Citation Nr: 21032169 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 16-44 657 DATE: May 26, 2021 ORDER Reopening of service connection for a right knee disability is granted. Reopening of service connection for a back disability is granted. Service connection for a right knee disability, to include degenerative arthritis associated with status post total knee replacement, is granted. REMANDED Service connection for a back disability, to include spinal generalized spondylosis with lumbar anterolisthesis and intervertebral disc syndrome, is remanded. FINDINGS OF FACT 1. The Veteran submitted new and material evidence regarding his claims of service connection for his right knee and back disability. 2. The Veteran's right knee disability began in service and has continued since that time. CONCLUSIONS OF LAW 1. New and material evidence, having been received, the previously denied claim of entitlement to service connection for a right knee disability is reopened. 38 C.F.R. § 3.156. 2. New and material evidence, having been received, the previously denied claim of entitlement to service connection for a back disability is reopened. 38 C.F.R. § 3.156. 3. The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from February 1972 to January 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran previously submitted a claim of entitlement to service connection for a right knee disability and a back disability. These claims were denied in a December 2012 rating decision. Since the December 2012 rating decision, additional medical records and lay statements have been associated with the file purporting to show the Veteran's disabilities are related service. This evidence is new, not duplicative of evidence previously of record, and material in that it addresses the fact that the Veteran's disabilities did not pre-exist and are related to service. Thus, the Board finds new and material evidence has been received sufficient to reopen his previously denied claim. 38 C.F.R. § 3.156(a). Service Connection The Veteran seeks service connection for his right knee disability. Service connection may be granted for a disability resulting in a disease or injury that is incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 U.S.C. § 3.303. To establish service connection for the claimed disorder, the following criteria must be met: (1): medical evidence of a current disability; (2) evidence of an in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and current disability. See 38 C.F.R. § 3.303; see also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999). The Board finds service connection is warranted. All three elements of service connection are established by the competent and credible lay and medical evidence of record. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; Shedden, 381 F.3d at 1166-67. The Veteran has a diagnosis of a right knee disability, to include degenerative arthritis associated with status post total knee replacement. The service treatment records show that the Veteran was found to be normal at service entry and received significant treatment for his right knee disability. The separation exam specifically notes a right knee scar for the Veteran's right knee meniscectomy. Further, he reports ongoing right knee problems since service, which is consistent with the lay and medical evidence of record. The Veteran's account of recurrent right knee problems since service is both competent and credible. The Veteran's statements are entitled to probative weight, as they are internally consistent and consistent with the evidence of record, showing that the Veteran had numerous complaints of and treatment for a right knee disability and pain as the result of an in-service injury. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). REASONS FOR REMAND The Veteran seeks service connection for a back disability. He contends that his back disability began in service and has continued since that time. Alternatively, he highlights that his service-connected knee disabilities have resulted in problems with his back. In a private medical opinion, received August 2017, Dr. B. opined that the Veteran's service-connected knee disabilities caused weight gain, which caused the current back disability. "Obesity may be an 'intermediate step' between a service-connected disability and a current disability that may be service connected on a secondary basis under 38 C.F.R. § 3.310(a)." G.C. Prec. Op. 1-2017, at 2-3. Entitlement under this theor requires consideration of both proximate causation and aggravation in its analytical framework: (1) whether the service-connected disability (caused the veteran to become obese/aggravated the veteran's obesity); (2) if so, whether the (obesity/aggravation of obesity) as a result of the service-connected disability was a substantial factor in causing the current disability; and (3) whether the current disability would not have occurred but for (obesity caused/obesity aggravated) by the service-connected disability. If these questions are answered in the affirmative, then the current disability may be service connected on a secondary basis. See Walsh v. Wilkie, 32 Vet. App. 300, 303-304 (2020), analyzing G.C. Prec. Op. 1-2017. The Board finds that further medical development is needed to make a fully informed decision on this issue. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) for the Veteran's low back disability. The VA examiner should opine whether it is at least as likely as not that any identified disorder began in service, is related to service, or is caused or aggravated by the Veteran's service-connected bilateral knee disabilities. The examiner should also address (1) whether a service-connected disability (caused the Veteran to become obese/aggravated the veteran's obesity); (2) if so, whether the (obesity/aggravation of obesity) as a result of the service-connected disability was a substantial factor in causing the current disability; and (3) whether the current disability would not have occurred but for (obesity caused/obesity aggravated) by the service-connected disability. In considering these questions, the examiner must address the private medical opinion, received August 2017, wherein Dr. B. opined that the Veteran's service-connected knee disabilities caused weight gain, which caused the current back disability. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ijitimehin, Kemi D. 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.