Citation Nr: 21072505 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 17-23 347 DATE: December 3, 2021 ORDER Entitlement to service connection for a left knee condition (claimed as left knee nerve damage/reflex sympathetic dystrophy) is granted. REMANDED Entitlement to service connection for a right knee condition (claimed as right knee nerve damage), to include as secondary to service-connected left knee condition is remanded. Entitlement to service connection for a left hip condition (claimed as left hip nerve damage), to include as secondary to service-connected left knee condition is remanded. Entitlement to service connection for a low back condition (claimed as lower back nerve damage), to include as secondary to service-connected left knee condition is remanded. FINDING OF FACT The Veteran's left knee condition had its onset in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left knee condition have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from June 2009 to November 2009 and from March 2011 to August 2011. Entitlement to service connection for a left knee condition. Service connection may be granted for a disability resulting in a disease or injury that is incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 U.S.C. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table decision). The Veteran contends that his left knee pain began in April 2011 during a training exercise in service and has consistently worsened since discharge from service. Service treatment records (STRs) indicate the Veteran's complaints of left knee pain that radiates to his thigh. The treating physician also noted that the Veteran did not have a history of complications and surgeries related to his left leg. See April 2011 STR. Post-service treatment records show a diagnosis of reflex sympathetic dystrophy. See December 2012 VA examination. The Veteran has consistently been treated for bilateral knee pain, reporting chronic pain, weakness, and difficulty walking, standing, and bending. See Medical Treatment Records dated September 2011, April 2012, May 2012, January 2013, May 2013, and August 2015. The Veteran's brother and father submitted lay statements, reporting that the Veteran's knee pain began in service and have continued since service. See July 2016 Lay Statements from E.W. and T.W. In light of the evidence of record, the Board finds that service connection for a left knee condition is warranted. The competent and credible lay evidence includes the Veteran's lay statements that left knee pain began during active service in 2011 and has been recurrent since discharge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board acknowledges the September 2015 VA examiner's negative nexus opinion. The Board, however, affords little probative weight to the VA examiner's opinion as the evidence of record, including STRs and the Veteran's lay statements, indicates left knee pain began during service and has been continuous since discharge from active service. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinions based on an incomplete or inaccurate factual premise are not probative). The examiner provided no rationale in regard to the negative opinion and the opinion was provided after submission of STRs, which indicated that the Veteran sought treatment for left knee pain. Based on the lay and medical evidence of record, the Board concludes that the evidence shows the Veteran's left knee condition became manifest while he was on active duty and thus was incurred in service. See Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting that "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty"). Resolving all reasonable doubt in the Veteran's favor, service connection for a left knee condition is therefore warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for a right knee condition, to include as secondary to service-connected left knee condition is remanded. 2. Entitlement to service connection for a left hip condition, to include as secondary to service-connected left knee condition is remanded. 3. Entitlement to service connection for a low back condition, to include as secondary to service-connected left knee condition is remanded. In light of the newly service-connected left knee condition, the Board finds that an opinion based on secondary service connection is warranted. The Veteran contends that his left knee condition caused his subsequent disabilities. See September 2020 Hearing Transcript. As such, the Veteran should be afforded a VA examination to assess the nature and etiology of his service connection claims. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) from a medical professional with appropriate expertise to determine the nature and etiology of his right knee, left hip, and low back disabilities. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. For each diagnosis identified, the examiner should opine as to the following: Whether it is at least as likely as not that (50 percent or greater probability) the Veteran's right knee disability, left hip disability, and low back disability is (1) caused by the service-connected left knee disability, or (2) that the Veteran's service-connected left knee disability has caused additional functional impairment of the right knee disability, left hip disability, and low back disability (e.g., a worsening of symptoms beyond those expected by the baseline level of disability, even if temporary). The examiner should specifically consider and discuss the Veteran's reports of overcompensating with his left knee. The Board notes that in a recent decision, the United States Court of Appeals for Veterans Claims held that the term "aggravation" requires that a service-connected disability condition (left knee disability) causes a "functional increase in the severity" of the nonservice-connected disability (right knee disability, left hip disability, and low back disability). Garner v. Tran, 33 Vet. App. 241 (2021). The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinion. 2. Then, after conducting any other development deemed necessary, readjudicate the Veteran's claims. If any benefits sought on appeal remain denied, provide the Veteran and his representative with a supplemental statement of the case, and allow an appropriate time for response. Thereafter, return the case to the Board. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Adeleke, T. 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.