KNEE IMPAIRMENT OF

Summary

The veteran, who served from January 1995 to January 1999, appeals the denial of service connection for bilateral knee disorders. The veteran claimed direct service connection for the knee conditions, alleging they were due to service or alternatively secondary to a service-connected left ankle disability. The Board acknowledged current diagnoses of knee disorders, including cartilage contusion, chondromalacia patella, knee strain, and degenerative arthritis, and noted in-service complaints of mild right knee pain and right LCL pain. However, the Board found the medical evidence weighed against service connection. Multiple VA examinations concluded that the bilateral knee disorders were less likely than not related to service, attributing them to age-dependent wear and tear, obesity, and post-service injuries like a fall in 2011. While a private physician opined a link between the knee arthropathy and an in-service fall, the Board found this opinion conclusory and lacking a detailed rationale, especially concerning the post-service injury and obesity. The Board also found the evidence did not support presumptive service connection due to lack of chronicity in service or within one year of separation, and the post-service medical records did not reflect ongoing knee complaints since service. The Board afforded greater weight to the VA examiners' opinions due to their thorough rationale. Service connection for both right and left knee disorders was denied.

Rationale

Lack of chronicity in service or post-service; VA opinions found less likely than not related to service; Private opinion found conclusory and lacking rationale

Full Decision Text

Citation Nr: 25014186
Decision Date: 11/20/25	Archive Date: 11/20/25

DOCKET NO. 18-05 522
DATE: November 20, 2025

ORDER

Service connection for right knee disorder is denied. 

Service connection for left knee disorder is denied. 

FINDINGS OF FACT

1. The Veteran served on active duty from January 1995 to January 1999. 

2. A bilateral knee disorder was not shown in service, not continuous since service, not shown to a compensable degree within one year of separation from service, not shown for many years after service, and is not causally or etiologically related to service or caused by or worsened in severity by a service-connected disability.

CONCLUSIONS OF LAW

1. A right knee disorder was not incurred in service, is not presumed to have been incurred in service, and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1101, 1110, 1112, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2025).

2. A left knee disorder was not incurred in service, is not presumed to have been incurred in service, and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1101, 1110, 1112, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3. 310 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2021. A transcript of the hearing has been associated with the claims file. In March 2022, the Board denied the appeals. The Veteran appealed to the Veterans Claims Court. 

In December 2022, the Court Clerk granted a joint motion for partial remand (JMPR), vacating and remanding the claims to the Board for readjudication. In March 2023, the Board remanded the issues for additional development. In June 2025, the Board the issues a second time. The case has now been returned to the Board for further appellate action.

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

The Veteran contends that the bilateral knee disorders were due to service or alternatively secondary to a service-connected left ankle disability.

As to the first element of service connection, current diagnoses have been shown. Specifically, a March 2011 MRI reflected left knee cartilage contusion versus chondrom
) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

The Veteran contends that the bilateral knee disorders were due to service or alternatively secondary to a service-connected left ankle disability.

As to the first element of service connection, current diagnoses have been shown. Specifically, a March 2011 MRI reflected left knee cartilage contusion versus chondromalacia patella. Further, bilateral knee strain and bilateral degenerative arthritis were diagnosed at the June 2014 VA examination. Additionally, an April 2019 imaging study showed right knee mild narrowing of the medial joint compartment and left knee mild narrowing of the lateral joint compartment. 

Next, a June 2019 MRI showed left knee medial meniscus tear. Further, a left knee meniscal tear and bilateral degenerative arthritis were diagnosed at the June 2024 VA examination. Finally, bilateral degenerative arthritis, other than post traumatic, was diagnosed at the September 2025 VA examination. Therefore, the first element of service connection is met.

As to in-service incurrence, the service treatment records (STRs) reflect complaints of mild right knee pain that was resolving in February 1996. In January 1998, the Veteran complained of right lateral collateral ligament (LCL) pain for one month and pain when running. The diagnosis was right iliotibial band syndrome (ITBS). In September 1998, he noted right knee pain for one and half weeks.

On a November 1998 Report of Medical History at separation, the Veteran reported swollen or painful joints but denied "trick" or lock knees. The November 1998 separation examination noted a history of right knee injury, currently asymptomatic. He indicated that he had "multiple injuries since I've been in, bad knees from running etc." A concurrent physical examination reflected a normal clinical evaluation of the lower extremities. Nonetheless, as knee complaints were shown in service, the second element of service connection has been met.

As to a medical nexus, the evidence does not show any complaints regarding the knees for more than 10 years after discharge. Rather, post-service medical evidence reflects multiple medical treatment notes in 2011, where the Veteran complained of knee pain. In March 2011, he complained of severe left knee pain and popping. The clinician noted that the left knee pain began after the Veteran slipped on stairs at home.

In May 2019, the Veteran's private physician, Dr. R.B.H., reflected that the Veteran had been his patient for more than 10 years and he had knee pain and other related symptomatology through that time, dating the onset of treatment to 2009, 10 years after discharge. A June 2019 private treatment record reflected that the Veteran complained of chronic left knee pain and reported having pain for 20 plus years, dating the onset to the year he separated from service, with increased pain over the last three months.

To the extent that the Veteran asserts a nexus between service and his current bilateral knee disorders, a March 2023 private medical opinion from Dr. N. P. D., found that the Veteran's bilateral knee arthropathy was at least as likely as not due to the arduous task and a fall in service. The clinician noted that the presence of musculoskeletal injuries sustained during recruit training was well-documented in today's medical literature. 

The clinician further noted that the evidence supported service-connection for bilateral knee arthritis based on the fact that the Veteran suffered a fall that led to a fracture of the left metatarsal and left ankle and it was not speculation that ankle/foot injuries can lead to bilateral knee arthritis as the medical literature supported this theory. 

The clinician also indicated that although the Veteran was working in manual labor jobs following service, his current employment as a salesman put him in a more sedentary position that would not subsequently increase the risk for developing the severe bilateral knee arthritis that he was currently suffering from. 

The evidence also includes a November 2018 statement submitted by the Veteran's employer that he required a change of position within the company due to existing medical complications. The employer noted that the Veteran began working with the company in 1999, shortly after service. They indicated that the Veteran's initial position required physical movements such as but not limited to, laying under vehicles and dashes for extended periods of time and holding a paint gun in an elevated position for extended periods of time.

The Veteran would often complain of pain and discomfort in the bilateral knees which started during service. As his pain increased over
 salesman put him in a more sedentary position that would not subsequently increase the risk for developing the severe bilateral knee arthritis that he was currently suffering from. 

The evidence also includes a November 2018 statement submitted by the Veteran's employer that he required a change of position within the company due to existing medical complications. The employer noted that the Veteran began working with the company in 1999, shortly after service. They indicated that the Veteran's initial position required physical movements such as but not limited to, laying under vehicles and dashes for extended periods of time and holding a paint gun in an elevated position for extended periods of time.

The Veteran would often complain of pain and discomfort in the bilateral knees which started during service. As his pain increased over time and mobility decreased, he was reassigned to the sales department to minimize the amount of exertion to the bilateral knees. 

The Veteran's employer is competent to report symptoms because this requires only personal knowledge as it comes to them through the senses; the employer is not competent to offer an opinion as to the etiology of the Veteran's knee disorders due to the medical complexity of the matters involved. 

On the other hand, in a June 2014 VA examination, the Veteran reported previous swelling and fluid on his knees, popping and grinding in both knees and cortisone shots in the right knee years before. He noted that he wore bilateral knee braces when he ran, and he wore the knee braces about 2-3 times a week regularly.

The examiner diagnosed bilateral knee strain, with a date of diagnosis of 2014 and bilateral knee degenerative arthritis, with a date of diagnosis of 2004. The reference to 2004 appears to be a typographical error and the record suggests that this should have read 2014 when arthritis was first identified.

The examiner opined that it was less likely as not that the claimed knee disorders were the result of or incurred in service. The examiner observed that there was documentation of a right knee injury while in service in November 1998 but indicated that there was a March 2011 MRI reflecting an impression of cartilage contusion versus chondromalacia patella and there was documentation of knee pain on the March 2011 private treatment note which stated that the Veteran had left knee pain which began after he slipped on stairs at home. She noted that there was no documentation of chronicity from 1998 to 2011 regarding the claimed knee disorders.

Further, in an August 2014 VA addendum opinion, the examiner noted that after reviewing the private treatment records contained in the claims file, they concurred with June 2014 VA examiner's opinion; however, neither the June 2014 nor August 2014 VA opinions took into consideration the Veteran's reports of pain and discomfort in the knees beginning in 1999. Therefore, they are assigned lesser probative value. 

Next, a June 2024 VA examiner opined that the Veteran's right knee strain and right knee degenerative arthritis were less likely than not incurred in or caused by service. The examiner acknowledged the in-service complaints of mild right knee pain (resolving in February 1996), right lateral collateral ligament pain for 1 month and a diagnosis of right iliotibial band syndrome (ITBS) (January 1998), right knee pain for 112 weeks (September 1998), and the November 1998 self-reported history of swollen or painful joints but no "trick" or lock knees, the notation of a history of right knee injury but asymptomatic, the complaints of "multiple injuries since I've been in, bad knees from running etc.," and a concurrent physical examination was normal for evaluation of the lower extremities at discharge.

Further, the examiner noted the Veteran's testimony and lay statements that the right knee disorder had been present since service, and the relevant evidence of record including the November 2018 letter from a former employer acknowledging the reports of pain and discomfort in the right knee beginning in 1999 in formulating the opinion. However, the examiner explained that there was a lack of substantiating evidence supporting a nexus between the current diagnosis of degenerative arthritis and service and without chronicity during service or after service, a post-service event, illness, or injury was considered to be a more likely etiology. 

The examiner noted that the Veteran was found to have degenerative arthritis in 2019, and the Veteran stated during the examination that he weighed 265 pounds in the early 2000s and was told to lose weight to help his knee pain. They noted that the Veteran's BMI the day of the examination was 33.1 (obesity) and, according to The American Academy of Orthopaedic Surgeons, "[Obesity] is one of the most common diseases that adversely affect bone and joint health . . . Obesity frequently contributes to soft tissue damage and osteoarthritis-a progressive wear and
 chronicity during service or after service, a post-service event, illness, or injury was considered to be a more likely etiology. 

The examiner noted that the Veteran was found to have degenerative arthritis in 2019, and the Veteran stated during the examination that he weighed 265 pounds in the early 2000s and was told to lose weight to help his knee pain. They noted that the Veteran's BMI the day of the examination was 33.1 (obesity) and, according to The American Academy of Orthopaedic Surgeons, "[Obesity] is one of the most common diseases that adversely affect bone and joint health . . . Obesity frequently contributes to soft tissue damage and osteoarthritis-a progressive wear and-tear disease of the joints. The impact of obesity is especially felt in osteoarthritis of the hip and knee joints. Every pound of body weight places four to six pounds of pressure on each knee joint. Individuals with obesity are 20 times more likely to need a knee replacement than those who are not overweight." 

The examiner also noted that the degenerative arthritis was caused by obesity and not service and there was no medical probability that the diagnosed right knee degenerative arthritis (right knee strain and right knee degenerative arthritis since at least 2014) was due to or caused by in-service right knee pain in February 1996. Moreover, the examiner opined that the left knee meniscal tear and degenerative arthritis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. 

The examiner acknowledged the Veteran's separation medical history where he reported swollen or painful joints but denied "trick" or lock knees, a November 1998 report of "multiple injuries since I've been in, bad knees from running etc." and a concurrent normal physical examination of the lower extremities, the testimony and lay statements that the left knee disorder has been present since service, and the relevant evidence of record including the November 2018 letter from the Veteran's former employer acknowledging reports of pain and discomfort in the left knee beginning in 1999 in formulating his opinion. 

However, the examiner explained that there was a lack of substantiating evidence supporting a nexus between the current diagnosis of degenerative arthritis and service and without chronicity during service or after service, a post-service event, illness, or injury was considered to be a more likely etiology. The examiner further acknowledged that the claims file clearly showed that the Veteran fell down steps in 2011 and an MRI at that time showed internal injury. They noted that an MRI from 2019 was completed due to the left knee injury years ago, i.e. 2011 and the MRI showed a meniscal tear and he was also found to have degenerative arthritis. 

Further, the examiner indicated that the Veteran's meniscal tear was caused by an injury sustained in 2011 and degenerative arthritis was caused by obesity. They explained that there was no medical probability that the diagnosed left knee degenerative arthritis and meniscal tear (left knee cartilage contusion vs. chondromalacia patella, left knee strain, left degenerative arthritis, and left knee medial meniscus tear since at least 2014) were due to or caused by in-service bad knees from running. 

Most recently, a September 2025 VA examiner opined that the Veteran's bilateral knee disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the more likely etiology of current bilateral knee disorders, as supported by medical literature, was age-dependent degeneration/wear and tear of the bilateral knee joints and not the result of service or the result of a service-connected ankle disability. 

The examiner noted that the Veteran's 2019 bilateral knee radiology reported only mild joint degeneration, which was 27 years after service and the mild degeneration in 2019 did not surpass age-related degenerative changes, otherwise it would be moderate or severe degeneration. There was no clinical evidence of a bilateral knee degeneration that had been aggravated beyond the time dependent natural wear and tear of the knee joints across 27 years after service. 

Based on the above, the medical evidence does not support the claim for direct service connection. The Board affords the June 2024 and August 2025 VA examiners' opinions more probative value because they offered a more thorough rationale that was consistent with the medical evidence. Specifically, the VA examiners noted that Veteran's bilateral knee disorders were age-dependent wear and tear of the bilateral knee joints and obesity. Further, the VA examiners identified a post-service injury, the left knee meniscal tear was caused by an injury sustained in 2011, which they found to be a more likely cause of left knee disorder.

In contrast, the private clinician provided a conclusory opinion which did not offer a rationale
27 years after service. 

Based on the above, the medical evidence does not support the claim for direct service connection. The Board affords the June 2024 and August 2025 VA examiners' opinions more probative value because they offered a more thorough rationale that was consistent with the medical evidence. Specifically, the VA examiners noted that Veteran's bilateral knee disorders were age-dependent wear and tear of the bilateral knee joints and obesity. Further, the VA examiners identified a post-service injury, the left knee meniscal tear was caused by an injury sustained in 2011, which they found to be a more likely cause of left knee disorder.

In contrast, the private clinician provided a conclusory opinion which did not offer a rationale or explanation and did not consider any post-service injury or complaints. Accordingly, the weight of the medical evidence does not support service connection for a bilateral knee disorder on a direct basis.

As to secondary service connection, the Veteran has been diagnosed with a bilateral knee disorder and is service connected for a left ankle disability. As such, the first two elements of secondary service connection have been met.

As to a medical link between the disorders and a service-connected disability, the March 2023 private medical opinion from Dr. N.P.D. found that bilateral knee arthropathy was at least as likely as not due to the arduous task and the fall that the Veteran experienced in service. The clinician noted that the presence of musculoskeletal injuries sustained during recruit training was well-documented in today's medical literature. 

The clinician further noted that the evidence supported service-connection for bilateral knee arthritis based on the fact that the Veteran suffered a fall that led to a fracture of the left metatarsal and left ankle, and it was not speculation that ankle/foot injuries could lead to bilateral knee arthritis as the medical literature supported this theory. The clinician also indicated that although the Veteran was working in manual labor jobs following service, the current employment as a salesman put him in a more sedentary position that would not subsequently increase his risk for developing the severe bilateral knee arthritis that he was experiencing. 

The clinician concluded that knee arthritis was at least as likely not due to the physical nature of performing duties while in service; however, except for that one assertion, the rest of the opinion focused on direct service connection and offered no rationale for the secondary opinion.

On the other hand, a September 2025 VA examiner opined that the bilateral knee disorders were less likely than not proximately due to or the result of the service-connected left ankle disability. The examiner explained that arthritis in one joint did not cause arthritis in another joint and a thorough review of medical literature failed to show such a causal relationship. They noted that it was not unusual for two joints to share properties in the same person, but one joint's disease did not 'spread' to another or cause damage to it. 

The examiner indicated that the more likely etiology of bilateral knee disorders, as supported by medical literature, was age-dependent degeneration/wear and tear of the bilateral knee joints, and not the result of service or a service-connected ankle. As noted above, the examiner related that the bilateral knee radiology in 2019 reported only mild joint degeneration, which was 27 years after service and the mild degeneration in 2019 did not surpass age-related degenerative changes, otherwise it would be moderate or severe degeneration. There was no clinical evidence of a bilateral knee degeneration that has been aggravated beyond the time dependent natural wear and tear of the knee joints across 27 years after service. This evidence weighs against secondary service connection and was based on a review of the medical literature.

The Board affords the VA examiner's opinion more probative value because it offered a more thorough rationale that was consistent with the medical evidence. Specifically, the VA examiner explained that arthritis in one joint did not cause arthritis in another joint and a thorough review of medical literature failed to show such a causal relationship. 

The examiner noted that it was not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. Further, they indicated that the more likely etiology of Veteran's current bilateral knee condition, as supported by medical literature, was age-dependent degeneration/wear and tear of the bilateral knee joints, and not the result of service or a service-connected ankle disability. 

In contrast, the private examiner provided a conclusory opinion which did not offer a rationale or explanation. Accordingly, the weight of the medical evidence does not support service connection for a bilateral knee disorder on a secondary basis.

As to presumptive service connection, as noted, the Veteran has been diagnosed with bilateral knee degenerative arthritis, which is entitled to presumptive service connection if shown to be chronic in service, or with continuous symptoms since service, or if it manifested to a degree of 10 percent or
 indicated that the more likely etiology of Veteran's current bilateral knee condition, as supported by medical literature, was age-dependent degeneration/wear and tear of the bilateral knee joints, and not the result of service or a service-connected ankle disability. 

In contrast, the private examiner provided a conclusory opinion which did not offer a rationale or explanation. Accordingly, the weight of the medical evidence does not support service connection for a bilateral knee disorder on a secondary basis.

As to presumptive service connection, as noted, the Veteran has been diagnosed with bilateral knee degenerative arthritis, which is entitled to presumptive service connection if shown to be chronic in service, or with continuous symptoms since service, or if it manifested to a degree of 10 percent or more within one year of service separation. However, the medical evidence does not support presumptive service connection.

A review of the record shows that, despite knee complaints in service, the Veteran was not diagnosed with a chronic knee disorder. To this end, the separation examination reflected a normal clinical evaluation of the lower extremities. Similarly, the medical evidence does not show that arthritis manifested within one year of separation. The first diagnosis was dated in 2014. The June 2014 VA examination noted that the Veteran had bilateral knee degenerative arthritis starting in about 2004. As noted above, although it appears that the 2004 date is a typographical error; however, 2004 would still be over 5 years after discharge from service. Additionally, an April 2019 imaging study showed right knee mild narrowing of the medial joint compartment and left knee mild narrowing of the lateral joint compartment which was not within one year of service separation.

As to presumptive service connection based on continuity of symptomatology, the contemporaneous post-service medical evidence does not support this theory of entitlement. Post-service treatment records are negative for complaints of, treatment for, or a diagnosis related to the bilateral knees for many years after service separation. The clinical treatment records do not reflect complaints of knee pain until 2011, when the Veteran sustained an injury after falling down stairs. 

Imaging performed in a March 2011 reflecting an impression of left knee cartilage contusion versus chondromalacia patella but not arthritis. The first reference to arthritis of the knees is the June 2014 VA examination. Additionally, an April 2019 imaging study showed right knee mild narrowing of the medial joint compartment and left knee mild narrowing of the lateral joint compartment.

The Veteran separated from service in January 1999. The medical evidence shows that symptoms of arthritis developed no earlier than 12 years after service. The multiple treatment records in 2011 noting the onset of knee pain do not relate any longstanding knee complaints prior to 2011, including any ongoing symptoms since service, nor do they relate any injury in service. Further, the March 2011 treatment record noted knee pain began after the Veteran slipped on stairs at home.

Therefore, despite the Veteran's contentions, the post-service medical evidence reflects that he did not report ongoing knee symptoms since service, and in some instances, he reported knee pain due to intervening post-service incidents. This weighs against his credibility as to ongoing symptoms since service. As such, the medical evidence, which does not support service connection based on continuity of symptomatology, outweighs the Veteran's contentions in this regard.

The Board has also considered the Veteran's lay statements that his bilateral knee disorders were due to service or alternatively due to a left ankle disability. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses; however, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved.

Such competent evidence has been provided by the service records, clinical evidence, examinations, and medical opinions obtained and associated with the claims file. Here, the Board attaches greater probative weight to the medical evidence than to his statements. In light of the above, the evidence weighs persuasively against service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

 

 

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Oettle, Teresa I.

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. § 20.130