Citation Nr: 21030423 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 14-24 727 DATE: May 18, 2021 ORDER Entitlement to service connection for a right knee disability, as secondary to service-connected back condition, is denied. FINDING OF FACT The Veteran's right knee disability was not due to or aggravated by his service-connected back condition. CONCLUSION OF LAW The criteria for service connection for a right knee disability, as secondary to service-connected back disability, have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1977 to November 1981. In a July 2018 decision, the Board of Veterans' Appeals (Board) denied the Veteran's claim for entitlement to service connection for a back condition and a right knee disability, claimed as secondary to his back condition. The Veteran timely appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In an August 2019 Order, the Court granted the parties' Joint Motion for Partial Remand (JMPR), partially vacated the July 2018 Board decision, and remanded the matter to the Board for readjudication consistent with the JMPR. In December 2019, the Board remanded the Veteran's service connection claims to the agency of original jurisdiction (AOJ) for further development. In September 2020, the AOJ granted service connection for the Veteran's back condition (as reflected in a September 2020 rating decision). As this decision constitutes a full grant of the benefits sought on appeal for that issue, it is not before the Board. In April 2021, the AOJ denied entitlement to service connection for a right knee disability (as reflected in an April 2021 supplemental statement of the case (SSOC)). 1. Entitlement to service connection for a right knee disability As noted in the Court order and Board remand, the Veteran contends that he is entitled to service connection for a right knee disability as secondary to his service-connected back disability. Service connection may be granted 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). When service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. 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) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). VA is responsible for determining whether the evidence supports the claim, with the veteran prevailing, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Pursuant to the Board remand, VA medical opinion was obtained in March 2021. The examiner opined that it was less likely than not that the Veteran's right knee disability was caused by or proximately due to his service-connected back condition. As rationale, he stated that "osteophyte formation, degenerative changes and tricompartment osteoarthritis is an age-related condition and unrelated to his service-connected thoracolumbar spine conditions." He clarified that the Veteran's back conditions do not share "any anatomical nor physiological closeness in which a compensatory pattern could conceivably be argued." Moreover, the examiner stated that "the Veteran has had no history of abnormal gait patterns which could cause a compensatory strain pattern from his thoracolumbar spine to his hip to his knee." Upon review of the evidence of record, the Board finds that the March 2021 VA examiner's medical opinion is probative evidence weighing against secondary service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). The VA examiner relied on the medical evidence of record when opining that it is less likely than not that the Veteran's right knee disability is proximately due to or the result of the Veteran's service-connected back condition, as discussed above. Although the VA examiner did not specifically address aggravation, his opinion read as a whole shows that the Veteran's age-related changes are the causal factors for his right knee disability in this particular case. He discounted any causal effect from his right knee condition to service-connected thoracolumbar spine condition and thus far less than the at least as likely not evidentiary standard. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read and in the context of the evidence of record). Thus, the examiner's comments are broad enough to foreclose the possibility of aggravation. El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (considering the possibility that language in a medical opinion could be considered to address aggravation without specifically using that word, but rejecting the argument on the facts of that case); Chavez v. McDonald, No. 13-2886 (mem. dec. Sept. 22, 2014) (medical opinion on secondary relationship was adequate even though it did not specifically say "not aggravated," because read as a whole it encompassed aggravation); see also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). To the extent the Veteran asserts a nexus, this issue is a complex medical question since it involves the cause of an internal disease with multiple possible causal factors. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (lay persons are not competent to address complex medical matters). Since the Veteran is not competent to report a nexus, any such nexus reports from him have no probative value. Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). The Veteran has not identified any other competent evidence to warrant further investigation of a secondary nexus. Given that the preponderance of the evidence is unfavorable to the claim, VA's benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, the Board finds the preponderance of the evidence is against the claim and service connection is for a right knee disability is denied. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kovacs, 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.