Citation Nr: 21024878 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 15-35 112A DATE: April 26, 2021 ORDER Entitlement to service connection for a right knee disability, to include as secondary to a right ankle disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s current right knee disability is secondary to service-connected right ankle disability, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1980 to May 1982. This case is before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office. In September 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. The Board previously remanded the matter for more development in August 2018, August 2020, and January 2021, Now the matter is returned to the Board. A veteran is entitled to VA disability compensation if there is disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. § 1131 (2012). To establish an entitlement to service connection for a disability, a veteran must show: (1) a present disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to or the result of an established service-connected disability. 38 C.F.R. § 3.310 (2020). This includes disability made chronically worse by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” 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) (2012). For VA to deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App., at 54. The Veteran is seeking service connection for a right knee disability. He contends that his right knee condition is due to the knee overuse while playing various sports in service and also secondary to his service-connected right ankle disability. The Veteran underwent VA examinations for knee conditions in July 2012, May 2019, and November 2020. On July 2012 examination, the examiner noted the Veteran’s diagnosis of chondromalacia of patella of bilateral knees, but provided that the Veteran did not report any problems with the right knee. The Board notes that the Veteran also denied any right knee pain during the May 2019 examination, and range of motion for the right knee during the examination was all normal. On November 2020 examination, the examiner noted a diagnosis of right knee strain and provided that the right knee strain is a new and separate condition from his service-connected chondromalacia patella of the left knee. Thus, resolving any reasonable doubt in the Veteran’s favor, the Board finds that the Veteran has a current right knee disability. The Board notes that the Veteran’s service treatment record does not contain any complaint, diagnosis, or treatment related to a right knee condition. The May 2019 VA examiner did not provide a medical opinion for the Veteran’s right knee disability as the Veteran denied a right knee condition during the May 2019 VA examination. The requested etiology opinion in the August 2020 Board remand directives was provided by the November 2020 VA examiner, including a February 2021 addendum opinion. The examiner opined that the claimed right knee condition is less likely than not etiologically related his active duty service, to include the Veteran’s assertion that the condition is due to overuse and playing sports during service. The examiner reasoned that there is no medical record to substantiate a chronic right knee condition in service and no complaint or diagnosis regarding the right knee was reported during the Veteran’s separation examination. The examiner noted that the Veteran’s right knee condition manifested 30 years after service, and it is more likely developed due to the Veteran’s post-service work, e.g., being a cook for over thirty years and working as a maintenance person, which involved prolonged standing. As to the causal relationship between the Veteran’s current right knee disability and his service-connected disabilities, the examiner opined that it is less likely than not proximately due to service-connected disabilities with giving specific consideration to the Veteran’s assertion that his right knee pain developed over the years because his right ankle caused gait issues. The examiner observed during the November 2020 examination that the Veteran has a slightly antalgic gait where he puts more weight on the left lower extremity and not putting stress on the right side. The examiner pointed out that the Veteran has been claiming over the years that his left lower extremity disability is secondary to his right ankle injury, and there is nothing in the medical records to substantiate the claim of the left lower extremity placing strain on the right knee. In this regard, the Board notes that the Veteran testified during the September 2017 hearing that he experiences significant pain in the left side, because he is leaning and putting his weight on the left side due to the right ankle disability, but did not provide any statements as to the right knee. The examiner also opined that the Veteran’s current right knee disability is less likely than not aggravated beyond its natural progression due to his service-connected right ankle disability. The examiner provided that his current right knee strain is normal progression and manifestation of his age and years of weight-bearing work, and there is no medical evidence to support that the right knee condition was aggravated beyond its natural progression. While the Board has considered the Veteran’s contentions that his right knee condition is due to the knee overuse in service and secondary to his service-connected right ankle disability, he has not been shown to be competent to render an opinion on complex medical questions. The Board finds the most probative evidence to be the opinions of the VA examiner discussed above. Based on foregoing, the Board concludes that the preponderance of the evidence is against finding that the Veteran’s current right knee disability is secondary to service-connected right ankle disability, or is otherwise related to an in-service injury or disease. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply here. Consequently, the Veteran’s entitlement to service connection for a right knee disability, to include as secondary to a right ankle disability is not warranted. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. E. Kim, 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.