Citation Nr: 21013884 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 18-00 426 DATE: March 10, 2021 ORDER Service connection for lower back condition is granted. Service connection for right hip condition is granted. FINDINGS OF FACT 1. The Veteran’s back condition, diagnosed as lumbosacral strain, was caused by his service-connected left knee disabilities. 2. The Veteran’s right hip disability, diagnosed as right hip replacement, was caused by his service-connected left knee disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for lower back condition, to include as secondary to service-connected knee condition have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. 2. The criteria for service connection for right hip condition, to include as secondary to service-connected knee disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1958 to June 1974. The Board remanded the above issues for additional development in May 2019 and October 2020. Service Connection In general, service connection may be granted for a disability or injury incurred in or aggravated by active military service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be established by credible lay evidence and medical evidence provided by the Veteran or otherwise. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Also, service connection may also be found on a secondary basis where the following criteria is met: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and, (3) evidence that the non-service-connected current disability is either proximately due to or as the result of a service connected disability; or, aggravated beyond its natural progress by a service connected disability. See 38 C.F.R. § 3.310; see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. See Alemany v. Brown, 9 Vet. App. 518 (1996). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. See 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a). The Board is charged with the duty to assess the credibility and weight given to evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). In Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104 (a) (West 2002). Further, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. See Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). 1. Entitlement to service connection for lower back condition, to include as secondary to service-connected knee condition The Veteran is seeking service connection for a low back condition which he asserts is attributable to his service-connected left knee instability. See October 2018 Correspondence; see also July 2020 VA 21-4138, Statement in Support of Claim. Specifically, the Veteran states that, while he was on a ladder, his left knee gave way and caused him to fall, which was witnessed by his friend. See July 2020 VA 21-4138, Statement in Support of Claim. The Veteran has current diagnoses of lumbosacral strain. See November 2019 Back DBQ. The Veteran is service connected for left knee instability. The Veteran’s treatment records show treatment for chronic back strain. See July 2018 Treatment Note; November 2020 Primary Care Note. The Veteran’s friend submitted a statement that he was present when the Veteran’s left knee instability caused him to fall and injure his low back. See June 2019 Buddy/Lay Statement. The Board acknowledges the January 2021 VA examiner’s negative opinion. However, the VA examiner acknowledged the Veteran did not have any documented history for his back prior to the reported fall injury. The examiner acknowledged the Veteran’s report of left knee instability with reported history of fall injuries to his back and right hip. The VA examiner noted, the cause of the fall injury is based on veteran report only and reasoned that falls can occur for several reasons including knee instability. However, the Board notes the Veteran is service connected for left knee instability and the Veteran’s friend submitted a corroborating statement. See June 2019 Buddy Statement. The evidence is at least evenly balanced as to whether the Veteran's current low back disability was due to a fall caused by his service-connected left knee instability. The Veteran has a history of kyphoplasty of L2 of the lumbar spine and history of recurrent chronic low back. See October 2008 Medical Treatment record; see also April 2011 and July 2011 Private Examination Reports. The Veteran’s report of falling is supported by his friend. See June 2019 Buddy/Lay Statement. Additionally, the Veteran's own reports of instability in the knee are competent evidence of instability. See English v. Wilkie, 30 Vet. App. 347 (2018). The Veteran has competently and consistently detailed the circumstances regarding his injury, stating that his left knee disability caused him to slip and injure his low back. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a)(2). There is no indication in the record that the Veteran lacks credibility, thus his statement regarding the cause of his injury is afforded significant probative weight. Thus, based on the lay and medical evidence of record, and with resolution of all reasonable doubt in the Veteran’s favor, the Board finds that the establishment of service connection for chronic low back condition as secondary to the service-connected left knee instability is warranted. 2. Entitlement to service connection for right hip condition, to include as secondary to service-connected knee disability. The Veteran is seeking service connection for a right hip strain which he contends is attributable to his service-connected left knee instability. See October 2018 Correspondence; see also July 2020 VA 21-4138, Statement in Support of Claim. Specifically, the Veteran states, that his service-connected left knee instability caused him to fall which was witnessed by his friend and injure his right hip. See July 2020 VA 21-4138, Statement in Support of Claim. The Veteran has current diagnoses of right hip strain and right hip joint replacement. See November 2019 Back DBQ; see also January 2021 Medical Opinion DBQ. The Veteran is service connected for left knee instability. The Veteran’s medical treatment records show the Veteran consistently reported his service-connected left knee collapsed and the subsequent fall resulted in a right hip injury, including right hip surgery. See December 2017 Medical Treatment Record; see also June 2018 Primary Care Note; November 2018 Correspondence. The Board acknowledges the January 2021 VA examiner’s negative opinion. However, the VA examiner noted the Veteran did not have any documented history for his back condition prior to his reported fall injury. The examiner acknowledged the Veteran’s report of left knee instability with reported history of fall injuries to his back and right hip. The VA examiner noted the cause of the fall injury is based on the Veteran’s report only and reasoned that falls can occur for several reasons including knee instability. However, the Board notes the Veteran is service connected for left knee instability and the Veteran’s friend submitted a supporting statement that he was present when the Veteran’s left knee instability caused him to fall and injure his right hip. See June 2019 Buddy/Lay Statement. The evidence is at least evenly balanced as to whether the Veteran’s current low back disability was due to a fall caused by instability in his service-connected left knee. The Veteran has a history of kyphoplasty of L2 of the lumbar spine and history of recurrent low back. See October 2008 Medical Treatment record; see also April 2011 and July 2011 Private Examination Reports. The Veteran’s report of falling is supported by his friend. See June 2019 Buddy/Lay Statement. Additionally, the Veteran’s own reports of instability in the knee are competent evidence of instability. See English v. Wilkie, 30 Vet. App. 347 (2018). The Veteran has competently and consistently detailed the circumstances regarding his injury, stating that his left knee disability caused him to slip and injure his low back. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a)(2). There is no indication in the record that the Veteran lacks credibility, thus his statement regarding the cause of his injury is afforded significant probative weight. Thus, based on the lay and medical evidence of record, and with resolution of all reasonable doubt in the Veteran’s favor, the Board finds that the establishment of service connection for right hip strain as secondary to the service-connected left knee instability is warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jacquelynn M. Jordan, 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.