Back to BVA DecisionsGRANTEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 18-43 018A
DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)
JENNA BRANT · 2026 · Case ID: 26001914
Summary
The Veteran, who served from April 1986 to November 1989, appeals the denial of service connection for neck arthritis and the denial of secondary service connection for left knee arthritis, lumbar spine arthritis, right shoulder disability, right hip disability, and left hip arthritis, all claimed secondary to a service-connected right knee disability. The Board reopened the claim for right hip disability based on new and material evidence, specifically a November 2023 private medical opinion from Dr. R.M. The Board found that the evidence was in approximate balance for all claimed conditions, and therefore, resolving reasonable doubt in the Veteran's favor, granted service connection for neck arthritis, left knee arthritis secondary to right knee disability, lumbar spine arthritis secondary to right knee disability, right shoulder disability secondary to right knee disability, right hip disability secondary to right knee disability, and left hip arthritis secondary to right knee disability. The Board noted that the Veteran's altered gait and posture due to his service-connected right knee disability, as supported by private and VA medical opinions, was a key factor in granting the secondary claims. The Board also noted that the Veteran's in-service neck complaint and subsequent degenerative changes, coupled with the favorable VA opinion, led to the grant of service connection for neck arthritis.
Rationale
Approximate balance of evidence on nexus; Resolving reasonable doubt in Veteran's favor
Full Decision Text
Citation Nr: 26001914 Decision Date: 02/11/26 Archive Date: 02/11/26 DOCKET NO. 18-43 018A DATE: February 11, 2026 ORDER As new and material evidence has been received, the matter of entitlement to service connection for a right hip disability is reopened. Entitlement to service connection for neck arthritis is granted. Entitlement to service connection for left knee arthritis, secondary to service-connected right knee disability, is granted. Entitlement to service connection for lumbar spine arthritis, secondary to service-connected right knee disability, is granted. Entitlement to service connection for a right shoulder disability, secondary to service-connected right knee disability, is granted. Entitlement to service connection for a right hip disability, secondary to service-connected right knee disability, is granted. Entitlement to service connection for left hip arthritis, secondary to service-connected right knee disability, is granted. FINDINGS OF FACT 1. Since a final February 2012 rating decision, new and material evidence has been received in the form of the November 2023 private medical opinion by Dr. R.M., which provides evidence bearing on the nexus element of the previously denied service connection claim for a right hip disability. 2. The evidence is in approximate balance regarding whether the Veteran's neck arthritis is caused by his service. 3. The evidence is in approximate balance regarding whether the Veteran's left knee arthritis is caused by his service-connected right knee disability. 4. The evidence is in approximate balance regarding whether the Veteran's lumbar spine arthritis is caused by his service-connected right knee disability. 5. The evidence is in approximate balance regarding whether the Veteran's right shoulder disability is caused by his service-connected right knee disability. 6. The evidence is in approximate balance regarding whether the Veteran's right hip disability is caused by his service-connected right knee disability. 7. The evidence is in approximate balance regarding whether the Veteran's left hip arthritis is caused by his service-connected right knee disability. CONCLUSIONS OF LAW 1. The criteria for granting the petition to reopen the service connection claim for right hip disability have been met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 2. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for neck arthritis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for left knee arthritis secondary to service-connected right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for lumbar spine arthritis secondary to service-connected right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right shoulder disability secondary to service-connected right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right hip disability secondary to service-connected right knee disability, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for left hip arthritis secondary to service-connected right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1986 to November 1989. These matters are before the Board of Veterans' Appeals (Board) on appeal from a March 2017 (service connection for neck, back, and left knee disabilities) and a February 2017 rating decision (service connection for left hip, right shoulder disabilities and whether new and material evidence was received to reopen the claim hip arthritis secondary to service-connected right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1986 to November 1989. These matters are before the Board of Veterans' Appeals (Board) on appeal from a March 2017 (service connection for neck, back, and left knee disabilities) and a February 2017 rating decision (service connection for left hip, right shoulder disabilities and whether new and material evidence was received to reopen the claim for entitlement to service connection for a hip disability) issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before a DRO on these matters in February 2018. The Veteran additionally testified at a December 2024 Board hearing on these matters before the undersigned Veterans Law Judge (VLJ). The Board notes that at the Board hearing, the issue of service connection for a back disability was mischaracterized as whether new and material evidence has been received to reopen the matter of service connection for a back disability, and the issue of whether new and material evidence has been received to reopen the matter of service connection for a right hip disability was mischaracterized as service connection for a right hip disability; however, the Board is granting service connection for lumbar spine arthritis and a right hip disability, representing a full grant of these benefits, and as such, the Board finds that these mischaracterizations were harmless errors by the Board. These matters have complex procedural histories. Most recently, the appeal streams for entitlement to service connection for neck, back, and left knee disabilities and service connection for left hip and right shoulder disabilities and the issue of whether new and material evidence has been received to reopen the matter of service connection for a right hip disability were separately certified to the Board. The Board has merged these issues into a single appeal and will be taking action on all of the issues herein. The Board notes that after the July 2018 statement of the cases (SOCs) were issued for all of the matters on appeal, new, pertinent medical records have been added to the claims file; however, as the Veteran waived AOJ initial jurisdiction at his December 2024 hearing, the Board can proceed with adjudicating the matters on appeal. See 38 C.F.R. § 19.31. New and Material Evidence Generally, decisions that are not timely appealed are final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 20.1100, 20.1103. If a decision denying a claim for service connection has become final, that claim may be reopened only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108 (prior to amendment in 2017). New evidence is defined as existing evidence not previously submitted to AOJ decision makers, while material evidence is defined as evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). The evidence must not be cumulative or redundant of the evidence previously of record and must raise a reasonable possibility of substantiating the claim. Id. The credibility of the evidence present is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Irrespective of the AOJ's determination, the Board must independently assess whether new and material evidence has in fact been submitted in order to assume jurisdiction over the merits of the claim. See Jackson v. Principi, 265 F.3d 1366, 1369-70 (Fed. Cir. 2001). As new and material evidence has been received, the matter of entitlement to service connection for right hip disability is reopened. In September 2016, the Veteran submitted a petition to reopen the issue of entitlement to service connection for a right hip disability. Previously, a February 2012 rating decision denied service connection for a right hip disability. The decision stated that the evidence does not show that there is a link between the Veteran's right hip disability and his service-connected right knee disability. The Veteran did not appeal the February 2012 rating decision within one year of its issuance or submit new and material evidence during that period. 38 C.F.R. §§ 3.156(b), 19.21, 19.52. As such, the February 2012 rating decision became final. 38 C.F.R. § 20.1103. Since 2016, the Veteran submitted a petition to reopen the issue of entitlement to service connection for a right hip disability. Previously, a February 2012 rating decision denied service connection for a right hip disability. The decision stated that the evidence does not show that there is a link between the Veteran's right hip disability and his service-connected right knee disability. The Veteran did not appeal the February 2012 rating decision within one year of its issuance or submit new and material evidence during that period. 38 C.F.R. §§ 3.156(b), 19.21, 19.52. As such, the February 2012 rating decision became final. 38 C.F.R. § 20.1103. Since the February 2012 rating decision, new evidence has been associated with the claims file. Notably, new evidence has been received in the form of the November 2023 private medical opinion by Dr. R.M., which indicated that the Veteran's right hip disability was caused by his service-connected right knee disability. Based on the foregoing, the Board finds that the new evidence is material because it relates to the previously unestablished element of a nexus, thereby raising a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a); see also Shade v. Shinseki, 24 Vet. App. 110, 117 (2010) (the threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low). Accordingly, the Board grants the petition to reopen the claim for service connection for a right hip disability. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present 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 or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Entitlement to service connection for neck arthritis The Veteran seeks service connection for neck arthritis. Regarding a current diagnosis, the August 2024 VA examination report diagnosed the Veteran with degenerative arthritis of the neck. Regarding an in-service event, the Veteran's STRs indicated that in October 1986 he complained of a neck problem. He indicated that his neck was stiff and he could not move it well for more than a week. He was diagnosed with a muscle strain and given motrin. Regarding a nexus between the Veteran's neck arthritis and his service, a March 2017 VA examiner indicated that the Veteran's neck arthritis is less likely than not incurred in or caused by the muscle strain of neck during the service. The examiner stated that the structural changes of neck occurred over many years and would not be caused by one event. The August 2024 examiner indicated that the Veteran's neck disability is at least as likely as not caused by his service. The examiner noted the Veteran's in-service neck complaint and stated that degenerative arthritis, particularly in the cervical spine, refers to the wear and tear of the cartilage and bones in the neck area, leading to conditions such as cervical spondylosis. This condition can result in pain, stiffness, and reduced mobility, significantly impacting quality of life. Military training often involves physically demanding activities, including rucking with heavy packs. This type of training can impose significant mechanical stress on the cervical spine. Research indicates that tactical athletes, including military personnel, are at a many years and would not be caused by one event. The August 2024 examiner indicated that the Veteran's neck disability is at least as likely as not caused by his service. The examiner noted the Veteran's in-service neck complaint and stated that degenerative arthritis, particularly in the cervical spine, refers to the wear and tear of the cartilage and bones in the neck area, leading to conditions such as cervical spondylosis. This condition can result in pain, stiffness, and reduced mobility, significantly impacting quality of life. Military training often involves physically demanding activities, including rucking with heavy packs. This type of training can impose significant mechanical stress on the cervical spine. Research indicates that tactical athletes, including military personnel, are at a higher risk for developing osteoarthritis due to the physical demands of their roles. The repetitive strain from carrying heavy loads can lead to accelerated wear on the cervical joints, contributing to degenerative changes over time. The Veteran testified at his December 2024 Board hearing that he began to notice his neck pain in service, and it has progressed since then. The Board finds that the evidence of record is in approximate balance regarding the nexus element, and therefore, resolving reasonable doubt in favor of the Veteran, his service connection claim for neck arthritis must be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for left knee arthritis, secondary to service-connected right knee arthritis The Veteran seeks service connection for left knee arthritis. Regarding a current diagnosis, the August 2024 VA knee examiner diagnosed the Veteran with left knee arthritis. Regarding a nexus between the Veteran's left knee arthritis and his service-connected right knee arthritis, the March 2017 VA examiner indicated that the Veteran's left knee arthritis is less likely than not due to his service-connected right knee arthritis. The examiner indicated that the Veteran stated that he has been shifting weight to left side, however, x-ray findings show minimal arthritis in both knees, and one would have expected more arthritis in the left knee than the right at this time given duration of time since the Veteran left the service. The Veteran testified at the February 2018 DRO hearing that he puts a lot of pressure on his left knee because his right knee is so damaged, and that this overcompensation caused his left knee arthritis. A November 2023 private opinion by Dr. R.M., a private doctor, indicated that the Veteran's left knee arthritis is at least as like as not caused by overcompensation due to his service-connected right knee disability. He stated that one of the ways the body deals with pain is through compensation patterns. By making adjustments in our normal movement or our gait, our bodies create new movement patterns intended to diminish or avoid the pain we are experiencing. This process is known as compensation patterns, or, more colloquially, overcompensation. Unfortunately, new pain often occurs as a result because these compensating joints and muscles are not usually designed to carry this added burden. Consequently, they can become painful or even he injured with overuse. Long-term or chronic compensatory pain can lead to debility and increasingly painful symptoms. He indicated that the Veteran stated that he has been shifting his weight to the left knee because of the discomfort that he experiences in the right knee. The August 2024 VA examiner indicated that the Veteran's left knee disability was at least as likely as not due to his service-connected right knee disability. The examiner stated that degenerative arthritis in the right knee can have an impact on osteoarthritis in the left knee. The examiner indicated that osteoarthritis in the opposing knee can develop as a result of compensatory processes brought on by altered gait, higher stress, and altered joint alignment. The examiner additionally stated that a postoperative tear of the right medial meniscus may have an impact on osteoarthritis of the left knee. Osteoarthritis in the left knee can be caused by modified mechanics, increased strain on the opposing knee, and compensatory weight-bearing habits. The Veteran testified at his December 2024 Board hearing that babying his right knee because of his disability lead to his left knee issues. The Board finds that the evidence is in approximate balance regarding the issue of a nexus; therefore, resolving reasonable doubt in favor of the Veteran, his service connection claim for left knee arthritis must be granted on a secondary basis. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for lumbar spine arthritis, secondary to service-connected right knee disability The Veteran seeks service connection for lumbar spine arthritis as secondary to a service-connected right knee disability. Regarding a current diagnosis, the August 2024 VA examiner diagnosed back arthritis and noted an MRI of Board hearing that babying his right knee because of his disability lead to his left knee issues. The Board finds that the evidence is in approximate balance regarding the issue of a nexus; therefore, resolving reasonable doubt in favor of the Veteran, his service connection claim for left knee arthritis must be granted on a secondary basis. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for lumbar spine arthritis, secondary to service-connected right knee disability The Veteran seeks service connection for lumbar spine arthritis as secondary to a service-connected right knee disability. Regarding a current diagnosis, the August 2024 VA examiner diagnosed back arthritis and noted an MRI of the lumbar spine from December 2014 which showed moderate multilevel degenerative disc disease. Regarding a nexus between the Veteran's back arthritis and his service-connected right knee disability, a June 2010 VA examiner opined that the Veteran's back disability is not likely related to or aggravated by his right knee disability. The examiner stated that the Veteran has very minimal degenerative changes in his right knee according to x-rays. The examiner stated that the Veteran has been having chronic musculoskeletal diffuse pain syndrome as per his neurologist's progress note, and the Veteran's condition is mostly related to a degenerative process but not related to the degenerative process of the service-connected right knee condition. A March 2011 VA examiner opined that the Veteran's back disability is less likely than not related to his right knee disability. The examiner stated that the Veteran's back strain does not correlate with an arthritic knee, and there is minimal degenerative change per the x-ray, which is likely age related, and no previous injury reported. A March 2017 VA examiner opined that the Veteran's back disability is less likely than not due to a fall that was due to his right knee disability. The examiner stated that the Veteran's degenerative arthritis and disc bulges were present in the MRI dated 2010, and the structural changes already present in the back would not be caused by the fall. The examiner indicated that The Veteran also denied a fall as the cause of his back pain. The Veteran testified at his February 2018 DRO hearing that because of a fall due to his right knee, he hurt his back. A November 2023 private medical opinion by Dr. R.M. indicated that the Veteran's back disability is more likely than not a result of his altered gait and posture, which developed due to his service-connected right knee disability. He stated that research has found that altered gait would also accelerate disc degeneration in the lumbar spine. A December 2012 article titled "When Loiter Extremity Dysfunction Contributes To Back Pain" states that when walking abnormally, different timings of flexion destabilize the spine, and increase force on it. The torque applied to the lower spine through an altered gait occurs when the hip flexes, as the load that is supposed to be carried by the hips shifts upward. According to the article, a 15 to 20 percent body weight load can be carried by the back during this stage in the cycle of an altered gait, and over time this increased load will result in damage to the intervertebral disks. An August 2024 VA examiner opined that the Veteran's back disability was at least as likely as not due to his service-connected right knee disability. The examiner stated that the two disorders may influence one another through modified biomechanics, activity modifications, inflammatory processes, and possibly genetic factors. As a result of these interrelated conditions, those who have knee arthritis may be more susceptible to lumbar disc degeneration. The Veteran testified at his December 2024 Board hearing that his altered gait due to his service-connected right knee disability caused his back issue. The Board finds that the evidence regarding a nexus is in approximate balance; therefore, resolving reasonable doubt in favor of the Veteran, his service connection claim for lumbar spine arthritis must be granted as secondary to service-connected right knee disability. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for right shoulder disability, secondary to service-connected left knee disability The Veteran seeks service connection for right shoulder disability secondary to service-connected right knee disability. Regarding a current diagnosis, the August 2024 VA examiner diagnosed right shoulder impingement syndrome, rotator cuff tear, and acromioclavicular joint osteoarthritis. Regarding a nexus between the Veteran's right shoulder disability and his service-connected right knee disability, the Veteran testified at his February 2018 DRO hearing that he sustained a fall due to his right knee disability and hurt his right shoulder. The November 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for right shoulder disability, secondary to service-connected left knee disability The Veteran seeks service connection for right shoulder disability secondary to service-connected right knee disability. Regarding a current diagnosis, the August 2024 VA examiner diagnosed right shoulder impingement syndrome, rotator cuff tear, and acromioclavicular joint osteoarthritis. Regarding a nexus between the Veteran's right shoulder disability and his service-connected right knee disability, the Veteran testified at his February 2018 DRO hearing that he sustained a fall due to his right knee disability and hurt his right shoulder. The November 2023 private medical opinion by Dr. R.M. indicated that that the Veteran's right shoulder tendinosis and rotator cuff residuals are at least as likely as not due to his altered gait, which is caused by his right knee arthritis. He cited to articles that indicate that knee arthritis can cause unstable movement during walking, which can create a major risk of falling, and noted that the Veteran fell in 2015, which contributed to his right shoulder disability. The August 2024 VA examiner opined that the Veteran's right shoulder disability is at least as likely as not due to his service-connected right knee disability. The examiner stated that when an individual has degenerative arthritis in the knee, they may alter their gait or movement patterns to compensate for pain or instability. This compensatory behavior can lead to increased stress on the shoulder joint, potentially contributing to the development of glenohumeral joint osteoarthritis or exacerbating existing shoulder conditions, such as rotator cuff tears. Over time, these altered mechanics can lead to wear and tear on the shoulder joint due to abnormal loading patterns. The Veteran testified at his December 2024 Board hearing that his altered gait due to his service-connected right knee disability caused his right shoulder issue. There is no medical evidence of record indicating that the Veteran's right shoulder disability was not caused by his service-connected right knee disability, and the Court has cautioned VA against seeking a medical opinion where favorable evidence in the record is unrefuted. See Mariano v. Principi, 17 Vet. App. 305, 312 (2003). Therefore, resolving reasonable doubt in favor of the Veteran, his service connection claim for a right shoulder disability as secondary to service-connected right knee disability must be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for right hip disability, secondary to service-connected left knee disability The Veteran seeks service connection for right hip disability secondary to service-connected right knee arthritis. Regarding a current diagnosis, the February 2011 VA examiner diagnosed the Veteran with greater trochanteric bursitis of the right hip, and the August 2024 VA examiner diagnosed the Veteran with right hip arthritis. Regarding the element of a nexus between the Veteran's right hip arthritis and his right knee disability, A June 2010 VA examiner opined that the Veteran's right hip arthritis is not related to or aggravated by his right knee disability. The examiner indicated that the Veteran's right knee x-ray shows minimal degenerative changes, and his right hip x-ray shows moderate degenerative changes. The examiner stated that a neurologist's progress note indicates that he is having chronic musculoskeletal diffuse pain syndrome. The examiner stated that the Veteran's right hip arthritis is mostly related to a degenerative process but not related to the degenerative process of the service-connected right knee disability. A February 2011 VA examiner stated that the Veteran's right hip disability is less likely than not due to his service-connected right knee disability. The examiner stated that the Veteran's right hip is a trochanteric bursitis, which does not correlate with an arthritic knee. The Veteran testified at his February 2018 DRO hearing that he sustained a fall due to his right knee disability and hurt his right hip. The November 2023 private medical opinion by Dr. R.M. indicated that it is more likely than not that the Veteran's right hip disability is caused by his service-connected right knee disability. He stated a medical article indicates that poor balance and abnormal gait patterns are often the cause of trochanteric pain, as additional stresses are placed on the affected side to compensate for discomfort elsewhere. Not only has abnormal gait been documented, but the Veteran has a history of falling, and use of a cane inherently shifts the weight from one side to the other. This shifting placed strain on the hip and sacroiliac joints, leading to their degeneration. The August 2024 VA examiner opined that the Veteran's right hip disability is November 2023 private medical opinion by Dr. R.M. indicated that it is more likely than not that the Veteran's right hip disability is caused by his service-connected right knee disability. He stated a medical article indicates that poor balance and abnormal gait patterns are often the cause of trochanteric pain, as additional stresses are placed on the affected side to compensate for discomfort elsewhere. Not only has abnormal gait been documented, but the Veteran has a history of falling, and use of a cane inherently shifts the weight from one side to the other. This shifting placed strain on the hip and sacroiliac joints, leading to their degeneration. The August 2024 VA examiner opined that the Veteran's right hip disability is as likely as not due to his service-connected right knee disability. The examiner stated that right hip osteoarthritis can be influenced by right knee degenerative arthritis. This connection primarily arises from the way joint health and function are interrelated. When one joint, such as the knee, suffers from degenerative arthritis, it can lead to compensatory changes in how a person moves, which may place additional stress on adjacent joints, including the hip. The Veteran testified at his December 2024 Board hearing that his altered gait due to his service-connected right knee disability caused his right hip issue. The Board finds that the evidence regarding a nexus is in approximate balance; therefore, resolving reasonable doubt in favor of the Veteran, his service connection claim for a right hip disability must be granted as secondary to service-connected right knee disability. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for left hip arthritis, secondary to service-connected right knee disability The Veteran seeks service connection for left hip arthritis secondary to service-connected right knee disability. Regarding a current diagnosis, the August 2024 VA examiner diagnosed the Veteran with left hip arthritis. Regarding the element of a nexus between the Veteran's left hip arthritis and his right knee disability, the Veteran testified at his February 2018 DRO hearing that he sustained a fall due to his right knee disability and hurt his left hip. The November 2023 private medical opinion by Dr. R.M. indicated that it is more likely than not that the Veteran's left hip disability is caused by his service-connected right knee disability. He stated that in a medical article states that poor balance and abnormal gait patterns are often the cause of trochanteric pain, as additional stresses are placed on the affected side to compensate for discomfort elsewhere. Not only has abnormal gait been documented, but the Veteran has a history of falling, and use of a cane inherently shifts the weight from one side to the other. This shifting placed strain on the hip and sacroiliac joints, leading to their degeneration. The August 2024 VA examiner stated that the Veteran's left hip disability is at least as likely as not due to the Veteran's service-connected right knee disability. The examiner stated that the biomechanical changes and increased stress on the left hip due to compensatory movements can contribute to the development or worsening of osteoarthritis in that joint. The examiner indicated that osteoarthritis in the hip can be influenced by various factors, including injuries and surgeries related to other joints, such as the knee. A postoperative right medial meniscus tear can potentially contribute to the development of osteoarthritis in the left hip through several mechanisms such as altered biomechanics, increased load on the hip, impact of meniscus function and postoperative changes. The Veteran testified at his December 2024 Board hearing that his altered gait due to his service-connected right knee disability caused his left hip issue. There is no medical evidence of record indicating that the Veteran's left hip disability was not caused by his service-connected right knee, and the Court has cautioned VA against seeking a medical opinion where favorable evidence in the record is unrefuted. See Mariano v. Principi, 17 Vet. App. 305, 312 (2003). Therefore, resolving reasonable doubt in favor of the Veteran, his service connection claim for a left hip arthritis as secondary to service-connected right knee disability must be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jenna Brant Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sunshine, Ahuva 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. , his service connection claim for a left hip arthritis as secondary to service-connected right knee disability must be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jenna Brant Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sunshine, Ahuva 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.