Citation Nr: 21076928 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 14-07 349A DATE: December 28, 2021 ORDER Service connection for a right knee disability, as secondary to service-connected posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for a left knee disorder, as secondary to a right knee disability, is remanded. FINDING OF FACT Resolving all reasonable doubt in the Veteran's favor, her right knee disability was caused by her service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for a right knee disability have been met. 38 U.S.C. §§ 1110, 5107; 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 Air Force from July 1988 to February 1992. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in March 2012 by the Department of Veterans Affairs (VA) Regional Office in Nashville, Tennessee. In September 2016, the Veteran testified before the undersigned at a Board hearing. A transcript of that hearing has been associated with the record. These matters were previously before the Board in January 2019, January 2020, and December 2020, at which times they were remanded for further development. The Board finds that there has been substantial compliance with its remand instructions, and further appellate consideration is appropriate. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection As noted in the Board's December 2020 remand, the Veteran asserts that her right knee disability was caused by the impact of her PTSD symptomology. Specifically, she claims that in 2000, while operating an all-terrain vehicle (ATV) owned by her sister, her PTSD induced symptoms caused her to be distracted, and she drove over an embankment and crashed, injuring her right leg. Those injuries eventually led to a right knee surgery, with lasting residuals. As an initial matter, the Board notes that the Veteran does not contend, nor does the record suggest, that her right knee disability is related to service on a direct basis. In this regard, the ATV accident occurred in April 2000, some 8 years after her discharge from service. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008) (claims which have no support in the record need not be considered by the Board as the Board is not obligated to considered "all possible" substantive theories of recovery. Where a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory). Rather, the Veteran contends that the symptoms of her service-connected PTSD impaired her judgment to the point that she crashed the ATV and incurred her right knee injuries. Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a). 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. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Service connection may not be established on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The record reflects that the Veteran has been diagnosed with right knee posterior cruciate ligament tear, meniscus tear, post-traumatic arthritis, and internal derangement, as evidenced by VA treatment records and multiple VA examinations. Additionally, she has been awarded service connection for PTSD. Thus, the remaining inquiry is whether her right knee disabilities were caused by her service-connected disability. In its October 2020 remand, the Board found that there was no adequate medical evidence which addressed whether the Veteran's PTSD caused her accident and injuries, and remanded for a new examination. Thereafter, in October 2021, a VA examiner reviewed the entirety of the evidence of record and opined that the Veteran's right knee injury was less likely than not proximately due to or the result of his service-connected PTSD. In support of such opinion, he noted that it would entail "100% guessing and speculation" to determine what caused the Veteran to crash the ATV. However, he then cited at least eight plausible reasons why the Veteran's ATV crashed, to include being tired from "work or family or home issues." The Board notes that the Veteran's sister has submitted a statement in which she described the circumstances around the crash of the ATV. She described the Veteran's state of mind leading up to the crash as confrontational, anxious and irritable. The Veteran herself has testified and provided statements in which she indicated that she was distracted by her PTSD symptomology and turned her sister's ATV down what she thought was a road, but which was an embankment, and that she would not have made such a mistake if not for her PTSD symptomology. Therefore, based on the analysis above, and resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection for a right knee disability, as due to service-connected PTSD, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Although the October 2021 examiner opined that he could not conclude the cause of the Veteran's crash, he indicated that it was plausible that the accident could be caused by distraction. The Veteran and her sister have described the Veteran's state of mind on the day of the accident, which included symptoms such as distraction and anxiety, presumably due to PTSD. Thus, the Board must find that the evidence is at least in equipoise, and the benefit of the doubt doctrine warrants a finding that service connection is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. The claim is granted. REASONS FOR REMAND The Veteran contends that her right knee disability caused her to alter her gait, which caused her to develop a left knee disorder. The record reflects that she has been diagnosed with a left knee meniscus tear, degenerative arthritis and internal derangement. As noted above, service connection may be granted on a secondary basis when a service-connected disability has caused or aggravated a disability. 38 C.F.R. § 3.310(a); Allen, supra. Service connection for a right knee disability has been granted herein; therefore, the Board finds that an opinion addressing a link, if any, between that disability and the Veteran's diagnosed left knee disorders is warranted. The matter is REMANDED for the following action: Schedule the Veteran for an appropriate examination to determine the nature and etiology of her diagnosed left knee disorders. The examiner is asked to identify all left knee disorders present during the appeal period. Then, for each diagnosed disorder, the examiner is asked to opine as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder is proximately due to and/or aggravated by her service-connected right knee disability, to include as a result of an altered gait. For any aggravation found, the clinician should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering any opinion, the examiner should consider the Veteran's statements regarding the onset and continuity of symptomatology of her claimed disorders. A detailed rationale should be provided for any opinion offered. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeremy J. Olsen, 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.