Citation Nr: 21028054 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 14-35 292 DATE: May 10, 2021 ORDER Entitlement to service connection for left knee strain is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran's left knee condition is the result of his military service, or that is proximately due to or aggravated by his service-connected conditions. CONCLUSION OF LAW The criteria for entitlement to service connection for left knee strain have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the United States Army from March 1973 to July 1976. This matter comes to the Board of Veterans' Appeals (Board) on appeal of a August 2013 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). In February 2016, the Veteran presented testimony in a videoconference hearing before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims folder. In February 2019 and October 2020, the Board remanded the issue on appeal for additional development, and the case has since been returned for further appellate review. A remand by the Board confers on the claimant a legal right to substantial compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). The Board's October 2020 remand directed the RO to obtain outstanding VA treatment records which were associated with the file in November 2020. The Board's remand also instructed the RO to provide the Veteran with an in-person examination to determine the nature and etiology of his left knee condition, which was provided in February 2021. As such, substantial compliance with the Board's prior remand has been achieved and the merits of the claim are discussed below. Id. at 271. Notably, the issue of entitlement to service connection for a right knee disability was also before the Board. A June 2020 rating decision granted service connection for the Veteran's right knee strain. As it represents a full grant of the benefit sought, it is no longer before the Board in appellate status. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists, and (2) that the current disability was either (a) caused by, or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a); Allen v. Brown, 7 Vet. App. 439 (1995). When, after careful consideration of all evidence and argument, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. "Reasonable doubt" means one that exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. 1. Entitlement to service connection for left knee strain The Veteran contends that he is entitled to service connection for his left knee condition. Specifically, the Veteran asserts that he places additional weight and pressure on the left knee to compensate for his service-connected right knee condition. He also testified to experiencing a knee injury on active duty while playing basketball and that his knee is stiff and locks, requiring a brace. The question for the Board is whether the Veteran has a current left knee disability that is related to service, including whether it is proximately due to, the result of, or was aggravated beyond its natural progress by his service-connected right knee disability. The Board concludes that, while the Veteran has a current disability of left knee strain, the preponderance of the evidence is against finding that the Veteran's knee condition is related to his service, or is proximately due to or the result of, or aggravated beyond its natural progression, by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310(a). The Veteran has a current diagnosis of left knee strain as evidenced by his most recent VA examination in February 2021. The Board notes complaints of left knee pain while in service, following a basketball injury to the right knee. Thus, the first and second elements required for service connection are met. However, regarding the third element necessary for service connection, the Board finds the evidence is against a nexus relationship. Following the Board's second remand, the February 2021 VA examiner opined that the Veteran's left knee condition is less likely than not secondary to, or aggravated by, the Veteran's service-connected right knee strain. Rather, his left knee strain is more likely due to multilevel spinal disease and compensation for the resulting left leg weakness and pain. The examiner explained that January 2020 physical therapy records that indicate the Veteran's symptoms of left leg pain, instability, weakness, and left foot drop are neurologic conditions related to his multilevel disc disease of the spine. She further notes diagnostic imaging taken of the left knee in February 2021 was negative for a left knee condition. The examiner opined that a left knee condition aggravated by a right knee disability for more than 40 years would be evidenced by pathology in recent X-ray imaging. The February 2021 examiner also addresses a direct theory of entitlement concerning the evidence of left knee pain while in service. She explains the Veteran's STRs contain one report of left knee pain in June 1976, which was likely secondary to his right knee tendonitis. Although the left knee may have been strained for compensating for the right knee, the left knee did not receive a diagnosis or treatment as the physician did not provide any meaningful explanation that would provide a diagnosis or etiology. Further, she notes the left knee pain is shown by the remainder of the medical evidence to have resolved during service as the February 2021 radiology consultation was negative for arthritis, fracture, and bone or soft tissue abnormality. She concludes the Veteran is experiencing different symptoms with a separate diagnosis related to his spinal disease. The Board finds the opinion probative and affords it significant weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA physician based the opinion on a thorough examination of the Veteran, including relevant diagnostic imaging. The examination report indicates a thorough review of the Veteran's in-service and post-service medical history, including recent physical therapy and VA treatment records. The conclusions are supported by medical reasoning and are not contradicted by relevant facts or the remainder of the Veteran's treatment records. Similarly, in August 2013 and October 2019, VA examiners declined to provide a positive nexus for the Veteran's left knee condition. Although the Veteran is competent to report observable symptoms and believes his left knee strain is related to his military service, or proximately due to or the result of his right knee condition, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to VA examiner's opinion. As the preponderance of the evidence is against service connection, the benefit of the doubt doctrine is not for application and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.N. Chapman, 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.