of the lower extremities. The record includes a September 2016 examination of the knees wherein the Veteran reported left knee, but not right knee, symptoms; an unremarkable examination of the right knee was noted. At his May 2019 hearing before the Board, the Veteran explained that he believed that his right knee was aggravated by his left knee condition, he stated that if it wasn't for his left knee, he would not have a right knee problem. The record includes June 2019 findings of private physician Dr. J.L.T. who opined that the Veteran's right knee disorder was due to his military service. Dr. J.L.T. stated that running exercises in service injured his bilateral hips and right knee. Dr. J.L.T. further stated that running exercises injured the left knee which caused secondary changes to the right knee. He stated that the Veteran's gait was off which aggravated a left ankle condition. In a June 2019 VA treatment note, the Veteran reported ongoing and constant bilateral knee pain. Also included in the claims file is a November 2020 examination report wherein the Veteran was found to have right knee patellofemoral pain syndrome. The Veteran reported that he injured his left knee in the late 1970s and during a ruck march in service and stated that he experienced right knee pain about a year thereafter. Following a review of the Veteran's claims file and examination of the Veteran, the examiner concluded that it was less likely than not that the Veteran's right knee disorder is proximately due to or the result of the Veteran's left knee disorder. The examiner explained that review of orthopedic literature showed no clear evidence to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb unless there was major muscle or nerve injury causing partial or complete paralysis or shortening of the limb significant enough to alter the gait, and that the level of severity was not supported in this case. It was further noted that the Veteran denied right knee concerns during a 2016 examination. In an August 2021 examination report, the Veteran was found to have functional loss, pain, and locking of the right knee. Following examination of the Veteran and review of the claims file, the examiner noted that review of the Veteran's service treatment records showed no documentation for right knee problems. The examiner opined that a right knee disorder was less likely than not incurred in or caused by service. The examiner explained that review of the Veteran's service treatment records showed documentation of left knee pain for two weeks after a run and a diagnosis of bruised patella tendon and ligament and that a June 1976 treatment note diagnosed mild patellar complaints and a February 1977 examination for discharge demonstrated normal lower extremities. It was noted that the Veteran's examination revealed a normal right knee without any clinical evidence of abnormalities and the Veteran's service treatment records were silent for right knee problems. The examiner stated that examination revealed normal right knee without clinical evidence of abnormality, it also revealed that the Veteran had a normal gait which would indicate that there was no undue stress to the right knee from his service-connected left knee syndrome to cause any aggravation to the right knee. The examiner started that it was therefore less likely than not that the Veteran's right knee disability was aggravated by his service-connected left knee disability. The examiner further found that the Veteran's right knee condition was less likely than not proximately due to or the result of a left knee disability. The Board concludes that, while the Veteran has a current right knee disability in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), as he has demonstrated impaired function due to right knee symptoms, the preponderance of the evidence is against finding that the Veteran's right knee disability is due to service or proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). Having weighed the evidence in favor and against the Veteran's claim, the Board finds that the preponderance of the evidence weighs against the Veteran's claim. In so finding, the Board has considered the medical opinions of the Veteran's examiners and that of Dr. J.L.T. The Board finds the November 2020 and August 2021 examiner's findings carry more weight based on the fact to have provided rationale for their findings, noting that medical research did not support a finding that the Veteran's left knee affected his right knee. In contrast, Dr. J.L.T. did not provide rationale for his finding that the Veteran's right knee disorder was due to military service and his left knee disorder. Further, Dr. J.L.T. indicates that the Veteran injured his right knee in service by running fifteen miles with heavy gear, but does not address the service treatment records which demonstrate a left but not a right knee injury in service and normal right knee findings during treatment for that left knee injury and at discharge. It stands to reason that if the Veteran was experiencing right knee symptoms while receiving treatment for a left knee injury in service, he would have reported them. While the Veteran may sincerely believe that his right knee is due to service or proximately due to his left knee disorder or aggravated by it, the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex and therefore it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). As such, for the reasons stated above, the Board finds that the preponderance of the evidence is against the Veteran's claim and service connection must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Slovick, 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.