Citation Nr: 22013579 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 14-28 934A DATE: March 10, 2022 ORDER Service connection for a right knee disorder is denied. FINDING OF FACT A right knee disorder was not incurred in, or is otherwise etiologically related to, military service, nor is this disorder aggravated by, proximately due to, or the result of a service-connected disease or injury; right knee arthritis did not onset within one year of military separation. CONCLUSION OF LAW The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1131, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from June 1983 to April 1987, including foreign service and with additional reserve service. For his meritorious service, the Veteran was awarded (among other decorations) the Air Force Achievement Medal and the Air Force Overseas Service Long Tour Ribbon. The Veteran testified during an October 2016 Decision Review Officer (DRO) hearing. A transcript of this proceeding has been associated with the record. Most recently, this appeal was remanded by the Board in September 2021 to ensure that the Veteran's full service personnel records had been obtained. These records were associated with the claims file in October 2021. See Stegall v. West, 11 Vet. App. 268, 271 (1998). At that time, the Board further instructed that a complete copy of the Veteran's service treatment records (STRs) be obtained. Further review of the claims file indicates that said records were previously associated with the claims file, such that no further development is required on this point. Service Connection The Veteran remains in pursuit of service connection for a right knee disorder on both direct and secondary bases. Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current disability; (2) 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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may also be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). As to the first element, there is competent evidence of a current disorder. Historically, February 2013 and July 2013 VA examiners diagnosed the Veteran with a right anterior cruciate tear, post-surgical repair. Subsequently, May 2017 and November 2019 VA examiners diagnosed the Veteran with right knee arthritis. His right knee symptoms are also documented throughout his medical treatment records. Accordingly, the first element of direct and secondary service connection is met. Briefly, the Board has considered whether this appeal may be granted on a presumptive basis, given the Veteran's diagnosed arthritis. However, it is apparent that this condition did not onset within one year of the Veteran's military separation, such that presumptive service connection is not available in this case. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307, 3.309; see, e.g., May 2017 VA examination (recording an onset of February 2013); November 2019 VA examination (recording an onset of November 2019). Turning to the second element, the Veteran has testified that he injured his right knee while playing basketball during service. See, e.g., October 2016 DRO hearing transcript. However, his STRs unequivocally show that the Veteran injured his left knee during the reported incident, rather than his right. See also September 2020 VA opinion ("it is overwhelmingly clear that the veteran has confused which knee was problematic during active service," given the Veteran's reporting of the injury and contemporaneous medical records). Rather, the sole instance of a right knee injury in the Veteran's STRs appears in an August 1993 reserve record, wherein the examiner reports that the Veteran had arthroscopic surgery on his right knee in August 1992. The Veteran's personnel records do not reflect that he was serving on a period of active duty, active duty for training (ACDUTRA), or inactive duty for training (INACDUTRA) in August 1992, nor is there any evidence that he incurred injury to his right knee during such a period. 38 U.S.C. § 101(21) and (24); 38 C.F.R. § 3.6(a). Accordingly, there is not competent evidence of an in-service event in this case, such that the second element of direct service connection is not found. As such, further inquiry into the nexus requirement is moot and service connection on a direct basis is denied. However, the Veteran maintains that his right knee disorder is also causally related to a left knee disability. He is currently service-connected for left knee degenerative joint disease (DJD) post cartilage tear, such that the second element of secondary service connection is also met. Thus, the appeal can succeed upon the finding of a nexus between the two conditions. The Veteran has undergone repeated VA examinations of the knee. As an initial matter, the Board notes that a February 2013 examiner did not offer a nexus opinion, such that this evaluation does not merit further assessment herein. Further, VA nexus opinions were obtained in July 2013, August 2013, May 2017, and November 2019. Collectively, these opinions are limited to direct theories of entitlement, which the Board has precluded given its finding regarding the claimed in-service incurrence. Even if these opinions were relevant to the remaining theory of entitlement, they are inadequate for a number of reasons, to include the examiners' reliance on an inaccurate factual basis or the lack of accompanying documentation during service, or their failure to properly account for the Veteran's lay testimony in this case. Thus, these evaluations offer no probative value and are not for further consideration herein. Conversely, a September 2020 VA opinion offers significant probative value with respect to whether the claimed in-service injury was to the right knee. As the Board has previously relied upon the value of this opinion, in part, to deny the in-service incurrence element of direct service connection, the evaluation does not require further assessment herein, as a secondary theory of entitlement is not addressed in the opinion. Rather, the remaining VA opinion was obtained in July 2021. At that time, the examiner concluded that it was less likely than not that the Veteran's right knee disorder was due to or aggravated by his left knee disability. Here, the examiner noted that the Veteran had been diagnosed with DJD of the right knee, status-post operative repair of a torn meniscus. Gait accommodation for one knee does not cause a condition in the contralateral knee, particularly with respect to DJD. Rare exceptions can include chronic, exaggerated Trendelenburg gait and/or > 5% leg length discrepancy, neither of which is evident here. Instead, arthritis is a naturally-occurring, age-related condition. Contributing factors include prior internal knee injury and active chondromalacia, which are not caused by the Veteran's left knee disability. It is clear that the Veteran experienced an acute event in approximately July 2007 with injury to the lateral meniscus, which was repaired that same year. Chondromalacia was identified at that time and was likely related to the Veteran's post-service activities, arising approximately 20 years post-service. Additionally, there was no evidence of aggravation of the Veteran's right knee conditions due to any cause, including by his left knee disability. DJD naturally progresses, often requiring injections and or surgical intervention, in addition to the prior right meniscus surgery. In sum, it was less likely than not that the Veteran's right knee conditions are due to or have been aggravated by his left knee disability. It was more likely than not that the chondromalacia developed after service, in or around 2006 or 2007 with an acute meniscal tear in or around July 2007. DJD was documented in 2013. Though this was age-appropriate, the Veteran's risks were increased by the post-service diagnoses for the right knee and unrelated to those of the left knee. The examiner then cited to medical literature in support of this opinion. Significant probative value is afforded to this opinion, which directly contemplates the nature and onset of the Veteran's bilateral knee conditions and their observable relationships, as supported by his unique medical history and medical knowledge at large. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008); Prejean v. West, 13 Vet. App. 444, 448-49 (2000). There is no indication that this examiner relied upon incomplete or inaccurate data in providing their nexus opinion, and they possess the requisite expertise to offer a competent etiological opinion. Notably, there are no competent opinions of record which tend to contradict the examiner's findings, as the Veteran lacks the medical expertise to offer such. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the appeal also fails on a secondary basis. For the reasons set forth herein, the preponderance of the evidence is against the claim, and the evidence is not in approximate balance. The benefit-of-the-doubt rule is inapplicable, and the appeal seeking service connection for a right knee disorder is hereby denied. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.