Citation Nr: 21013061 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 15-24 502 DATE: March 8, 2021 ORDER Service connection for a left knee disability, to include as secondary to service-connected disabilities, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s current left knee disability is due to a disease or injury in service or secondary to his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.102, 3.303, 3.307, 3.309(a), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Army from September 1995 to September 1998. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board videoconference hearing in September 2018; a transcript of that hearing is of record. This matter was subsequently remanded by the Board in August 2020 for additional development. This matter has now returned to the Board for appellate consideration. The Board finds there has been substantial compliance with its prior remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). An additional medical opinion was obtained. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must generally be 1) evidence of a current disability; 2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and 3) causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability, which is proximately due to, or aggravated by, a service-connected disease or injury. 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 caused or aggravated by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 43, 448-49 (1995). Service connection for certain diseases may also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). A nexus between a current disability and an in-service injury or event may be established by evidence of continuity of symptomatology, if the condition is a chronic disease enumerated under 38 U.S.C. § 1101. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Arthritis is an enumerated chronic disease. See 38 U.S.C. §§ 1101, 1112. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). Entitlement to service connection for a left knee disability, to include as secondary to service-connected disabilities. The Veteran asserts service connection for a left knee disability, to include as due to service and/or as secondary to his service-connected disabilities. The Board concludes that, while the Veteran has diagnoses of degenerative joint disease and chondrocalcinosis during the period on appeal, the preponderance of the evidence is against finding they are related to service. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), 3.309(a). The Veteran has diagnoses of left knee chondrocalcinosis and degenerative joint disease during the period on appeal. As such, the first element of service connection is met. The Board acknowledges the Veteran’s assertions that his left knee disability is due to service as he had reported knee pain during service and he was a mechanic. However, his service treatment records are limited to bilateral ankle complaints and right knee complaints. He testified at a Board hearing in September 2018. He reported that he has had left knee pain since 1997, and that he believes it is due to overcompensation because of his service-connected right knee disability. The Veteran is competent and credible to report that he compensates for his right knee pain with his left knee. The Board also acknowledges the Veteran’s belief that his disability is secondary to his service-connected right knee; however, he is not competent to opine on the nexus as it requires specialized knowledge of the orthopedic system to determine that his current left knee disability is due to overcompensation. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such evidence is not competent, the Board does not find that it is relevant or probative of the matter on appeal. The Board previously found the January 2020 examination insufficiently addressed the Veteran’s credible lay statements that he has placed more weight on his left knee due to his service-connected right knee. Addendum opinions were obtained in November 2020 to address the Veteran’s contentions. The examiner provided negative secondary opinions. She found that his left knee disabilities were not proximately due to or aggravated by his service-connected right knee; right ankle; left ankle; tinnitus; bilateral hearing loss; or pseudofolliculitis barbae. In support of finding that his disability was not secondary to his right knee, right ankle, or left ankle, the examiner stated that orthopedic literature, such as WHEELESS’ TEXTBOOK OF ORTHOPEDICS & OXFORD’S TEXTBOOK ON ORTHOPEDICS AND TRAUMA, does not show that an injury to one joint would have any significant impact to another or opposite uninjured joint unless the injury caused major muscle or nerve damage. The nerve or muscle damage would need to cause partial or complete paralysis or shortening on the injured limb with a length discrepancy of more than five centimeters. The length discrepancy would then alter the gait pattern to show an obvious Trendelenburg gait, which the Veteran does not have. Further, the examiner reported that it is not unusual for two joints to share properties. Concerning whether his disability was secondary to his tinnitus, bilateral hearing loss, or pseudofolliculitis barbae, the examiner stated that medical literature does not support such a relationship as they are not medically related and are separate entities.   The examiner also addressed the Veteran’s assertions that his disability was due to overcompensation from his service-connected disabilities. However, she found his claim was not supported by medical literature or the evidence of record in the absence of a Trendelenburg gait as reported above. The Board finds these opinions to have great probative value and they carry much weight. The examiner thoroughly reviewed the medical records as reported above, addressed the Veteran’s claim concerning overcompensation, and cited medical literature. She also explained why the Veteran’s overcompensation would not result in his current left knee disabilities in light of the evidence of record. The Board finds the examiner’s rationale to be logical and supported. After review of the competent and probative evidence, the Board finds that the preponderance of the evidence is against service connection for a left knee disability. The competent and highly probative November 2020 opinion provides a negative nexus opinion, which is supported by a thorough review of the evidence of record and orthopedic medical literature. Additionally, there is no positive nexus opinion for service connection of record. See 38 U.S.C. § 5107(b) (“Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary.”). The Board acknowledges the Veteran’s belief that his current left knee disability is secondary to his service-connected disabilities, but he is not competent to provide a nexus statement in a matter involving a disease process like degenerative joint disease. As such, statements in this regard lack weight. Additionally, the probative competent evidence tends to weigh against a nexus. Moreover, there is no indication from the claims file, nor has the Veteran asserted, that his degenerative joint disease began during service, or manifested within one year after exiting service and continued. The Board acknowledges the Veteran’s testimony that he has had left knee pain due to his service-connected right knee since 1997. However, evidence of record, to include an x-ray in September 2013 showed chondrocalcinosis. Mild degenerative joint disease was diagnosed in 2020, which is many years after service.   Therefore, the preponderance of the evidence is against a finding that the Veteran’s disability is related to his active service or secondary to his service-connected disabilities to include overcompensation. The available competent and probative evidence weighs against a nexus to service. As such, reasonable doubt does not arise, and the appeal is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Morales, 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.