Citation Nr: 21075079 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 13-03 700A DATE: December 17, 2021 ORDER Service connection for left knee disability is denied. FINDING OF FACT The Veterans left knee joint osteoarthritis was not incurred in or due to his time in service, nor is it proximately due to any of his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for left knee osteoarthritis, to include as secondary to service-connected disabilities, have not 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 in the United States Army from February 1976 to November 1978 and from November 1978 to August 1984. The Veteran passed away died in May 2020; his surviving parent has been substituted as the Appellant. The Board remanded this issue in May 2021 for additional development. Specifically, the Board determined the July 2015 VA examiner employed the incorrect standard addressing the etiology of the Veteran's knee condition and remanded the claim to obtain a new medical opinion. Entitlement to service connection for left knee condition. The appellant seeks service connection for the Veteran's left knee condition. Specifically, the appellant asserts that the Veteran's left knee condition was related to service or was caused or aggravated by his service-connected peroneal nerve impairment with foot drop and/or right knee condition. As noted, the Board remanded this issue for additional development, to include an adequate medical opinion in May 2021. Service Connection 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. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran had a diagnosis of left knee osteoarthritis. See July 2015 VA Knee Examination Report. The October 2021 post-remand VA examination report contains numerous findings and conclusions that weigh against this claim. The October 2021 VA examiner opined that the Veteran's left knee condition was not secondary to his service-connected disabilities and opined that it is less likely than not proximately due to or the result of his service-connected condition. In explaining these conclusions, the examiner acknowledged that the Veteran had a service-connected diagnosis of right peroneal nerve of L5 nerve root neuropathy resulting in right foot drop, arthritis of the lumbar spine and right knee osteoarthritis. The examiner remarked that there are no medical records indicating complaints of left knee problems or injuries while in service including at the time of separation. He reasoned that review of medical literature failed to demonstrate a connection of contralateral knee arthritis resulting from or being caused by existing arthritis of the opposite extremity. He remarked that the Veteran did have a right foot drop which would alter walking dynamics however usually resulted in exaggeration of the movements of that limb. That should not have had affect the contralateral side enough to justify the development of arthritis due to this altered movement. The examiner added that there is also no evidence that lumbar spine arthritis can cause knee arthritis. He stated that his opinion is based on the body of current medical knowledge and the evidence of record. Additionally, the VA examiner opined that the Veterans left knee osteoarthritis was less likely than not aggravated beyond its normal progression due to his service-connected disabilities. The examiner remarked that the medical literature failed to demonstrate a connection of contralateral knee arthritis resulting from or being caused by existing arthritis of the opposite extremity. There is also no evidence that lumbar spine arthritis can cause knee arthritis. The examiner remarked that the Veteran's service-connected disabilities also cannot worsen arthritis of the left knee. The Veteran was competent to report the symptoms that he experienced. The Veteran was not competent to diagnose the condition that caused the symptoms that he experienced. Barr v. Nicholson, 21 Vet. App. 303 (2007), 38 C.F.R. § 3.159 (a)(2). In the present case, the Veteran and the appellant were competent to assert that he suffered from left knee pain. However, the Veteran was not competent to assert that the cause of his left knee osteoarthritis was his service-connected disabilities. As to direct service connection under 38 C.F.R. § 3.303, the record does not show that the Veteran's condition is directly related to or had its onset in service. In this regard, a review of the record on appeal does not show the Veteran being diagnosed with or complaints of his disability while on active duty. See 38 C.F.R. § 3.303 (a). Furthermore, the record does not contain a medical opinion linking the Veteran's disability with his military service. See 38 C.F.R. § 3.303 (d). In the October 2021 opinion, the examiner opined that the medical record indicates the patient was seen for left knee pain many years after his time in service. There are no medical records in the evidence provided indicating complaints of left knee problems or injuries while in service, including at the time of separation. Ultimately, the VA examiner concluded that it is less likely than not that the Veteran's left knee osteoarthritis was caused incurred in or a result of his time in service. Accordingly, because the preponderance of the evidence is against a finding of direct service connection, service connection on that basis is not warranted. In addition, because the preponderance of the evidence is against a finding that the Veteran's left knee arthritis was proximately due to or aggravated by a service-connected disability, service connection on a secondary basis is not warranted. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jordan, Jacquelynn 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.