Citation Nr: 21014433 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 09-03 427A DATE: March 12, 2021 ORDER Service connection for a bilateral knee condition, to include as secondary to service-connected disabilities, is denied. Service connection for a neck condition, to include as secondary to service- connected disabilities, is denied. FINDINGS OF FACT 1. The Veteran’s bilateral knee condition, diagnosed as bilateral chondromalacia patella, is not secondary to service-connected plantar fasciitis, pes planus or lumbar spine disabilities, and is not otherwise related to an in-service injury or disease. 2. The Veteran’s neck condition, diagnosed as chronic neck strain, is not secondary to service-connected plantar fasciitis, pes planus or lumbar spine disabilities, and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral knee condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. 1. The criteria for service connection for chronic neck strain are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty from January 1992 to July 1993. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2007 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran testified before the undersigned Veterans Law Judge via video conference in Waco, Texas. A transcript of the hearing has been associated with the electronic claims file. In August 2019, these matters were remanded for VA examinations and medical opinions. Since the VA examinations and medical opinions have been provided, and updated medical records were received, the Board finds substantial compliance with the August 2019 remand directives. Accordingly, these matters are ready for adjudication. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). As a general matter, establishing service connection requires competent evidence of (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. The current disability requirement is satisfied when a claimant "has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim," McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), or "when the record contains a recent diagnosis of disability prior to ... filing a claim for benefits based on that disability," Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Alternatively, service connection may be granted on a secondary basis for a disability that is proximately due to or the result of (caused) or worsened beyond its natural progression (aggravated) by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (en banc); 38 C.F.R. § 3.310. 1. Service connection for a bilateral knee condition is denied. The Veteran contends that her bilateral knee condition, diagnosed as chondromalacia patellae, is secondary to her service-connected plantar fasciitis and lumbar spine disability. See Hearing Transcript received 4/04/2019 at page 2; see also Form 9 received 2/11/2009. The Veteran was provided a VA examination for her bilateral knee condition in February 2013. At that examination, the Veteran was diagnosed with chronic bilateral chondromalacia patellae. The Veteran stated that she first noticed the bilateral knee pain during service and that it has continued since discharge. See VA examination received 2/12/2013 at page 15. In the medical opinion, the February 2013 examiner stated that it was less likely than not that the Veteran’s bilateral knee condition was the result of service since there was no evidence of chronicity in service. Id. at page 27. The February 2013 VA examiner also provided an opinion on aggravation and secondary service connection, wherein he stated that there was no medical authority to support the contention that the Veteran’s service-connected bilateral plantar fasciitis, pes planus, or lumbar strain can cause the development or aggravation of chondromalacia patellae. Id. Additionally, the February 2013 VA examiner opined that the Veteran’s gait was normal. In the Board’s August 2019 decision, this matter was remanded for an addendum medical opinion that considered the Veteran’s hearing testimony and her service treatment record, which showed that her gait was off during active duty. See BVA Decision received 8/14/2019 at page 7. The Veteran was provided a new VA examination in December 2019. At the December 2019 VA examination, the Veteran’s diagnosis of bilateral chondromalacia patellae was confirmed. During the examination, the Veteran stated that onset occurred 13 years ago with no specific trauma identified, roughly in 2006 which is approximately 13 years after service. See C&P Exam received 12/09/2019 at page 2. The December 2019 VA examiner reviewed the Veteran treatment records taking note of the inservice 2-point deviation in gait and the Veteran’s current treatment records showing a normal gait, and gave a negative nexus opinion. Specifically, the December 2019 examiner found it was less likely than not that the Veteran’s bilateral chondromalacia was incurred in or caused by an inservice injury, event or illness since the referenced 2-point gait was due to the use of crutches during service and is used when the patient can bear some weight on both lower extremities. Id. at page 10. The December 2019 examiner also opined that current medical literature does not support a link between limb pathology and the Veteran’s bilateral knee condition. Further, the December 2019 examiner opined that there was no knee condition while in service nor following service and the earliest documented knee condition was not until February 2013. As to etiology, the December 2019 VA examiner opined that the Veteran’s bilateral chondromalacia patella is the result of the aging process. The December 2019 VA examiner also provided an opinion on secondary service connection. The December 2019 VA examiner listed the Veteran’s service-connected conditions and opined that they do not have a direct causative effective on the Veteran’s bilateral knee condition nor do they aggravate the Veteran’s bilateral knee condition. The December 2019 VA examiner based this opinion on current medical literature. The examiner added that the record lacked evidence of severe gait abnormality or prolonged chronic antalgic gait in this veteran. Feet pain in patients with normal gait or near normal gait does not affect the remaining weight-bearing limbs. The examiner concluded by reiterating that the bilateral chondromalacia patella is the result of the aging process. See C&P Exam received 12/09/2019 at page 10-11. The Board finds the December 2019 medical opinion adequate since the VA examiner conducted an in-person examination of the Veteran, and thoroughly reviewed the Veteran’s medical records, as denoted from the recitation of relevant medical history, such as the Veteran’s gait issues noted in service, from active service to present included in the medical opinion. Further, the examiner showed awareness of the Veteran’s service-connected disabilities. Additionally, the VA examiner based the medical opinions on current medical literature. A review of the Veteran’s service treatment records found no complaints or treatment for a knee condition. The Veteran was first provided a VA examination less than a year after completing service in October 1993. The October 1993 examiner found that her knees could perform a full range of motion without difficulty. The Veteran’s lay statements have been inconsistent. The Veteran stated at the February 2013 VA examination that she first noticed her knee pain in service but later stated in the December 2019 VA examination that the condition had its onset well after service. Since the Veteran’s statement as to the onset of her knee condition are internally inconsistent, the Board affords these statements little to no probative weight. Additionally, the buddy statements from the Veteran’s spouse and son, which speak to the pain and limitation that her bilateral knee condition, only support that the Veteran has a current condition which is not at issue in this claim. See VA 21-4138 Statement in Support of Claim received 2/11/2013; see also Buddy/Lay statement received 2/11/2013. As such, they are not probative regarding the nexus element of service connection. The Veteran testified that her physician stated that her knee condition was related to her service-connected foot condition since it threw off her stride and threw her knees out of alignment. See Hearing Transcript received 4/04/2019 at page 3. Since the provider has not reduced the opinion to writing nor was a medical rationale as to the how her service-connected conditions cause her bilateral knee condition provided, which is needed especially since the two medical opinions of record stated that the reviewed medical literature does not support such an opinion, the Board gives this portion of the testimony no probative weight. Accordingly, the Board finds that the preponderance of the evidence, in this case the December 2019 VA examination, which is consistent with the conclusions of the February 2013 examination, weighs against the claim. 38 U.S.C. § 5107(b). Accordingly, service connection for a bilateral knee condition, diagnosed as bilateral chondromalacia patellae, is denied. 2. Service connection for a neck condition is denied. The Veteran contends that her chronic neck strain (neck strain) is secondary to her service-connected plantar fasciitis and lumbar spine disability. See Hearing Transcript received 4/04/2019 at page 2; see also Form 9 received 2/11/2009. A review of the Veteran’s service treatment records found no complaints or treatment for neck strain. The Veteran was first provided a VA examination less than a year after completing service in October 1993. The October 1993 examiner found that her neck was supple, and she could perform a full range of motion without difficulty. See VA Examination received 10/04/1993 at page 3. In February 2013, VA provided the Veteran an examination. At the examination, she was diagnosed with chronic cervical strain. The Veteran reported that her neck strain began in 1992 during active duty. See VA Examination received 2/12/2013 at page 29. At the time, the Veteran endorsed recurrent episodes since service. The February 2013 VA examiner provided a negative nexus statement since there was no evidence of chronic or recurrent neck strain in the service medical records. The February 2013 VA examiner further opined that the Veteran’s neck strain was less likely than not caused by or aggravated by her service-connected lumbar spine disability. The rationale being that there is no medical authority or peer reviewed medical literature that supports a causative or aggravative link between lumbar strain and the development of cervical strain. In the August 2019 Board decision, the claim was remanded for a new VA examination and medical opinion that opined on the Veteran’s alternate theory of entitlement, secondary service connection due to her plantar fasciitis and in service foot conditions. VA provided the Veteran a new VA examination in December 2019. At the VA examination, the Veteran stated her neck strain began 13 or 14 years ago, roughly in 2006, which would be approximately 13 years after service. She denied any injuries or trauma to her neck. See C&P Exam received 12/09/2019 at page 1. The December 2019 VA examiner opined that the Veteran’s neck strain was less likely than not due to service since her service records were silent for a neck condition and since the earliest documented neck condition was in 2001, or eight years after service. As to secondary service connection, the VA examiner opined that there was no causative or aggravative mechanism linking her current neck strain to her other service-connected disabilities including her foot conditions. Id. at page 9. The VA examiner further opined that chronic neck strain is the result of overuse such as to many hours hunched over the computer or smartphone. The Board finds the December 2019 medical opinion adequate since the VA examiner conducted an in-person examination of the Veteran, and thoroughly reviewed the Veteran’s medical records, as denoted from the recitation of relevant medical history from active service to present included in the medical opinion. Additionally, the VA examiner based the medical opinions on current medical literature. Here, again the Veteran’s lay statements were inconsistent. In the February 2013 examination she stated that her neck strain began in service with periodic occurrences since, and in the December 2019 examination the Veteran stated that her neck strain began instead 13 or 14 years ago. Therefore, the Board affords her statement as to in-service incurrence no probative weight since it is inconsistent. Additionally, since there is no in-service occurrence, as the Veteran’s service treatment records are devoid of complaints or treatments, and there are no medical opinions linking the Veteran’s service connected conditions to the development or aggravation of her neck strain, the Board finds the preponderance of the evidence weighs against service connection for a neck strain. The Board notes that the 1993 VA examination findings for full motion of the neck weigh against continuity of symptomatology. In reaching this conclusion, the Board affords great weight to the December 2019 VA examiners opinion which the Board finds adequate medical, and consistent with the conclusions of the February 2013 examination. Accordingly, service connection for neck strain, diagnosed as chronic neck strain, is denied. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Dixon, 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.