Citation Nr: 22012180 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 17-27 964 DATE: March 2, 2022 ORDER 1. Entitlement to service connection for a right knee disability, as secondary to the service-connected left foot disability, is granted. 2. Entitlement to service connection for a left knee disability, as secondary to the service-connected left foot disability, is granted. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, the diagnosed right knee disability is secondary to his left foot disability. 2. Resolving all reasonable doubt in favor of the Veteran, the diagnosed left knee disability is secondary to his left foot disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee disability, as secondary to the left foot disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. § § 3.102, 3.303, 3.310 (2020). 2. The criteria for entitlement to service connection for a left knee disability, as secondary to the left foot disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. § § 3.102, 3.303, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active-duty service in the United States Air Force from April 1987 to April 1991. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This appeal was previously remanded by the Board in November 2019 and August 2021 for further development. Entitlement to service connection for a bilateral knee disability, as secondary to the service-connected left foot disability, is granted. Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection generally requires evidence satisfying three criteria: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service. See Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013); Hickson v. West, 12 Vet. App. 247, 253 (1999). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Here, the Veteran contends that his bilateral knee disability is a result of his service-connected left foot disability. The record reflects that he has been diagnosed with a meniscal tear in both knees. See VA Examination Report dated February 2020. In December 2012, a VA examiner concluded that the Veteran's claimed knee condition was less likely than not caused by active duty. While she noted that medical literature did not support the contention that a stress fracture of the foot resulted in arthritis of the knee, she failed to provide a complete opinion addressing secondary service connection. The Veteran was provided with a new VA examination in February 2020. The examiner concluded that the Veteran's bilateral knee disability was proximately due to or the result of his service-connected left foot disability. She explained that the change in gait that results from such a foot condition can lead to a knee strain and, ultimately, to a meniscal tear, as observed in the Veteran's case. The examiner based this opinion upon a review of the Veteran's medical history, an in-person examination, as well as scientific principles. Indeed, she provided a physiological explanation regarding the impact of the foot condition, in this case an associated change in gait, upon each knee. As such, the Board affords this opinion probative weight. In September 2020 and December 2020, the February 2020 examiner provided two negative nexus opinions. However, she failed to provide any explanation for the change in her conclusions. Instead, she based these new opinions on the absence of a report of foot trouble upon separation and neglected to consider the Veteran's reports of symptomatology beyond service. She also stated that the claimed conditions would not be aggravated beyond their natural progression by the service-connected foot condition, but failed to provide a rationale in support of this conclusion. In November 2021, a new VA examiner concluded that the claimed knee condition was less likely than not proximately due to or aggravated by the service-connected left foot condition. He explained that the severity of the foot injury was not significant enough to result in a severely altered gait. Based upon the above findings, the Board finds that the Veteran is entitled to service connection for his bilateral knee disability. He has shown the presence of a current disability, via the February 2020 VA examination, and there is a probative medical opinion linking the claimed disability with the service-connected left foot disability. The only probative evidence against a finding of nexus was presented via the November 2021 VA examination addendum opinion. This is namely that the Veteran's foot disability was not severe enough to impact his gait in either leg. However, as discussed above, the February 2020 VA examiner concluded that the service-connected foot condition was capable of causing a meniscal tear due to an altered gait. At the very least there is an equitable balance of opinions for and against a finding of a current disability of a bilateral knee disability and nexus to the service-connected left foot disability. Therefore, because there are at least a balance of positive and negative nexus opinions available, the evidence at the very least is in equipoise. Accordingly, a basis upon which to establish service connection for a bilateral knee disability has been presented and the appeal is granted. S. Sorathia Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Erin J. Trojanowski, 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.