OSTEOARTHRITIS

Summary

The Veteran, an Army veteran who served from November 1975 to December 1978, appeals the denial of service connection for right knee osteoarthritis claimed as secondary to his service-connected left knee disability. The agency of original jurisdiction denied the claim in September 2020. The Veteran submitted a Notice of Disagreement in September 2021, electing the Evidence Submission docket. The Board's review was limited to evidence of record at the time of the AOJ decision or submitted within 90 days of the Notice of Disagreement. The Veteran's claim is that his right knee osteoarthritis is secondary to his left knee disability, citing a February 2020 fully developed claim. The Board considered a March 2020 VA examination and a December 2021 private medical opinion. The VA examiner opined that the right knee osteoarthritis was less likely than not due to the left knee disability, finding the left knee condition insufficiently severe to cause biomechanical strain on the right. The private physician, however, found the right knee disability to be at least as likely as not the result of the left knee disability, noting the Veteran's antalgic gait due to left knee pain caused him to shift weight to his right leg. The Board found the private opinion more probative, as the VA opinion did not consider aggravation and failed to account for the Veteran's lay statements about altered gait. The Board determined the evidence was in equipoise, resolving doubt in the Veteran's favor. Service connection for right knee osteoarthritis secondary to left knee disability was granted.

Rationale

Private opinion found right knee osteoarthritis at least as likely as not secondary to left knee disability.; VA opinion did not consider aggravation or Veteran's lay statements regarding altered gait.; Evidence found to be in equipoise, with doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: A25039197
Decision Date: 04/29/25	Archive Date: 04/29/25

DOCKET NO. 210917-185591
DATE: April 29, 2025

ORDER

Entitlement to service connection for right knee osteoarthritis, to include secondary to service-connected left knee disability, is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, his right knee osteoarthritis is due to service-connected left knee disability.

CONCLUSION OF LAW

The criteria for service connection for a right knee disability as secondary to service-connected left knee disability are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from November 1975 to December 1978.

The agency of original jurisdiction (AOJ) denied service connection for a right knee disability in a September 2020 rating decision. In the September 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the September 20202 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

The Veteran contends that his right knee osteoarthritis is secondary to his left knee disability. See February 2020 fully developed claim.

Service connection may be established on a secondary basis for a disability resulting from a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability"). The but-for causation standard in a secondary service-connected case is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. See Spicer, supra

The Veteran presented for a VA examination in March 2020 for his claim. He reported that his weight bearing is predominantly on the right leg. As a result, he gets stiffness in his right leg, particularly after kneeling and squatting. The examiner opined it was less likely than not that his right knee osteoarthritis was due to his left knee disability. In rendering the opinion, the examiner noted the left knee was of insufficient severity to result in increased biomechanical strain on the right knee. Barring evidence of severe degenerative changes, recurrent surgical intervention, fracture healed in malalignment, ankylosis, amputation or other left knee pathology, the right knee disability was not proximately due to or result of the left knee disability. The examiner did not render an opinion as to aggravation.

During the evidentiary window, the Veteran submitted a December 2021 private opinion. The private physician acknowledged a review of the records. The physician noted the Veteran has been compensated for the pain in his left knee by shifting his weight to the right knee, resulting in an antalgic gait. An antalgic gait was noted to be a precipitant of degenerative arthritis. Citing to research that patients adapting such a gait place weight on other parts
 changes, recurrent surgical intervention, fracture healed in malalignment, ankylosis, amputation or other left knee pathology, the right knee disability was not proximately due to or result of the left knee disability. The examiner did not render an opinion as to aggravation.

During the evidentiary window, the Veteran submitted a December 2021 private opinion. The private physician acknowledged a review of the records. The physician noted the Veteran has been compensated for the pain in his left knee by shifting his weight to the right knee, resulting in an antalgic gait. An antalgic gait was noted to be a precipitant of degenerative arthritis. Citing to research that patients adapting such a gait place weight on other parts of the body that were not created to absorb the alteration and the Veteran's lack of evidence for a right knee injury, the right knee disability was at least as likely as not the result of his left knee disability. 

In this instance, the Board places more probative weight in the December 2021 private opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The March 2020 VA opinion did not consider whether the right knee disability was aggravated by the left knee disability. Furthermore, the opinion took into consideration the severity of a left knee disability and its effects on the right knee, but did not consider the Veteran's lay statements that he placed more weight on his right knee to compensate for pain. As noted in the December 2021 private opinion, every individual's pain from arthritis is different. While the Veteran's left knee disability may not have been so severe as to cause the right knee disability, the pain itself, as demonstrated by the Veteran's lay statements, was enough to alter his gait and place more weight on his right knee to alleviate the pain. 

The Board has considered remand to obtain an opinion as to secondary aggravation, but notes that remanding for such an opinion would well be interpreted as a prohibited action to develop negative evidence with the single intention of denying this service connection claim. 38 C.F.R. § 3.304 (c); Andrews v. McDonough, 34 Vet. App. 216, 225 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim").

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current right knee osteoarthritis is due to or aggravated by the service-connected left knee arthritis. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for right knee osteoarthritis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jarman, Timothy

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.