Citation Nr: 21077214 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 15-09 383 DATE: December 29, 2021 ORDER Entitlement to service connection for left knee disability to include as secondary to right knee disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that left knee disability began during active service, or is otherwise related to an in-service injury or disease. 2. A left knee disorder was not caused or aggravated by the service-connected right knee disorder. CONCLUSION OF LAW The criteria for entitlement to left knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Air Force December 1974 to August 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from September 2014 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). The Board issued a remand in June 2021 instructing the RO to obtain medical treatment records from March 2014 to the present. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The RO obtained VA treatment records from March 2014 to October 2021. The Board finds the RO substantially complied with the June 2021 remand directives. Entitlement to service connection for left knee disability. The Veteran contends that he developed a left knee disability as a result of his military service. Alternatively, the Veteran contends that his service-connected right knee caused him to develop a left knee disability. In his October 2008 statement, the Veteran wrote that while he was stationed in Okinawa, he was sent to the Philippines because of his knee condition. Currently being seen at the VAMC Martinsburg. On the March 2015 Form 9, the Veteran requested to have his left knee evaluated considering service incapacitation in right knee. Veteran states that he had no knee injuries to either leg prior to 1974. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (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). Secondary service connection requires: (1) a service-connected disability; (2) a nonservice connected disability; and (3) evidence that the nonservice connected disability is either (a) proximately due to or the result of the service-connected disability or (b) aggravated (increased in severity) by the service-connected disability. See 38 C.F.R. § 3.310. A March 1976 service treatment record (STR) showed the Veteran was stationed in Okinawa when he complained of right knee pain. A June 1977 STR showed the Veteran was treated for bilateral knee pain. Films showed no bony abnormality for the left knee and no degenerative joint disease for the left knee. An April 1979 STR indicated the Veteran had an old injury to the knees bilaterally. Post-service treatment records indicate the Veteran sustained an injury to the left knee in a motor vehicle accident (MVA) in April 1979. See December 2005 Nurse Practitioner Note; October 2007 Nursing Note. In August 2012, the Veteran underwent a total knee replacement. The Veteran underwent a VA examination in January 2009. The examiner stated that he reviewed the claims file and found a September 1975 that noted complaint of hearing knee crack after climbing fence for two days. On examination, the examiner could hear the Veteran's knee pop as he walks in the room. The examiner noted that June 1977 x-ray showed the left knee to be normal. The Veteran reported that he injured both knees in 1979 in a MVA while working at a telephone company. Both knees continued to bother him since that time. The examiner opined that the Veteran's left knee condition was less likely than not (less than 50 percent probability) caused by or incurred in service. The examiner explained that there was no evidence of a left knee injury while in service. The left knee condition was clearly from the MVA in 1979 which is nonservice related. It is not likely that the left knee arthritis was caused by military service. See also April 2011 VA examination. The Veteran was re-evaluated in August 2014. The examiner reviewed the claims file and noted that during the December 1974 enlistment examination, the Veteran said no to "trick or locked knee." Clinical evaluation showed normal strength and range of motion lower extremities, except feet. He was qualified for enlistment. The examiner also noted injury to the right knee and ongoing treatment in service. However, there was no evidence of a left knee injury in service. The examiner further noted that the Veteran first went to the Martinsburg VA Medical Center in April 1979 after an auto accident injury to the left knee. He was at the local hospital for a week. He then when to VAMC for about two weeks. He was discharged and went back to work. He went to North Carolina in July 1981. Once there, he visited the North Carolina VAMC for pain medication. From 1985 to 1988, he went back to work as a telephone installer. Thereafter, he stated while on a telephone pole, it felt like his kneecap was moving around. He tried to get down on the ground as quickly as possible. From 1983 until 2007, he was in California. He was seen at West LA VAMC. X-rays were taken and showed severe tricompartmental osteoarthritis with evidence of old trauma in the lateral tibial plateau and generalized osteopenia. He started care at Martinsburg VA in 2008. He complained about his knees during the first visit. He received a knee brace and steroid injections periodically. In 2012, he completed a total left knee replacement. In March 2014, he slipped and fell on ice. He fractured his left femur. He underwent open reduction and internal fixation of distal left femur. The examiner did not provide a medical opinion related to the etiology of the Veteran's left knee disability on this examination. An aggravation opinion was obtained in February 2021. The condition claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran's service-connected condition. The examiner stated that he reviewed the examination completed in August 2014. It was indicated that the Veteran had a MVA in April 1979 and had a severe left knee injury. Subsequently, he was seen at Martinsburg VAMC at that time. He also was admitted here at Martinsburg VAMC for his left knee condition for 2 weeks and subsequently he was discharged. It was also noted that after that MVA he worked September 1979 until May 1980. He used to work as a telephone installer. This note also indicated that he was seen at North Carolina VMAC back in 1985 because of his left knee pain. Subsequently, he was followed by orthopedic surgeon and also received physical therapy. He had total left knee replacement that was done in August 2012. After that left knee replacement, his service-connected right knee condition aggravated pain due to non-service-connected left knee prosthesis. It was also indicated that back in March 2014, the Veteran slipped on ice and had a periprosthetic fractured left femur. He underwent open reduction and internal fixation of distal left femur. Therefore, the examiner opined that the Veteran's left knee pain was not secondary to his service-connected right knee condition and was not aggravated because of service-connected right knee condition. The Board acknowledges the Veteran's contentions that his current left knee disability is related to his duties in service or his service-connected right knee disability. Reporting the symptom of pain is within realm of knowledge a lay person can report and it be sufficient for the purpose of service connection. However, this report is not sufficient to establish a nexus between the current reports of pain and an in-service note about pain. A lay person is not considered competent to medically attribute a knee disability to service as doing so to requires medical knowledge and expertise the Veteran has not been shown to possess. See Kahana v. Shinkseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, the objective medical evidence of record answered this question. The Veteran complained of bilateral knee pain in service, but STR indicated injury to the right knee only. The left knee was marked normal on x-ray. Post-service treatment record identify the MVA and subsequent injury to the left knee as the cause of the Veteran's current left knee disability. The VA medical opinions of record provide detail accounts of the Veteran's medical history related to the injury and treatment of his left knee. Neither support a finding that the Veteran's military service or service-connected right knee caused the Veteran to develop a left knee disability. The record lacks any medical opinions to contradict this finding. (Continued Next Page) Accordingly, the criteria for entitlement to service connection for left knee disability have not been established, either through medical or lay evidence. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim of entitlement to service connection for left disability, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Harris, Attorney Advisor 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.