Citation Nr: 18124030
Decision Date: 08/03/18	Archive Date: 08/03/18

DOCKET NO. 15-29 048
DATE:	August 3, 2018
ORDER
Entitlement to service connection for a right knee disorder is denied.
Entitlement to service connection for an acquired psychiatric disorder, to include major depression and generalized anxiety disorder, is denied.
FINDINGS OF FACT
1. The preponderance of the competent and credible evidence indicates that the Veteran’s right knee disorder did not manifest within one year of separation from active service and is not otherwise etiologically related to service.
2. The preponderance of the competent and credible evidence indicates that the Veteran’s right knee disorder was not caused by or aggravated by her service-connected left knee disability.
3. The preponderance of the competent and credible evidence indicates that the Veteran’s acquired psychiatric disorder, to include major depression and generalized anxiety disorder was not caused by or aggravated by her service-connected left knee disability; and is not otherwise etiologically related to service.
CONCLUSIONS OF LAW
1. The criteria for service connection for a right knee disorder have not been met.  38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 
2. The criteria for service connection for an acquired psychiatric disorder, to include major depression and generalized anxiety disorder, have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
In her August 2015 substantive appeal, the Veteran limited the issues on appeal to service connection for right knee and anxiety/depression.  See August 2015 VA Form 9.  The issues on appeal are reflected on the title page accordingly.  
The Board notes that the Veteran’s claim for service connection for depression has been broadened to entitlement to service connection for an acquired psychiatric disorder, to include major depression and generalized anxiety disorder.  Clemons v. Shinseki, 23 Vet. App. 1 (2009).
Service Connection
A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service.  38 U.S.C. §§ 1110, 1131.
Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).
Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service.  38 C.F.R. § 3.303(d).  
Certain diseases, to include arthritis, may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty.  38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. 
Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden elements for certain chronic disabilities such as arthritis is through a demonstration of continuity of symptomatology.
Under section 3.310(a) of VA regulations, 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.  38 C.F.R. § 3.310(a).  Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability.  See Wallin v. West, 11 Vet. App. 509, 512 (1988).  As to the third Wallin element, the current disability may be 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).  
1. Right knee
The Veteran filed a September 2012 claim for service connection for a right knee condition as secondary to service-connected left knee degenerative joint disease (DJD).  See September 2012 VA 21-526b Veteran’s Supplemental Claim.  She contends that her right knee condition is a secondary deterioration of her service-connected left knee disability.  See August 2015 VA Form 9.  
The first and second Wallin elements are met and not in dispute.  The Veteran has a diagnosis of right knee DJD.  See July 2013 VA examination report.  Further, the Veteran is service-connected for left knee DJD.  See March 2018 rating code sheet.   
As such, the crux of this case centers on whether there is an etiological relationship between the Veteran’s right knee condition and her service-connected left knee disability.  The July 2013 VA examiner opined that the Veteran’s right knee condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected left knee disability.  The examiner stated that the Veteran did not complain of right knee pain until after the cerebrovascular accident (CVA) in 2010 that affected the right side of her body.  The examiner determined that it is less likely than not that the right knee pain is related to the left knee pain, but more likely than not related to the CVA.
Further, the Board notes that the evidence of record does not support the Veteran’s right knee DJD was diagnosed or treated within one year of service and the Veteran did not report that she had ongoing right knee issues immediately following service.  Therefore, there is no basis for the Board to conclude that the Veteran’s right knee DJD manifested to a compensable degree within one year of her discharge from active duty service in February 1999, so as to warrant service connection pursuant to 38 C.F.R. §§  3.307, 3.309.  Likewise, as the Veteran has not asserted right knee issues immediately following service, the Board concludes that the weight of the evidence is against a finding of any continuity of symptomatology since service. 
Regarding service connection on a direct basis, the Board notes that the evidence of record does not support, and the Veteran has not asserted, that her right knee condition is directly related to her service. 
Significantly, the only medical opinion addressing the etiology of the claimed right knee disability weighs against the claim.  Therefore, the Board finds that entitlement to service connection for a right knee disorder is not warranted on a direct or secondary basis.  As the preponderance of evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied.  38 U.S.C. § 5107(b).
2. Acquired psychiatric disorder, to include major depression and generalized anxiety disorder
The Veteran filed a December 2012 claim for service connection for depression as secondary to constant pain.  See December 2012 Correspondence.  
The first and second Wallin elements are met and not in dispute.  The Veteran has current diagnoses of generalized anxiety disorder and major depression.  See August 2013 VA examination report.  Further, the Veteran is service-connected for left knee DJD.  See March 2018 rating code sheet.   
Thus, the crux of this case centers on whether there is an etiological relationship between the Veteran’s acquired psychiatric disorder, to include major depression and generalized anxiety disorder and her service-connected left knee disability.  The August 2013 VA examiner opined that the Veteran’s psychiatric condition is less likely than not (less than 50 percent probability) due to or the result of the Veteran’s service-connected left knee disability.  The examiner stated that the Veteran reported an onset of depression in 1997 following a hysterectomy and described feeling her best while in boot camp in 1998.  The examiner indicated that based upon the Veteran’s reports, her depressive symptoms resolved until 2006 when she returned to North Carolina as her daughter entered active duty.  The examiner stated that this episode of depression was triggered by the stress of her daughter being deployed in a combat zone along with caring for her grandchildren.  The examiner stated that treatment records showed a diagnosis of Insomnia in 2007 which could be considered a symptom of depression and also showed a diagnosis of depression beginning in November 2009.  The examiner indicated that her anxiety symptoms had an onset in May 2013.  The examiner stated that the Veteran did not cite knee pain as causing her depression.  The examiner determined that the Veteran’s reported chronology of events/symptoms and review of medical records does not provide any link between her knee pain and her depression.
Regarding service connection on a direct basis, the Board notes that evidence of record does not suggest, and the Veteran has not asserted, that her psychiatric condition is directly related to service.  Significantly, the Veteran has attributed her anxiety and depression symptoms to her husband passing away and factors unrelated to service.  See August 2015 VA Form 9.  
As the only medical opinion addressing the etiology of the Veteran’s psychiatric condition weighs against the claim, the Board finds that entitlement to service connection for an acquired psychiatric disorder, to include major depression and generalized anxiety disorder, is not warranted on a direct or secondary basis.  The preponderance of evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim is denied.  38 U.S.C. § 5107(b).
 
DONNIE R. HACHEY
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S. Schick, Associate Counsel 

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