Citation Nr: 22017131 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-57 229 DATE: March 24, 2022 ORDER Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability, is granted. FINDING OF FACT The Veteran's diagnosed left knee disability has been shown to be etiologically related to his service-connected right knee disability. CONCLUSION OF LAW The criteria for service connection for a left knee disability have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1984 to January 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran and his wife testified at a hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability, is granted. During his November 2021 Board hearing, the Veteran testified that his current left knee disability was caused by wear and tear from his duties as a medical specialist, which is supported by his DD-214. Alternatively, the Veteran reported that his current left knee disability may have been caused or aggravated beyond its natural progression by his service-connected right knee disability. To this end, he explained that he used his left knee to compensate for limitations imposed by his right knee disability. See November 2021 Hearing Transcript, pages 2-6; January 1987 Certificate of Release or Discharge From Active Duty (e.g. DD 214, NOAA 56-16, PHS 1867). The Veteran's service treatment records (STRs) are silent for any findings or diagnoses related to his left knee. See November 1986 STR Medical. A review of the post-service treatment records shows that the Veteran initially sought treatment for a lump on the back of his left knee in February 2011. To this end, the Veteran stated that the lump caused pressure, but denied pain, redness, and calf tenderness. A physical examination revealed palpable swelling in the popliteal fossa region of the Veteran's left knee, and the examiner diagnosed him with a possible Baker's cyst. Five days later, the Veteran sought treatment for a lump behind his left knee and left knee pain, and the examiner confirmed the Veteran's Baker's cyst diagnosis. During an April 2011 orthopedic surgery consultation, the Veteran reported that his right knee symptoms improved after he underwent a right knee arthroscopy and partial medial meniscectomy in January 2011. However, he also indicated that he was starting to experience significant left knee pain. To this end, he explained that he had been favoring his left knee over his right. Subsequent VA treatment records indicate that the Veteran underwent a left knee arthroscopy, medial meniscectomy and chondroplasty for left knee pain in June 2011, as well as a left knee arthroscopy and chondroplasty with a partal meniscectomy, also for left knee pain, in September 2012. See August 2017 CAPRI. An October 2012 orthopedic surgery outpatient note indicates that the Veteran had a prior procedure on his left knee, which led him to favor his right knee for many years. To this end, the examiner opined that the Veteran's left knee disability may have led to early degeneration of his right knee. The Board notes that the October 2012 VA examiner appears to have attributed the Veteran's right knee symptoms and medical history to his left knee and vice versa. To this end, the October 2012 medical record should reflect that the Veteran had a prior procedure on his right knee, which led him to favor his left knee for many years and may have led to early degeneration of his right knee. See October 2018 Medical Treatment Record Government Facility; November 2012 Hearing Transcript, page 7. The Veteran underwent a VA examination for knee and lower leg conditions in December 2013. The examiner noted that the Veteran had been diagnosed with left knee strain with meniscal tear. During the examination, the Veteran reported that he underwent a surgery for his right knee disability in 2011 but noted that he still experienced pain with use. In addition, he denied a left knee injury. After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's left knee disability was related to his service-connected right knee disability. To the contrary, the December 2013 VA examiner opined that the Veteran's left knee disability was caused by natural age progression. In support of his opinion, the examiner noted that the Veteran had no left knee injuries during service and that he initially endorsed left knee pain after his right knee operation. In addition, the examiner found that any aggravation of the Veteran's right knee disability could not be resolved without resorting to speculation. See August 2017 CAPRI. Lastly, the Veteran was also afforded a VA examination for knee and lower leg conditions in August 2021. The examiner diagnosed the Veteran with status-post bilateral total knee replacement (previously right knee only), explaining that the Veteran underwent a total right knee replacement in 2017 and a total right knee replacement in 2018. After performing an examination and reviewing the evidence of record, the examiner opined that the Veteran's diagnosed status-post total knee replacement was directly due to or the result of his service-connected right knee disability. In support of her opinion, the examiner explained that the Veteran's left knee joint gradually deteriorated during the years he spent performing movements to compensate for his service-connected right knee disability. As such, the examiner found that the Veteran's current left knee disability was directly related to his service-connected right knee disability. See August 2021 C&P examination. Following a review of the evidence of record, the Board finds that service connection for a left knee disability, to include as secondary to a service-connected right knee disability, is warranted. In the present case, there is sufficient evidence the Veteran meets the threshold criterion for service connection of a current disability. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Specifically, the December 2013 VA examiner noted that the Veteran had been diagnosed with left knee strain with meniscal tear, and the October 2021 VA examiner diagnosed the Veteran with status-post bilateral total knee replacement. See August 2017 CAPRI; See August 2021 C&P examination. Accordingly, the remaining question is whether the Veteran's diagnosed left knee disability is related to service. In this regard, the Board notes that service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury; or, for any increase in severity of a nonservice-connected disease or injury which is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of nonservice-connected condition. 38 C.F.R. § 3.310(a), (b). 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) (en banc). To this end, the Board notes that there are conflicting medical opinions of record as to whether the Veteran's current left knee disability is related to his active duty service. After a review of those opinions, the Board finds the August 2021 VA examination report and medical opinion to be the most probative evidence of record. To this end, the Board finds the December 2013 VA medical opinion inadequate because the examiner failed to provide adequate rationale for the medical opinion rendered. Specifically, the Board finds that the December 2013 VA examiner failed to cite any additional evidence, beyond noting that the Veteran did not seek treatment for a left knee disability during service, to support his opinion that the Veteran's left knee disability was related to natural age progression. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Moreover, although the December 2013 VA examiner acknowledged the Veteran's reports that his left knee disability was aggravated beyond its natural progression by his service-connected right knee disability, he found any finding of aggravation could not be resolved without resorting to speculation. Accordingly, the Board also finds the December 2013 VA medical opinion incomplete and thereby inadequate to adjudicate the issue on appeal. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (a medical opinion is inadequate when it fails to adequately address the question of aggravation). Conversely, the Board finds the August 2021 VA medical opinion to be the most probative evidence of record. To this end, after performing an examination and reviewing the evidence of record, the examiner opined that the Veteran's diagnosed left knee disability was directly due to or the result of his service-connected right knee disability. In support of her opinion, the examiner explained that the Veteran's left knee joint gradually deteriorated during the years he spent performing movements to compensate for his service-connected right knee disability. As such, the examiner found that the Veteran's current left knee disability was directly related to his service-connected right knee disability. See August 2021 C&P examination. Thus, the Board finds the August 2021 VA examiner's opinion probative as it is factually supported, consistent with the other evidence of record, and included review of the claims file and relevant medical literature. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Based on the foregoing, the Board finds that the only competent medical evidence of record supports a finding that the Veteran's diagnosed left knee disability is secondary to his service-connected right knee disability. Thus, all three Shedden requirements have been met and the claim is granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, 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.