HIP IMPAIRMENT OF

MICHAEL MARTIN · 2025 · Case ID: 25010527

DENIED

Summary

The veteran, who served in the Navy from May 1967 to February 1971, appeals the denial of service connection for bilateral hip conditions and bilateral knee conditions, claimed as secondary to his service-connected right ankle, lower back, and bilateral lower extremity radiculopathy. The case has a lengthy procedural history involving multiple remands due to inadequate VA examinations. The Board reviewed extensive medical evidence, including private opinions from Dr. A.U. and VA examinations from March and April 2025. The Board found that the Veteran's service treatment records were silent regarding any hip or knee injuries during service. While private providers noted knee issues and Dr. A.U. provided nexus opinions for the ankle and lumbar spine, his opinions regarding the knees were considered vague and unsupported by the Board. The April 2025 VA examination diagnosed bilateral hip and knee osteoarthritis, but opined it was less likely than not related to service or secondary to the Veteran's service-connected conditions, citing a lack of direct pathophysiology and no evidence of in-service hip or knee injury. The Board found the VA examiner's rationale adequate and persuasive. The Veteran's lay statements attributing his hip and knee pain to his service injury were considered, but the Board found that determining the etiology of these conditions falls outside the realm of common knowledge for a layperson. The Board concluded that the evidence persuasively weighed against the Veteran's claims, and therefore, service connection for the bilateral hip and knee conditions was denied. The benefit of the doubt doctrine was considered but found not applicable.

Rationale

No in-service hip injury or treatment documented.; Post-service records silent on hip conditions until ~50 years after service.; VA examiner opined less likely than not related to service or secondary conditions due to lack of direct pathophysiology.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-37 324

Full Decision Text

Citation Nr: 25010527
Decision Date: 08/14/25 Archive Date: 08/14/25

DOCKET NO. 16-37 324
DATE: August 14, 2025

ORDER

Service connection for a left hip condition, to include as secondary to a right ankle disability, lower back disability, and bilateral lower extremity radiculopathy, is denied.

Service connection for a right hip condition, to include as secondary to a right ankle disability, lower back disability, and bilateral lower extremity radiculopathy, is denied.

Service connection for a left knee strain to include as secondary to a right ankle disability, lower back disability, and bilateral lower extremity radiculopathy, is denied.

Service connection for a right knee strain, to include as secondary to a right ankle disability, lower back disability, and bilateral lower extremity radiculopathy, is denied.

FINDINGS OF FACT

1. The Veteran's left hip condition is not secondary to his service-connected right ankle, lower back, or bilateral lower extremity radiculopathy, and is not otherwise related to an in-service injury or disease.

2. The Veteran's right hip condition is not secondary to his service-connected right ankle, lower back, or bilateral lower extremity radiculopathy, and is not otherwise related to an in-service injury or disease

3. The Veteran's left knee condition is not secondary to his service-connected right ankle, lower back, or bilateral lower extremity radiculopathy, and is not otherwise related to an in-service injury or disease.

4. The Veteran's right knee condition is not secondary to his service-connected right ankle, lower back, or bilateral lower extremity radiculopathy, and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left hip condition due to right ankle, lower back, or bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for a right hip condition due to right ankle, lower back, or bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a left knee strain due to right ankle, lower back, or bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for a right knee strain due to right ankle, lower back, or bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1967 to February 1971.

On appeal is a July 2014 rating decision that, as relevant here, denied service

connection for a left hip condition, right hip condition, left knee strain, and right knee strain, all of which were claimed, at that time, as secondary to the Veteran's right ankle disability.

When the matter was initially before the Board of Veterans' Appeals (Board) in

July 2019, the Board remanded for additional development to include obtaining outstanding VA treatment records.

When the matter returned to the Board in June 2021, the Board denied service

connection, as relevant here, for a bilateral hip condition as secondary to a right ankle, and a bilateral knee strain as secondary to a right ankle disability. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court).

In March 2023, the Court issued a Memorandum Decision that set aside the

Board's June 2021 decision, finding the Board erred when it relied on inadequate VA examinations of the right ankle (the primary disability for which the Veteran now claims his left hip condition, right hip condition, left knee strain, and right knee strain, are secondary to). In addition the Court found the January 2020 VA knee examination to be inadequate. As such, the bilateral knee and hip claims were remanded as inextricably intertwined with the right ankle claim.

In July 2023 the Board remanded the issues, consistent with the Court's

Memorandum Decision. New examinations
of Appeals for Veterans Claims (Court).

In March 2023, the Court issued a Memorandum Decision that set aside the

In July 2023 the Board remanded the issues, consistent with the Court's

Memorandum Decision. New examinations/medical opinions were to be obtained before the Board can properly adjudicate the claims.

When the matter returned to the Board in May 2024, the Board again remanded for further development, with specific remand directives. The Board found that although new VA examinations/medical opinions were obtained in March 2024 as requested, the examiner: (1) failed to address and consider the Veteran's lay statements, and (2) failed to address the statement from Dr A.U in the September 2023 Certificate of Disability that was associated with the Veteran's claims file in October 2023.

In a separate but related matter, in June 2024, the Agency of Original Jurisdiction (AOJ) issued a rating decision that granted service connection for a lower back disability as well as bilateral lower extremity.

When the matter returned to the Board in February 2025, the Board: (1) granted service connection for a right ankle disability; (2) recharacterized the bilateral hip and bilateral knee service connection claims as "secondary to right ankle disability, lower back disability, and bilateral lower extremity radiculopathy;" and, (3) remanded the bilateral hip and bilateral knee claims for additional development, finding the June 2024 VA medical examinations were inadequate as the examiner had [mistakenly] determined that "a medical opinion regarding secondary service connection or aggravation is not applicable."

The requested development has been completed, and the matter has now returned to the Board for further adjudication.

Duty to Notify and Assist

The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board").

The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. Also of record are VA examinations/medical opinions conducted in March 2025 and April 2025.

The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002).

Service Connection

To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

Service connection may also be granted on a secondary basis, for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

1. Entitlement to service connection for a left hip condition as secondary to right ankle disability, lower back disability, and bilateral lower extremity radiculopathy.

2. Entitlement to service connection for a right hip condition as secondary to
to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

1. Entitlement to service connection for a left hip condition as secondary to right ankle disability, lower back disability, and bilateral lower extremity radiculopathy.

2. Entitlement to service connection for a right hip condition as secondary to right ankle disability, lower back disability, and bilateral lower extremity radiculopathy.

The Veteran seeks service connection for a left hip condition and a right hip condition, which he claims is due to service or alternatively, is secondary to his service-connected right ankle disability, lower back disability, and bilateral lower extremity radiculopathy.

The Veteran's service treatment records are associated with his claims file. These records are silent for any complaint, diagnosis, or treatment of a left or right hip condition. With regards to the in-service injury, the Veteran did not report any

pain in either hip at the time of his July 1970 incident involving a fall from the wing of an airplane.

Post-service VA treatment records from the Orlando VAMC are associated with the Veteran's claims file. These records are silent for any complaint, diagnosis, or treatment of a left or right hip condition.

In an August 2019 letter from a private physician, Dr. A. U., the doctor stated the Veteran "has a history of service related injury to his right ankle along with both knees and his low back. He was in the Navy from 1969-1971 and fell off the wing of a plane." The doctor noted "facet loading, tenderness of the knee with mild valgus deformity [and] soft tissue swelling of the right ankle". Medical Treatment Record - Non-Government Facility, November 2019) There was no reference to a left or right hip condition.

In a September 2023 Certificate of Disability, Dr. A.U. stated the Veteran is under his care due to multiple issues including but not limited to ankle, knee and severe low back pain. He was a member of the US Navy from 1969-1971 at which time he had a traumatic incident where he fell from the wing of a plane resulting in severe damage to his right ankle. As such, he has chronic ankle pains and this has over time resulted in an abnormal gait which has detrimentally affected his lumbar spine. He has severe loss of disc height, severe facet arthropathy and modic changes at multiple levels in his lumbar spine, and this is directly related to his ankle injury. Again, there was no reference to a left or right hip condition.

In a June 2024 letter, Dr. A.U. stated, "I had the pleasure of caring for the Veteran on 5-24-2024, and my physical exam findings suggest that he is suffering from lumbar facet arthropathy; lumbosacral facet joint syndrome; lumbar facet joint pain; arthropathy of lumbosacral facet joint; facet arthritis of lumbar region; vertebrogenic low back pain; vertebrogenic pain syndrome; and, lumbar spondylosis. 2023 MRI lumbar spine reviewed and it shows severe DDD [degenerative disc disease] at 13-4, L4-5, no stenosis multi level facet hypertrophy and lumbar spondylosis with mixed MODIC type I and type II changes at L3-4, L4-5 level." There was no reference to a left or right hip condition.

As it relates to VA examinations and medical opinions on this issue, there are several VA examinations/medical opinions of record. As detailed above, this case has a long procedural history. However, all of the VA examinations and medical opinions obtained prior to the February 2025 Board Remand have been deemed inadequate by either the Board or the Court. As such, the Board notes that in its very last Remand, dated in February
at 13-4, L4-5, no stenosis multi level facet hypertrophy and lumbar spondylosis with mixed MODIC type I and type II changes at L3-4, L4-5 level." There was no reference to a left or right hip condition.

As it relates to VA examinations and medical opinions on this issue, there are several VA examinations/medical opinions of record. As detailed above, this case has a long procedural history. However, all of the VA examinations and medical opinions obtained prior to the February 2025 Board Remand have been deemed inadequate by either the Board or the Court. As such, the Board notes that in its very last Remand, dated in February 2025, new VA examinations/medical opinions were to be obtained. Specific directives were given - the examiner must address and consider the Veteran's lay statements as well as Dr. A.U.'s opinion(s).

In April 2025, a new VA examination/medical opinion was obtained. The examiner noted the Veteran reported he began to experience bilateral hip pain which has progressively worsened over the past 20 years. He attributed his hip pain to be associated with and aggravated by his right ankle condition, as well as his lumbar spine condition. He denied having had surgery but reported he has had lumbar spine pain which extends or radiates to the hips since his military service, but his doctors mainly focused treatment on the DDD [degenerative disc disease] of the lumbar spine with medications, muscle relaxants and procedures such as epidurals and nerve ablation procedures. He stated his lumbar spine pain responds better to the procedures than his hips, and thus the focus has been on identifying individual hip pain being separate from lumbar spine related pain. The examiner diagnosed the Veteran with bilateral hip strain. As it relates to direct service connection, the examiner opined it is less likely than not that the currently diagnosed bilateral hip condition incurred in or was caused by the service as there is no medical record evidence in the attached/reviewed medical records indicative of a hip injury or treatment for hip pain for the claimant while he was in the military due to military duties, nor is there any documentation of hip pain which was chronic, recurrent or affected function in the medical records in terms of follow up or post military until present. Also, nothing was noted in the Veteran's ETS [exit] examination to support the claim. As to secondary service connection, the examiner opined that the claimed condition diagnosed as left/right hip strain is less likely than not proximately due to or the result of the following: (1) right ankle strain; (2) intervertebral disc syndrome; (3) lumbar facet arthropathy, lumbosacral facet joint syndrome, facet arthritis of lumbar region, vertebrogenic pain syndrome, lumbar spondylolysis, and degenerative arthritis; (3) left lower extremity radiculopathy; and (4) right lower extremity radiculopathy. As rationale, the examiner stated there is no direct pathophysiology between the two isolated conditions to support a connection, nor is there is no direct pathology or supportive medical record evidence provided by a specialist to relate the two unrelated conditions. The Veteran's hip strain is directly related to the musculature of the hip as radiographic evidence is negative for degenerative changes or post traumatic changes and thus independent of secondary causes. As for aggravation, the examiner opined that the claimed left/right hip condition was less likely than not aggravated beyond its natural progression by the Veteran's service connected conditions. As rationale, the examiner stated there is no evidence of hip pain during the Veteran's military medical career and there are no post traumatic changes of ligament instabilities which would support aggravation.

In May 2025, an Addendum medical opinion was rendered. The examiner addressed direct service connection, stating the following: Review of the available records document the Veteran carries the diagnosis of bilateral hip strain per March 2024 Hip DBQ [Disability Benefits Questionnaire]. Review of the available records document the Veteran fell from the wing of a plane in July 1970 and injured his right ankle. The service treatment records document this and noted the soldier had right ankle pain. The service treatment records document that the Veteran had an x-ray of the right ankle that indicated no fracture at the time of injury. The encounter establishes the Veteran had a painful right ankle after he fell from the wing of a plane in July 1970. There is no report in the service treatment records of a hip injury or hip pain before, at the time of, or after this 1970 injury. The Veteran was in active duty for an additional six and a half months. The Veteran's separation examination in January1971 does not report any chronic hip condition or pain. Review of available records post service report complaint of right ankle pain
0 and injured his right ankle. The service treatment records document this and noted the soldier had right ankle pain. The service treatment records document that the Veteran had an x-ray of the right ankle that indicated no fracture at the time of injury. The encounter establishes the Veteran had a painful right ankle after he fell from the wing of a plane in July 1970. There is no report in the service treatment records of a hip injury or hip pain before, at the time of, or after this 1970 injury. The Veteran was in active duty for an additional six and a half months. The Veteran's separation examination in January1971 does not report any chronic hip condition or pain. Review of available records post service report complaint of right ankle pain in 2013 when the Veteran sought treatment with a private provider. Private provider notes in May 2013 report the Veteran has a history of injury to his right ankle, both knees, and low back when he fell off wing of plane during service. The private provider did not report an injury to hips during service nor that the Veteran had hip pain at the encounter in 2013. The examiner in May 2013 did not diagnose a hip condition. The Veteran continued treatment at the VA. During a December 2014 and December 2015 VA encounter, the Veteran had normal gait without any complaints of hip pain. The Veteran had a history and physical examination in December 2016 in which the examiner reported "Ambulates with ease up and down from exam table without assistance, sits through exam comfortably, normal gait." No hip pain was reported at the December 2016 encounter. A January 2018 VA primary care visit reports the Veteran had back pain and also reports there is no balance or gait problem but does not report hip pain. A January 2019 VA primary care encounter reports the Veteran has pain in knees, ankles and lumbar spine, and that he also has a "normal gait." A January 2020 VA primary care encounter recorded: "limited ROM [range of motion] to lumbar spine secondary to pain; pain with palpation facet and paraspinal region; positive leg raise and slump test bilaterally; bilateral knees without edema; right ankle no edema, no pain with palpation; negative exam for knees and right ankle; strength 5/5; and normal gait. Again, there are no objective findings of right and/or left hip pain or hip condition. The 2024 hip DBQ diagnosis of bilateral hip strain is likely due to and consistent with aging. It is not consistent with an injury over 50 years prior.

In this May 2025 Addendum medical opinion, the examiner also addressed Dr. A.U.'s September 2023 Certificate of Disability, stating the following: The certificate reported the Veteran fell from a plane wing in service resulting in severe damage to right ankle. The provider also reported in this certificate that the Veteran reports chronic pain in the right ankle which has resulted in a gait abnormality that results in a severe lumbar condition "that is directly related to the right ankle injury" and the Veteran is unable to work. The private provider did not report a bilateral hip condition in his 2023 certificate of disability. The private provider also reported in a letter dated in August 2019 that the Veteran has service related knee, right ankle, and low back conditions. Again, there is no report of chronic hip pain or diagnosis. The Veteran also followed up in April 2024 with a statement of support recounting his fall from the plane in 1970. The Veteran claims he sought treatment and was told he would have pain, that he had no fracture, and that he was put on light duty. The Veteran reported in his statement that his right ankle continues to hurt and has led to an altered gait that has resulted in hip, knee, and back pain. Review of available records does not supply objective evidence of any right and/or left hip condition due to active duty. The Veteran's report of right and/or left hip pain should be credible based upon what he felt. However, pain is subjective and not diagnostic. The Veteran's report that his hip pain and/or hip condition is due to his fall in service and has resulted in a chronic right and/or left hip pain or condition today is not credible. Such an assignment would require a medical background with diagnostic scope and thorough review of claims file and the chronology of medical records. This Veteran does not have that background. The examiner concluded by stating based upon the available records, to include the lay reports and Veteran's statements, the Veteran's right and/or left hip pain (diagnosed as right and left hip strain) is less likely than not incurred in or caused by the military service, including duties performed during service.

The Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no credible evidence that may serve
hip pain and/or hip condition is due to his fall in service and has resulted in a chronic right and/or left hip pain or condition today is not credible. Such an assignment would require a medical background with diagnostic scope and thorough review of claims file and the chronology of medical records. This Veteran does not have that background. The examiner concluded by stating based upon the available records, to include the lay reports and Veteran's statements, the Veteran's right and/or left hip pain (diagnosed as right and left hip strain) is less likely than not incurred in or caused by the military service, including duties performed during service.

The Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no credible evidence that may serve as a medical nexus between the Veteran's claimed left hip condition or right hip condition and his service or his service-connected right ankle, lower back, or bilateral lower extremity radiculopathy.

First, the Board notes that the Veteran has a current diagnosis of bilateral hip strain. However, this disability was not shown in service and did not manifest to a compensable degree within a presumptive period. Post-service treatment records show the Veteran was not diagnosed with bilateral hip strain until approximately 50 years after his separation from service. Thus, service connection on a direct basis is not warranted here.

Next, the Board notes that none of the Veteran's treatment providers have attributed his bilateral hip condition to his military service nor to his service connected disabilities. The April 2025 VA medical opinion that the Veteran's bilateral hip condition was less likely than not related to his service or his service-connected disabilities was supported by an adequate and detailed rationale that addressed all of the Board's prior Remand directives. Thus, service connection on a secondary basis is not warranted here.

Evidence in favor of the Veteran's claim includes his own statements, concerning his belief that his bilateral hip condition, diagnosed over 50 years after service, is due to service. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report symptoms of hip pain, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id.; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The claim for service connection for a bilateral hip condition is denied. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; the weight of the evidence is persuasively against the Veteran's claim, and the doctrine is not applicable. 38 U.S.C. §5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021)

3. Entitlement to service connection for a left knee strain as secondary to right ankle disability, lower back disability, and bilateral lower extremity radiculopathy.

4. Entitlement to service connection for a right knee strain as secondary to right ankle disability, lower back disability, and bilateral lower extremity radiculopathy.

The Veteran seeks service connection for a left knee condition and a right knee condition, which he claims is due to service or alternatively, is secondary to his service-connected right ankle disability, lower back disability, and bilateral lower extremity radiculopathy.

The Veteran's service treatment records are associated with his claims file. These records are silent for any complaint, diagnosis, or treatment of a left or right knee condition. With regards to the in-service injury, the Veteran did not report any pain in either knee at the time of his July 1970 incident involving a fall from the wing of an airplane.

Post-service VA treatment records from the Orlando VAMC are associated with the Veteran's claims file. In summary, these records reflect complaints, diagnosis, and treatment for bilateral knee pain. For example, a December 2014 record reflects chronic pain to knees; a June 2021 record reflects a complaint of pain in knees; and, a January 2024 record reflects the issuance of knee braces.

Post-service private treatment records are associated with the Veteran's claims file. In a May 2013 letter from a private provider at Henry Ford Health System, it states the Veteran has a history of service-related injury to his right ankle along with both knees and lower back. He was in the Navy and fell off the wing of a plane. On examination, the provider noted that the Veteran had tend
are associated with the Veteran's claims file. In summary, these records reflect complaints, diagnosis, and treatment for bilateral knee pain. For example, a December 2014 record reflects chronic pain to knees; a June 2021 record reflects a complaint of pain in knees; and, a January 2024 record reflects the issuance of knee braces.

Post-service private treatment records are associated with the Veteran's claims file. In a May 2013 letter from a private provider at Henry Ford Health System, it states the Veteran has a history of service-related injury to his right ankle along with both knees and lower back. He was in the Navy and fell off the wing of a plane. On examination, the provider noted that the Veteran had tenderness of the knees with mild valgus deformity. (Medical Treatment Record - Non-Government Facility, December 05, 2013)

In an August 2019 letter from a private physician, Dr. A. U., the doctor stated the Veteran "has a history of service related injury to his right ankle along with both knees and his low back. He was in the Navy from 1969-1971 and fell off the wing of a plane." The doctor noted "facet loading, tenderness of the knee with mild valgus deformity [and] soft tissue swelling of the right ankle". (Medical Treatment Record - Non-Government Facility, November 2019).

The Board finds these vague references to the source of the Veteran's knee complaints to be inconclusive and insufficient to establish a medical nexus. Dr. A.U. provided clear statements on nexus for the Veteran's right ankle and lumbar spine. The private medical opinions document the knee disability but do not provide sufficient evidence for a medical nexus on either direct or secondary service connection for the knee disabilities.

In a September 2023 Certificate of Disability, Dr. A.U. stated the Veteran is under his care currently and has previously been under his care due to multiple issues including but not limited to ankle, knee and severe low back pain. He was a member of the US Navy from 1969-1971 at which time he had a traumatic incident where he fell from the wing of a plane resulting in severe damage to his right ankle. As such, he has chronic ankle pains and this has over time resulted in an abnormal gait which has detrimentally affected his lumbar spine. He has severe loss of disc height, severe facet arthropathy and modic changes at multiple levels in his lumbar spine, and this is directly related to his ankle injury. The Board finds there was no nexus opinion provided for the knees.

As it relates to VA examinations and medical opinions on this issue, there are several VA examinations/medical opinions of record. As detailed above, this case has a long procedural history. However, all of the VA examinations and medical opinions obtained prior to the February 2025 Board Remand have been deemed inadequate by either the Board or the Court. As such, the Board notes that in its very last Remand, dated in February 2025, a new VA examination/medical opinion was to be obtained. Specific directives were given - the examiner must address and consider the Veteran's lay statements as well as Dr. A.U.'s opinion(s).

In April 2025, a new VA examination/medical opinion was obtained. The examiner noted the Veteran reported that at age 21, he fell off of a plane injuring his back and right ankle. He denied having any injury or trauma but reports gradual onset of pain with routine military duties. No treatment was sought during the military. The symptoms have progressed over the years and the Veteran reports that he has sought medical attention and has been prescribed multiple NSAIDS. Current symptoms include knee pain with stiffness. The examiner diagnosed the Veteran with knee joint osteoarthritis in both the left and right knee.

As it relates to direct service connection, the examiner opined
the Veteran's lay statements as well as Dr. A.U.'s opinion(s).

As it relates to direct service connection, the examiner opined that it is less likely than not that the current diagnosed bilateral knee condition incurred in or was caused by the Veteran's service. As rationale, the examiner stated there is no medical record evidence in the attached/ reviewed medical records indicative of a knee injury which was noted to be recurrent or had residual sequela with limitations. Nor is there any documentation [of] joint pain which was chronic, recurrent or affected function in the medical records in terms of follow up or post military until present. Also, nothing was noted in the Veteran's ETS [exit] examination to support the claim.

As it relates to secondary service connection, the examiner opined that it is less likely than not the left knee condition/right knee condition is due to: (1) right ankle strain; (2) intervertebral disc syndrome, lumbar facet arthropathy, lumbosacral facet joint syndrome, facet arthritis of lumbar region, vertebral-genic pain syndrome, lumbar spondylolysis, and degenerative arthritis; (3) left lower extremity radiculopathy; and (4) right lower extremity radiculopathy. As rationale, the examiner stated, "there is no direct pathophysiology between the two isolated conditions to support a connection, nor is there is no direct pathology or supportive medical record evidence provided by a specialist to relate the two unrelated conditions."

As it relates to aggravation, the examiner opined it is less likely than not that the current diagnosed left knee condition/right knee condition was aggravated beyond its normal aging process. As rationale, the examiner stated there are no medical record evidence in the attached/ reviewed medical records indicative of a knee injury which was noted to be recurrent or had residual sequela with limitations, nor is there any documentation [of] joint pain which was chronic, recurrent or affected function in the medical records in terms of follow up or post military until present. The mild osteoarthritis noted on x-ray is reflective of normal aging and is less significant than the typical findings noted in someone of this Veteran's age.

In May 2025, an Addendum medical opinion was rendered. The examiner addressed Dr. A.U.'s September 2023 Certificate of Disability.: The examiner concluded by stating based upon the available records, to include the lay reports and Veteran's statements, the Veteran's bilateral knee disabilities are less likely than not incurred in or caused by the military service, including duties performed during service. The examiner also concluded that the bilateral knee disabilities were not secondary service connected.

The Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no credible evidence that may serve as a medical nexus between the Veteran's claimed left knee condition or right knee condition and his service or his service-connected right ankle, lower back, or bilateral lower extremity radiculopathy.

First, the Board notes that the Veteran has a current diagnosis of bilateral knee osteoarthritis. However, this disability was not shown in service and did not manifest to a compensable degree within a presumptive period. Post-service treatment records show the Veteran began to complain of bilateral knee pain approximately 40 years after his separation from service. Thus, service connection on a direct basis is not warranted here.

Next, the Board notes that none of the Veteran's treatment providers have attributed his bilateral knee condition to his military service. Moreover, the April 2025 VA medical opinion that the Veteran's bilateral knee condition was less likely than not related to his service or his service-connected disabilities was supported by an adequate and detailed rationale that addressed all of the Board's prior Remand directives. Thus, service connection on a secondary basis is not warranted here.

In this case, the evidence in favor of the Veteran's claim includes his own statements, concerning his belief that his bilateral knee condition, diagnosed over 40 years after service, is due to service. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay
than not related to his service or his service-connected disabilities was supported by an adequate and detailed rationale that addressed all of the Board's prior Remand directives. Thus, service connection on a secondary basis is not warranted here.

In this case, the evidence in favor of the Veteran's claim includes his own statements, concerning his belief that his bilateral knee condition, diagnosed over 40 years after service, is due to service. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report symptoms of knee pain, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id.; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The Board finds the statements by the VA examiners which determined there was no medical nexus either on a direct or secondary basis as well reasoned and supported by the evidence. Dr. A.U.'s statements on service connection for the Veteran's ankle and lumbar spine disabilities were well reasoned and resulted in a grant of service connection for both of those disabilities. In contrast, Dr. A.U.'s statements on the bilateral knee conditions are vague and unsupported.

Based on the evidence of record, the Board concludes that the Veteran's bilateral knee conditions are not service connected either through a theory of direct or secondary service connection. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; the weight of the evidence is persuasively against the Veteran's claim, and the doctrine is not applicable. 38 U.S.C. §5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The claim for service connection for a left knee condition and a right knee condition is denied.

Martin T. Mitchell

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bess, T.

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.

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