Citation Nr: 21070393 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 18-34 021 DATE: November 23, 2021 ORDER Entitlement to service connection for left knee meniscal tear with osteoarthritis as secondary to service-connected right knee meniscal tear with chondromalacia is granted. FINDING OF FACT The Veteran's left knee meniscal tear with osteoarthritis is etiologically related to his to service-connected right knee meniscal tear with chondromalacia. CONCLUSION OF LAW The criteria for service connection for left knee meniscal tear with osteoarthritis as secondary to service-connected right knee meniscal tear with chondromalacia have been met. 38 U.S.C. § §§ 1110, 5107; 38 C.F.R. § §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1977 to August 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran presented testimony before the undersigned Veterans Law Judge. A transcript will be added to the record. Entitlement to service connection for left knee meniscal tear with osteoarthritis as secondary to service-connected right knee meniscal tear with chondromalacia is granted. Service connection is warranted for the Veteran's left knee condition as related to his service-connected right knee condition. Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability. See 38 C.F.R. § 3.310 (b); Allen v. Brown, 8 Vet. App. 374 (1995). In adjudicating a claim for VA benefits, 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, 53-56 (1990). Starting with the first element of service connection, the Board notes private treatment records from the Veteran's primary care physician demonstrate left knee pain dating to April 2015. The physician included in this first assessment of the Veteran's left knee that the Veteran has had a history of right knee problems. A magnetic resonance imaging (MRI) scan dated in June 2015 notes the diagnosis of a left knee meniscal tear and chondromalacia patella. In September 2017, a VA examiner diagnosed the Veteran with meniscal tear and knee joint osteoarthritis in both the Veteran's knees. Thus, a diagnosis has been established. As to the issue of nexus, at his hearing, the Veteran testified that his primary care physician, who has been treating him since 2014, had provided a positive opinion relating his left knee condition to his right knee. In a November 2021 letter, the physician rationalized that overcompensating for his service-connected right knee caused the Veteran to develop pain and instability and eventually a torn meniscus in his left knee, and noted MRI evidence supporting the presence of such an issue in the Veteran's left knee. The Board assigns this opinion great probative weight, as it was provided by a physician familiar with the Veteran's total disability picture, musculoskeletal symptoms, and specifically the Veteran's left knee condition since its onset, having treated the Veteran since 2014. Notably, there are no contrary medical opinions on file, but for the inadequate September 2017 VA opinion. Towards the opinion's inadequacy, the examiner failed to provide separate findings and rationales for causation and aggravation, as required by Atencio v. O'Rourke, 30 Vet. App. 74 (2018). Moreover, the examiner did not provide a reasoned medical explanation connecting supporting data to her conclusion. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). The examiner cited to a study from 2005, but did not relate the study's findings to this specific Veteran's circumstances. Moreover, the Veteran explained at his November 2021 hearing that the September 2017 VA examiner spent little time evaluating his left knee, as other disabilities were assessed at the time. The Board finds this assertion credible, as evinced by the less than complete opinion provided by the September 2017 VA examiner. As such, the September 2017 VA opinion is inadequate and nonprobative of the service-connection question at issue. (Continued on the next page) Accordingly, with medical evidence weighing in favor of finding the Veteran's left knee condition related to his service-connected right knee condition, service connection is warranted. Guerrieri v. Brown, 4 Vet. App. 467 (1993). The appeal is granted. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.A. Infante, Associate 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.