KNEE IMPAIRMENT OF

Summary

The Veteran, an Army veteran who served from May 1988 to February 1989, appeals the denial of service connection for a left anterior cruciate ligament (ACL) rupture, status-post reconstruction. The Veteran contended the condition was due to an in-service injury or, alternatively, secondary to his service-connected right hip disability. The Board reviewed evidence including the Veteran's testimony, a March 2019 VA examination, and a July 2020 VA medical opinion, alongside a contemporaneous August 1990 hospital record. The VA examinations opined that the left knee ACL rupture was not related to the service-connected right hip disability, citing no pathophysiological stress between the conditions and noting the left knee injury occurred after service. However, the August 1990 hospital record from the surgery indicated the Veteran had multiple left knee injuries due to favoring his right leg. The Board found the evidence to be in equipoise regarding the secondary nexus between the left knee ACL rupture and the service-connected right hip disability. Applying the benefit of the doubt, the Board found service connection warranted for the left ACL rupture as secondary to the service-connected right hip disability. The appeal was granted.

Rationale

Evidence in equipoise regarding secondary nexus; Benefit of the doubt applied; Contemporaneous hospital record noted multiple left knee injuries due to favoring right leg

Full Decision Text

Citation Nr: 21003640
Decision Date: 01/22/21	Archive Date: 01/22/21

DOCKET NO. 14-27 973A
DATE: January 22, 2021

ORDER

Entitlement to service connection for left anterior cruciate ligament rupture, status-post reconstruction, is granted.

FINDING OF FACT

The Veteran’s left anterior cruciate ligament (ACL) rupture, status-post reconstruction, is proximately due to his service-connected hip disability. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for left ACL rupture, status-post reconstruction, as secondary to service-connected right hip 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 May 1988 to February 1989.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office.

The Veteran testified at an October 2017 hearing before the Board; a transcript of the hearing is associated with the record.

This matter was previously before the Board in June 2018 and October 2019.

Entitlement to service connection for left ACL rupture, status-post reconstruction

The Veteran contends that service connection is warranted for left ACL rupture, status-post reconstruction, because it is due to an in-service injury.  Alternatively, he asserts that the disability is secondary to his service-connected right hip disability.

After considering the evidence, the Board finds that the evidence is at least in equipoise regarding whether the Veteran’s left knee ACL rupture is due to his right hip disability.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  “To establish a right to compensation for a present disability, a veteran must show: ‘(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’ — the so-called ‘nexus’ requirement.”  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

To establish a right to compensation for a present disability secondary to a service-connected disability, a veteran must demonstrate the existence of (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability.  38 C.F.R. § 3.310(a); Wallin v. West, 11 Vet. App. 509 (1998).  

Some evidence weighs against a finding of service connection.  A March 2019 VA examination indicated that the left knee ACL rupture was not related to the service-connected right hip disability because “There is no nexus between those two conditions . . . . On a pathophysiological basis, right hip problems do not inherently stress the contralateral ACL.”  A July 2020 VA medical opinions found that there was no direct relationship between the Veteran’s knee disability and service because he injured his knee in January 1990, eleven months after separation from service, leading to an August 1990 left ACL reconstruction surgery.   

On the other hand, a contemporaneous record provided evidence supporting secondary service connection.  An August 1990 record at the military hospital that performed his surgery noted that 

Because of favoring his right leg, the [Veteran] has had multiple injuries to the left knee.  There was questionable injury in January 1990 skiing, gave out with severe pain and minimal swelling. He continued to ski and approximately 48 hours later there was positive pain with twisting in the second injury . . . 

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current left ACL rupture, status-post reconstruction, is proximately due to his service-connected right hip disability.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for left ACL rupture, status-post reconstruction, is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

M. H. HAWLEY
 injury in January 1990 skiing, gave out with severe pain and minimal swelling. He continued to ski and approximately 48 hours later there was positive pain with twisting in the second injury . . . 

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current left ACL rupture, status-post reconstruction, is proximately due to his service-connected right hip disability.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for left ACL rupture, status-post reconstruction, is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

M. H. HAWLEY

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	W. Ripplinger, 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.