Citation Nr: 21013791 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 15-25 349 DATE: March 10, 2021 ORDER Entitlement to service connection for a left knee disorder, to include a secondary to service-connected back disorder, is denied. FINDING OF FACT The preponderance of the evidence is against finding that a left knee disorder, to include arthritis, began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease, and is not caused or aggravated by service-connected back disorder. CONCLUSION OF LAW The criteria for service connection for a left knee disorder due to service or service-connected back disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from December 1983 to December 1986. This claim was remanded by the Board in a February 2019 decision for further development and is returned to the Board for appellate review. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected back disorder, is denied. The Veteran asserts that his left knee disorder is caused or aggravated by service-connected back disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection for certain chronic diseases, including arthritis, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Briefly, the threshold legal requirements for a successful secondary service connection claim are: (1) Evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. Finally, service connection may be awarded for any disability which is proximately due to or the result of, or is otherwise aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert. v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran’s service-treatment records (STRs) are silent for complaints or treatment of the Veteran’s left knee. On the April 2012 VA back examination, the Veteran stated he works as a contractor for a telephone company. He stated he was not presently working because of a left knee condition. He stated the pain interferes with work related tasks, such as bending, lifting, and carrying items. In a May 2012 VA treatment record, the Veteran reported left knee pain for the prior two months. The Veteran stated he fell two months prior reinjuring the left knee. Since the fall, the Veteran has had increased swelling and pain with ambulation. The medical provider observed the Veteran to have a small effusion in the left knee. The imaging showed moderately severe degenerative arthritis in the left knee. In a December 2012 private treatment record, the Veteran presented with knee pain. He described the pain as catching, dull, and chronic. The Veteran’s knee is status post-surgery and the symptoms began 13 years prior. In a March 2013 private treatment record, the Veteran presented with left knee pain. He described the pain as dull, chronic, and constant. The Veteran stated the pain has a sudden onset and began 13 years prior. The medical provider stated the Veteran’s left knee underwent surgery for an anterior cruciate ligament (ACL) tear in 1999 and he reinjured the left knee in 2012 at work. The medical provider diagnosed the Veteran with pain, arthralgia, and osteoarthritis. In an August 2013 private treatment record, the Veteran stated he is waiting for confirmation for surgery on his knee from workman’s compensation and from VA. In a November 2013 authorization for release of information, the Veteran stated he needs a knee replacement due to his back disorder. On the May 2015 VA examination, the examiner opined that the Veteran’s left knee disorder, arthritis, is less likely than not caused or aggravated by the Veteran’s service-connected back disorder. The examiner reasoned that the Veteran’s left knee disorder is the result of a specific injury while the Veteran was working at post-service employment in 1999. The Veteran’s injury caused an acute injury ACL tear to the left knee. The May 2015 VA examiner also found the Veteran’s bilateral degenerative knee disorder is symmetric and noted the Veteran has been obese for many years. The examiner explained that obesity is the etiology of degenerative arthritis of the knees by greatly increasing the impact forces on meniscus and load-bearing component of the knee joint. The examiner stated that being overweight increases the load placed on the joints such as the knee, which increases stress and could possibly hasten the breakdown of cartilage. The May 2015 VA examiner also noted the Veteran’s STRs are silent to knee complaints and knee injury during military service. The May 2015 VA examiner explained that the Veteran’s degenerative arthritis of the bilateral knees is a degenerative process and does not have an etiology or relationship to the Veteran’s back disorder. The examiner stated the Veteran does not walk with a cane or walker and the Veteran’s gait is slow, but there is no lurch. The examiner concluded that the Veteran’s degenerative knee condition is independent and has no relationship to the Veteran’s back disorder. The December 2020 VA examiner opined that the Veteran’s left knee disorders, strain and arthritis, were less likely than not caused by service. The examiner reasoned that the Veteran’s left knee disorders are the result of a specific injury to the left ACL while working at post-service employment. The 1999 injury caused an ACL tear to the left knee and was filed with workman’s compensation insurance. The examiner stated the left knee etiology is acute trauma in 1999 and has no proximal or causal relationship to military service. The December 2020 VA examiner also opined that the Veteran’s left knee disorder is less likely than not caused or aggravated by service-connected disability. The examiner reasoned that the Veteran’s left knee disorder is the result of a specific injury at post-service employment in 1999, which caused an ACL tear in the left knee. The examiner concluded the Veteran’s left knee disorder and degenerative knee disorder is independent and has no relationship to the Veteran’s back disorder. Based on the foregoing, there is no evidence that the Veteran’s left knee disorder was manifested in service or to a compensable degree in the first year following his separation from service. The first indication of a left knee disorder occurred in 1999, over 10 year after separation from service. Consequently, service connection for a left knee disorder on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from a left knee disorder continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran’s left knee disorder is otherwise related to service. The Veteran’s post-service private treatment records and VA treatment records are silent for an opinion relating his left knee disorder to service. The only competent evidence in the record that addresses this question is the December 2020 VA medical opinion, which stated that the Veteran’s left knee disorder was not related to his service. Specifically, the examiner found the Veteran’s left knee disorder to be caused by a 1999 injury at the Veteran’s post-service employment. As there is no other evidence to the contrary, and the December 2020 VA medical opinion was based on a full review of the record as well as an interview and examination of the Veteran, the Board finds it persuasive. Also, there is no evidence that the Veteran’s left knee disorder is caused or aggravated by the Veteran’s service-connected back disorder. The Veteran’s post-service private and VA treatment records are silent for an opinion relating his left knee disorder to the back disorder. The only competent evidence in the record that address this question are the May 2015 and December 2020 VA medical opinions, which stated that the Veteran’s left knee disorder is not related to the Veteran’s back disorder and is therefore not caused or aggravated by the Veteran’s back disorder. As there is no other evidence to the contrary, and the May 2015 and December 2020 VA medical opinions were based on a full review of the record as well as an interview and examination of the Veterans, the Board finds them persuasive. Further, the Veteran’s own statements relating his left knee disorder to service and service-connected back disorder are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether a left knee strain and arthritis, in the absence of credible evidence of continuity, as here, is related to an incident in service or a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, a strain and arthritis are diseases of the musculoskeletal system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for a left knee disorder. Accordingly, it must be denied. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). T.D. JONES Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Thompson, 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.