11-01 466, 11-01 466

Veteran served 1970–1973 and 1973–1985; claim on appeal for service connection for a right knee disability (direct and secondary to service‑connected left knee disorder).
Initial RO denial (Feb 2010); Board hearings and remands in June 2014 and April 2016 for further development and medical opinions; VA obtained multiple examinations and a June 2016 addendum opinion.
Medical record: no chronic right knee condition documented at separation; sporadic in‑service complaints (1977, 1979) but no ongoing post‑service right knee complaints until 2009; bilateral knee arthritis noted in 2009; left knee partial (2009) and total (2010) replacements performed; cane use documented since 2008 and later increased complaints of right knee pain (2012 onward).
VA examiners (2010, 2015) diagnosed right knee degenerative arthritis but opined nexus to service unlikely; June 2016 addendum concluded right knee degenerative joint disease is more likely due to aging, manual labor, and obesity and not caused or aggravated by the service‑connected left knee disorder.
Board found VA complied with notice and duty‑to‑assist/remand requirements and gave significant probative weight to the June 2016 rationale; lay assertions by the Veteran were found insufficient to outweigh the medical opinion.
Holding: Claim for service connection for right knee disability (direct and secondary) denied; preponderance of evidence against nexus and no application of benefit of the doubt.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Direct service connection for right knee disability	Right knee symptoms began in service and continued thereafter; right knee arthritis is related to service	Lack of contemporaneous service evidence and medical opinions show later onset and non‑service etiology	Denied — no nexus shown; evidence weighs against service connection
Secondary service connection (right knee aggravated by service‑connected left knee)	Right knee worsened as a consequence of altered gait and left knee replacement; thus secondary to left knee disability	Medical opinion (June 2016) and records show right knee onset later and attributable to aging, work, obesity; cane use would reduce loading	Denied — June 2016 opinion persuasive; no aggravation nexus established

Stegall v. West, 11 Vet. App. 268 (1998) (Board remand requires compliance by AOJ)
McLendon v. Nicholson, 20 Vet. App. 79 (2006) (VA duty to obtain medical opinion when necessary)
Nieves‑Rodriguez v. Peake, 22 Vet. App. 295 (2008) (probative value of a medical opinion derives from its reasoning)
Monzingo v. Shinseki, 26 Vet. App. 97 (2012) (medical opinions must be read as a whole; imperfect phrasing does not automatically render opinion inadequate)
Jandreau v. Nicholson, 492 F.3d 1372 (2007) (lay evidence competency is fact‑specific)
Buchanan v. Nicholson, 451 F.3d 1331 (2006) (limitations of relying solely on absence of contemporaneous medical evidence)
Walker v. Shinseki, 708 F.3d 1331 (2013) (continuity of symptomatology limited to listed chronic diseases)
Davidson v. Shinseki, 581 F.3d 1313 (2009) (treatment of lay evidence competency for medical matters)
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir.) (nexus and service‑connection principles)
Acevedo v. Shinseki, 25 Vet. App. 286 (2012) (medical reports must be considered in context of the whole record)