Citation Nr: 21012651 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 08-13 236A DATE: March 4, 2021 ORDER Entitlement to service connection for a right knee disability, to include as secondary to service-connected orthopedic disabilities, is denied. FINDINGS OF FACT 1. The Veteran’s right knee disorder did not have its onset during service or within one-year of discharge from service; the weight of the probative evidence does not etiologically link the Veteran’s right knee disability to service or any incident therein. 2. The preponderance of the evidence is against finding that the Veteran’s right knee disability is secondary to his service-connected orthopedic disabilities. CONCLUSION OF LAW The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from April 1982 to May 1990. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. In an October 2017 decision, the Board found that new and material evidence had been received to reopen the Veteran’s claim for service connection for a right knee disability and remanded the matter for further development. Subsequently, the Board once again remanded the matter for further development in October 2020. The Board notes that the Veteran’s claim for an increased rating for right shoulder disability will be addressed in a later Board decision. Service Connection for a Right Knee Disability The Veteran contends that his right knee disability is due to service. Alternatively, he alleges that his right knee disability is secondary to his service-connected orthopedic disabilities. Specifically, he contends that his service-connected orthopedic disabilities altered his gait causing him to favor his right knee. See November 2016 Board hearing transcript. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases, to include arthritis, will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. Secondary service connection is warranted where a claimed disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The threshold legal requirements for a successful secondary service connection claim are evidence of (1) a current disability for which secondary service connection is sought; (2) a disability already service-connected; and (3) competent evidence that the already service-connected disability caused or aggravated the disability for which service connection is sought. Id. The Veteran’s service treatment records (STRs) reveal that he reported right knee pain after playing basketball in October 1985; he was diagnosed with patella femoral joint pain. His STRs indicate that his hip pain began in 1986, after he was struck in his right leg during a soccer game. The Veteran was afforded a VA examination in May 2010, in which he was diagnosed with right knee mild degenerative joint disease. The Veteran reported that his right knee has bothered him since the 1980s; he denied any severe traumatic injuries to the right knee. The examiner opined that the Veteran’s right knee disability was less likely than not incurred in or etiologically related to service. The examiner reasoned that the evidence of record was insufficient to demonstrate a linkage between his active duty, which ended in 1990, and his current right knee condition. The examiner further reasoned that the Veteran’s 1985 STRs do not document a serious right knee injury during service. Rather, the examiner indicated that the Veteran’s current right knee disability was non-specific and consistent with aging process and body habitus. The Veteran was afforded another VA examination in April 2019, in which he reported that he injured his right knee in 1989 while playing soccer. The examiner opined that the Veteran’s right knee was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that during the examination, when the Veteran discussed having pain, he pointed to his upper leg and not the knee. The examiner also noted that the March 1985 medical report, which noted right knee pain, was most likely a mistake as the Veteran reported left knee pain and was later diagnosed with a left knee injury in May 1985. The examiner also indicated that there was no chronicity as he reported right knee pain in 2010, approximately 20 years after separation from service. The examiner also opined that the Veteran’s right knee disability was less likely than not aggravated beyond its natural progression by his service-connected disabilities. The examiner indicated that the Veteran’s right knee disability was diagnosed in 2010, approximately 20 years after service. She also reasoned that the Veteran’s degenerative joint disease was mild in 2010 and has not changed much according to the 2017 X-ray, which noted mild degenerative joint disease. She further reasoned that degenerative joint disease of one joint does not cause degenerative joint disease of another joint and that according to medical literature degenerative joint disease is a natural aging process. A November 2020 VA examiner opined that the Veteran’s right knee disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted the March 1985 note regarding the Veteran’s right knee was a typographical error as the subsequent orthopedic evaluation addressed the Veteran’s left knee. He indicated that there was no reasonable nexus between the Veteran’s right knee condition and service. Regarding secondary service connection, the examiner opined that the Veteran’s right knee disability was less likely than not proximately due to or aggravated beyond natural progression by his service-connected conditions. He reasoned that there is no evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite, uninjured joint or limb, unless the injury resulted in major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5 cm. so that the individual’s gait patten has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner noted that this level of severity has not been shown based on review of the record, history, and examination reports. The examiner noted that while the Veteran has been documented to have an antalgic gait, the evidence does not show an obvious Trendelenburg gait. He indicated that while it is not unusual for two joints to share properties in the same person, one joint’s disease does not spread to another to cause damage to it. He further indicated that medical literature reveals that degenerative arthritis is a condition related to the gradual wearing out of the bony margins of the knee joint, typically due to the effects of aging and normal wear and tear. Therefore, he concluded that the Veteran’s right knee disability was less likely than not secondary to his back disability (with sciatica), bilateral hip disability, and left knee disability. He also concluded that there is no anatomic or pathophysiological basis for the Veteran’s service-connected right shoulder disability to affect his right knee. After considering all of the evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for a right knee disability. The Board concludes that while the Veteran has a diagnosis of degenerative arthritis of the right knee, it was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period of time, and was not noted in service with attributable continuity of symptomatology. The record shows that the Veteran was not diagnosed with right knee arthritis until 2010, well outside the applicable one-year presumptive period. As to continuity of symptomology, the Veteran contends that he has had right knee pain since service. However, the Board notes that besides the reported October 1985 right knee injury, the Veteran’s STRs are silent as to any right knee complaints or treatment. Additionally, the Veteran’s post-service medical records indicate that he first reported experiencing right knee pain in 2009, approximately 20 years after separation from service. Thus, the competent evidence of record weighs against any continuity of symptomatology. Moreover, the Board finds that the evidence of record does not support a finding for service connection as there is no evidence of a nexus between the Veteran’s right knee disability and service. The VA examiners have opined that the Veteran’s right knee disability was less likely than not incurred in or caused by an in-service injury, event, or illness. Specifically, the May 2010 VA examiner opined that Veteran’s current right knee disability was not incurred in or etiologically related to service, to include his 1985 right knee injury. Rather, the examiner opined that the Veteran’s right knee disability was consistent with aging process and body habitus. The Board finds the May 2010 VA medical opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Regarding secondary service connection, the Board concludes that preponderance of the evidence is against finding that the Veteran’s right knee disability is due to, or aggravated beyond its natural progression, by his service-connected disabilities. The Board finds the November 2020 VA medical opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Id. In reaching this decision, the Board has considered the Veteran’s lay contentions. Specifically, the Veteran testified at the November 2016 Board hearing that his service-connected disabilities caused him to have an altered gait, which led to his right knee disability. However, the Board finds that the Veteran does not possess the requisite training or credentials needed to render a competent opinion as to a medical nexus. The Veteran, as a layperson, is not competent to speak to such medically complex matters, such as the etiology of his right knee disability. 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, although the Board has carefully considered the lay contentions of record suggesting that the Veteran’s right knee disability is related to service, or alternatively, is secondary to his service-connected disabilities, the Board ultimately affords the objective medical evidence of record, which weighs against such findings, with greater probative weight than the lay opinion. Specifically, the Board affords more probative weight to the competent opinions of the November 2020 and May 2010 VA examiners.   Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Robinson, 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.