Citation Nr: 21070034 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 18-40 212 DATE: November 22, 2021 ORDER Service connection for degenerative arthritis of the right knee, as secondary to service-connected lumbar spine disability, is granted. Service connection for degenerative arthritis of the left knee, to include residuals of total knee replacement, as secondary to service-connected lumbar spine disability, is granted. FINDING OF FACT The Veteran's bilateral knee disorders are related to his service-connected lumbar spine disability. CONCLUSIONS OF LAW 1. The criteria for service connection for degenerative arthritis of the right knee, on a secondary basis, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for degenerative arthritis of the left knee, to include residuals of total knee replacement, on a secondary basis, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from October 1972 to May 1994. The case is on appeal from a March 2017 rating decision. In November 2021, the Veteran testified at a Board hearing. Service Connection Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran 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(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for a right knee condition. 2. Service connection for a left knee condition. The Veteran contends that his bilateral knee disorders are related to service, or alternatively, to his service-connected back disability. The Board notes the Veteran underwent a left total knee replacement in November 2016. Further, the Veteran has been service-connected for lumbar degenerative disc disease (DDD) since September 1994 and he underwent a lumbar laminectomy in August 2020. Following the Veteran's January 2017 claims, his treating physician, Dr. Klein, submitted a January 2017 VA medical opinion in support of the claims. The Board notes Dr. Klein has provided treatment to the Veteran since approximately December 2015. In the January 2017 medical record, the physician opined it is at least as likely as not that the Veteran's bilateral knee degeneration was caused by or at least aggravated by his service-connected back disability. The examiner indicated his opinion is based on the Veteran's altered gait mechanics and limp which resulted from his service-connected back disability. The Veteran was afforded a March 2017 VA examination in which he was diagnosed with bilateral knee degenerative arthritis and left knee arthroplasty from November 2016. As noted, he underwent a left total knee replacement surgery in November 2016. The examiner reported that the knee disorders are not related to the Veteran's service-connected back disorder. She indicated the Veteran's lumbar x-rays from January 2014 show DDD at L4-5 and mild generalized degenerative changes which are not overly unusual for the Veteran's age. The examiner stated degenerative arthritis is typically due to the wear and tear of aging or direct trauma to the joint. She indicated medical literature does not support that lumbar DDD would result in the degenerative process of the knee. She noted the Veteran's records do not contain evidence of acute back pain causing an altered gait resulting in an abnormal strain to his knees. The examiner further indicated the Veteran reported a gradual progression of knee pain over the past 10 years and his x-rays support the gradual onset of knee arthritis which is common with the wear and tear of aging. (Continued on the next page) There is medical evidence of in favor of and against the claims. The March 2017 VA examination report indicated the Veteran's bilateral knee conditions are not etiologically associated with the back disorder. However, the January 2017 medical record from the Veteran's attending physician adequately opined that his bilateral knee disorders were caused by or at least aggravated by his service-connected back disability, including an altered gait and limp which resulted from such. This opinion is particularly persuasive as it was authored by the Veteran's attending physician who had provided treatment to the Veteran since 2015. The Board finds the evidence has reached a level of equipoise as to the nexus element of the claims and all reasonable doubt is resolved in the Veteran's favor. In sum, when affording all reasonable doubt in the Veteran's favor, the Board determines his bilateral knee disorders are causally related to his service-connected back disability. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. As such, service connection is warranted on a secondary basis for degenerative arthritis of the right knee and for degenerative arthritis of the left knee, to include residuals of total knee replacement. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Isaacs, Brandon 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.