Citation Nr: 21071589 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 14-40 033 DATE: November 30, 2021 ORDER Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's current left knee disability is related to service, or his service-connected lumbar spine disability. 2. The preponderance of the evidence is against finding that the Veteran's current right knee disability is related to service, or his service-connected lumbar spine disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 2. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1975 to May 1979. This matter comes before the Board of Veterans' Appeals (Board) from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The case was last before the Board in August 2021, and has returned to the Board for further appellate review. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c). 1. Entitlement to service connection for a left knee disability 2. Entitlement to service connection for a right knee disability The Veteran seeks service connection for a left knee disability and right knee disability (hereinafter "bilateral knee disability"), which he asserts was caused by service. Alternatively, the Veteran asserts that his current bilateral knee disability is secondary to his service-connected lumbar spine disability. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (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). Where a veteran served continuously for 90 days or more during active service and certain chronic diseases, including arthritis, become manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury. 38 C.F.R. § 3.310. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with bilateral patellofemoral degenerative osteoarthritis. Thus, the remaining question is whether his current bilateral knee disability is related to service. The Veteran's service treatment records reveal the Veteran complained of joint pain in February 1979 and was diagnosed with arthralgia. Thereafter, the Veteran reported having painful joints in a March 1979 report of medical history prior to his separation from service. The first medical evidence of a bilateral knee disability is a February 2000 private treatment record, at which time the Veteran complained of knee pain and was diagnosed with bilateral knee trauma. The Veteran subsequently underwent a left knee arthroscopy in April 2000 and right knee arthroscopy in May 2000. Thereafter, a September 2007 VA treatment record reveals the Veteran was noted as having a swollen knee. In December 2010, the Veteran's private physician opined that it is more probable than not that the Veteran's bilateral knee disability is secondary to his service-connected back disability. The physician stated that the alignment problem causes degenerative changes at both knees and that it is more probable than not that the Veteran is presenting bilateral knee problem that should be service connected secondary to his back problem. During a May 2011 VA examination, a VA examiner indicated the Veteran had a diagnosis of bilateral patellofemoral degenerative osteoarthritis. The examiner opined that the Veteran's bilateral knee disability was less likely than not caused by or the result of his lumbar spine disability. The examiner noted that the Veteran previously suffered a fall while working and underwent an arthroscopy, and that he reported his current knee problems started in 2006. The examiner further explained that an x-ray done in 2008 showed minimal bilateral patellofemoral degenerative osteoarthritis which may be due to his trauma while working, or normal degenerative changes not due to or related to his back problems. The Veteran underwent a VA examination in September 2019, at which time the examiner opined that the Veteran's claimed bilateral knee disability was less likely than not incurred in or caused by service. In support of this opinion, the examiner explained that the Veteran's condition had its onset years after service and there is no radiological evidence of degenerative joint disease in the knees during service or in the year after discharge. The examiner further explained that there is no biomechanical or anatomical correlation connecting the Veteran's knee and lumbar spine disabilities. As such, the examiner opined that the Veteran's bilateral knee disability is less likely than not proximately due to or the result of his service-connected lumbar spine disability. Additionally, the examiner opined that the Veteran's knee disability could not have been aggravated by his service-connected low back condition, because there is no biomechanical or anatomical correlation between the lumbar and knee areas. In a September 2021 addendum opinion, the examiner opined that it is less likely than not the Veteran's bilateral knee disability was incurred in or caused by service. The examiner explained that there is no evidence of any injuries of the knees during service or in year thereafter and that the complaints of joint pain in the Veteran's service treatment records do not reveal evidence of any specific knee joint damage. Moreover, the examiner explained that the 2010 opinion from the Veteran's private physician was mere speculation as she did not have the chance to evaluate the Veteran's medical records. The examiner further opined that the Veteran's bilateral knee disability was less likely than not proximately due to, the result of, or aggravated by his service-connected lumbar spine disability. The examiner explained that the Veteran's knee condition is due to the aging process and that back conditions have nothing to do with bilateral knees degenerative joint disease in terms of anatomy, function, biomechanics, or pathophysiology. The Board finds the September 2021 VA opinion to be of greatest probative value, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Such opinion is also consistent with the other VA opinions of record. Conversely, the 2010 private opinion does not appear to be based on review of evidence in the claims file and provided no rationale for the conclusions reached. Accordingly, this opinion is afforded little, if any, weight. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). Although the Veteran believes that his current bilateral knee disability is related to service or service-connected disability, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this regard, the diagnosis and etiology of knee disabilities are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the onset and etiology of his current bilateral knee disability is not competent medical evidence. The Board finds the opinion of the VA examiner to be significantly more probative than the Veteran's lay assertions. In sum, the most probative evidence of record indicates the Veteran's current bilateral knee disability did not arise in service or within one year following discharge from service, is not related to service, and is not caused or aggravated by his service-connected back disability. Accordingly, the claim for service connection is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. As the preponderance of the evidence is against the claim, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 29, 55-56 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lance, 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.