Citation Nr: 21014302 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 17-55 154 DATE: March 11, 2021 ORDER Entitlement to a left knee disability, to include as secondary to a service-connected right knee disability, is denied. FINDINGS OF FACT 1. The Veteran’s left knee disability did not manifest during active service; arthritis did not manifest within one year of separation from service; and there is no indication that the disability is causally related to active service. 2. The Veteran left knee disability was not caused or aggravated by his service-connected right knee disability. CONCLUSION OF LAW The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from October 1972 to July 1974, and from September 1977 to January 1995. This case initially came before the Board of Veterans’ Appeals (Board) on appeal of an October 2013 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In a May 2019 decision, the Board denied the claim for service connection for the left knee disability. The Veteran appealed that determination to the United States Court of Appeals for Veterans Claims (Court). In April 2020, pursuant to a Joint Motion for Partial Remand (Joint Motion), the Court vacated that portion of the decision and remanded the matter to the Board for further consideration and readjudication. In July 2020, the Board remanded the claim for additional development. The case has since been returned to the Board. Service Connection – Left Knee The Veteran maintains that his left knee disability was incurred in or is related to service. Alternatively, he argues that his left knee disability is secondary to his service-connected right knee disability. The Veteran’s service treatment records are unremarkable for any complaints, treatment, or diagnoses related to the left knee. In May 1975, he complained of low back pain and pain in his left hip and left leg. On physical examination, muscle spasms were noted of the paraspinal muscles and the assessment was low back syndrome. In March 1988, during a routine physical examination, his lower extremities were normal. On his report of medical history, he denied having trick or locked knee. In October 1994, at his retirement examination, his lower extremities were normal. It was noted that repeat X-rays of the knees were within normal limits. On his report of medical history, he indicated that his right knee hurt when coming down stairs. There were no complaints of any left knee pain or problems. Post service, in June 2008, August 2008, September 2008, TriCare records indicated that there was no tenderness on palpation of the Veteran’s left knee. In March 2011, he complained of bilateral knee pain for the past eight months. He reported no past trauma, injury, or surgery. In December 2012, X-rays of the left knee revealed mild degenerative changes of the patellofemoral joint. The Veteran underwent a VA examination in October 2013. At that time, he reported that he did not recall the exact onset of his left knee symptoms but that it started sometime during physical training in service. The diagnosis was bilateral knee strain. The examiner was asked to provide an opinion as to whether his current “knee condition” was related to the knee complaints and treatment he had while in service. The examiner opined that the Veteran’s claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran had been seen for “painful knees on 3/28/11, and 6/23/11 and this can become a chronic condition lasting many years.” The Board notes, however, that while the Veteran was treated for the right knee complaints during service, he was not treated for any left knee complaints. Therefore, the medical opinion was based on an inaccurate factual premise, at least as it pertained to the left knee. In December 2014, private X-rays of the left knee showed tricompartmental osteoarthritis. In June 2017, the RO requested another VA medical opinion. The examiner opined that the left knee disability was less likely than not incurred in or caused by service. The VA examiner explained, after thoroughly reviewing all available records, to include the October 2013 VA examination report, that: (1) there were no records in service that showed a chronic condition of the Veteran’s left knee; (2) the Veteran was first diagnosed with a left knee strain in October 2013, years after separating from the service; (3) the October 1994 retirement examination provided a negative condition of the left knee with negative X-ray imaging; (4) there was a negative finding of the tenderness on palpation; and (5) the left knee condition was not identified in various treatment records, e.g., dated September 30, 2008, January 18, 2011, and June 2012. In a May 2019 decision, the Board denied service connection for a left knee disability. As noted above, in April 2020, pursuant to a Joint Motion, the Court vacated that portion of the Board’s decision. The parties to the Joint Motion agreed that the Board failed to consider a May 1975 service treatment record that noted complaints of left leg pain and failed to address whether the left knee was caused or aggravated by his service-connected right knee disability. In July 2020, the Board remanded the claim for an additional VA medical opinion. The Board requested that the examiner consider the May 1975 service treatment record and provide an opinion as to whether the left knee disability was caused or aggravated by the right knee disability. In September 2020, an additional VA medical opinion was obtained. The examiner indicated that he reviewed the Veteran’s electronic claims file, which included his service treatment records and relevant post service treatment records. The examiner opined that the left knee disability was less likely than not incurred in or caused by service. The examiner noted that there was no evidence of a left knee disability during service or at separation. The examiner noted that at separation, only the right knee was discussed and that it was unlikely that a left knee problem would have gone unreported. The examiner also noted that there was no evidence of care for the left knee until many years later. Regarding any relationship between the left knee and the service-connected right knee, the VA examiner noted that a condition in one joint did not cause a condition of the contralateral joint and that this was accepted medical knowledge and practice, supported by standard texts. The examiner noted that this included gait accommodation for the service-connected right knee disability, which did not occur except in rare cases, such as leg-length discrepancy and/or chronic extreme Trendelenburg gait. The examiner noted that this was particularly true of degenerative joint disease, noting that degenerative joint disease in one joint did not cause the same condition in another joint and that degenerative joint disease was considered an aging process due to normal wear and tear over time and genetic predilection. The examiner indicated that the same rationale applied to whether the right knee aggravated the left knee, noting that there was no evidence that the Veteran’s left knee disability was aggravated beyond its natural course due to any cause. In this case, the Board finds that the evidence weighs against the claim. The evidence does not indicate that the Veteran’s left knee disability manifested during active service. Although he was treated for left leg pain in May 1975, along with low back and left hip pain, there were no specific complaints or findings related to the left knee. The assessment at that time was low back syndrome. Furthermore, the October 1994 separation examination indicated that his lower extremities were normal and, although he complained of right knee pain going down stairs, no complaints were made pertaining to the left knee. Furthermore, although the Veteran indicated that he continued to have left knee problems since physical training during active service, his service and post-service treatment records do not reflect as such. In 2008, TriCare records indicated that there was no pain on palpation of the left knee. The first complaints and objective evidence of the claimed disability occurred in 2011, over 16 years after service, and those records indicated that his knee pain began eight months previously, i.e., sometime in 2010. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Furthermore, the June 2017 and September 2020 VA examiners’ opinions weigh against the claim. As noted above, the examiners indicated that it was less likely than not that the Veteran’s left knee disability was incurred in or caused by service. In addition, the September 2020 VA examiner opined that the left knee disability was not caused or aggravated by the service-connected right knee disability. The examiners considered and addressed the relevant evidence of record, the Veteran’s contentions, and provided rationale for their opinions. For those reasons, the Board finds the VA examiners’ opinions significantly probative. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The only medical opinion to the contrary is that made by the October 2013 VA examiner. As noted above, however, the opinion was based on an inaccurate factual premise, i.e., that the Veteran received treatment for a left knee condition during active service. Therefore, the opinion has no probative weight. The Board has also considered the lay evidence. The Veteran is competent to describe what he has personally observed or experienced; however, to the extent his reports conflict with the contemporaneous medical evidence, the Board does not find his statements credible. Furthermore, the ultimate question of etiology in this case extends beyond the immediately observable cause-and-effect relationship and is beyond the competence of lay witnesses. For these reasons, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a left knee disability is not warranted. 38 U.S.C. § 5107(b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Mishalanie, 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.