ERECTILE DYSFUNCTION

L. M. BARNARD · 2026 · Case ID: A26001805

DENIED

Summary

The Veteran served in the Army from August 1976 to August 1979. The Veteran appeals the denial of service connection for erectile dysfunction (ED) as secondary to service-connected lumbar degenerative disc disease (DDD) and spinal stenosis. The Veteran also appeals the denial of service connection for left knee strain and right knee degenerative arthritis, both claimed as secondary to the same lumbar spine conditions. The Board denied all claims. For ED, the Board found no current diagnosis or treatment for ED in the record, and the VA examiner opined that ED was less likely than not related to service, noting the veteran's reported onset in the 1970s predated diagnosed service-connected conditions. The Board gave more weight to the VA examiner's opinion due to the medical complexity of ED. For the left knee strain, the Board found the veteran's lay assertions regarding onset and aggravation were not sufficiently probative, and the VA examiner opined the condition was less likely than not related to service, noting a lack of in-service documentation and a gap in treatment history. For the right knee degenerative arthritis, the Board found the condition was diagnosed after the service-connected lumbar and hip conditions, and the VA examiner opined it was less likely than not aggravated by those conditions, citing inconsistent gait documentation and lack of progression evidence. The Board concluded the preponderance of the evidence was against all claims.

Rationale

No current diagnosis or treatment for ED in records; VA examiner opined ED less likely than not related to service; Veteran's reported onset predated service-connected conditions

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250331-531290

Full Decision Text

Citation Nr: A26001805
Decision Date: 01/08/26 Archive Date: 01/08/26

DOCKET NO. 250331-531290
DATE: January 8, 2026

ORDER

Entitlement to service connection for erectile dysfunction (ED) as secondary to lumbar spine degenerative disc disease (DDD) and spinal stenosis with right neural foraminal narrowing at L5-S1 is denied.

Entitlement to service connection for left knee strain as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1 is denied.

Entitlement to service connection for degenerative arthritis, right knee as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1 is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had ED at any time during or approximate to the pendency of the claim.

2. The left knee condition did not begin in service, nor was otherwise related to an in-service event, injury, or disease, and it was not caused or aggravated by service-connected lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1.

3. The right knee condition did not begin in service, nor was otherwise related to an in-service event, injury, or disease, and it was not caused or aggravated by service-connected lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for ED as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1 have not been met. 38 U.S.C. §§ 1111, 1131, 5107; 38 C.F.R. § § 3.102, 3.303, 3.306.

2. The criteria for service connection for left knee strain as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1 have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309.

3. The criteria for service connection for degenerative arthritis, right knee as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1 have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1976 to August 1979.

In the March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the March 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F
line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Secondary service connection may be granted 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.

Additional laws and regulations apply when there is evidence that a disability preexisted service. Every Veteran is presumed to have been in sound condition at entry into service, except as to defects, infirmities, or disorders noted at the time of such entry, or where clear and unmistakable evidence demonstrates that the injury or disease existed before entry and was not aggravated by such service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b).

Entitlement to service connection for ED as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1

The Veteran contends that his ED is the result of his service-connected lumbar spine DDD.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of ED and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

In pertinent part, the February 2025 VA examiner stated:

There is no objective information in the available records to support a diagnosis of ED. There us plenty mention of ED while the veteran is trying to get it service connected but no visit, complaint or treatment. There are some conditions that don't need a diagnosis, ie. headaches, it only requires that the veteran subjectively report the headaches. I was not sure if ED was similar, so a MO was provided. There is no objective evidence to support the diagnosis of ED. 4B. The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the Veteran's service connected condition.

ED claimed on the 4/5/2023 and 9/5/2023 Disability Claims. While there is documented claim and denial information for ED, there continues to be no complaint, visit, diagnosis or treatment for ED to a medical professional in the records. The diagnosis of ED is not supported in the available records. In the event that there is ED, it is reported by the veteran to have started in the 1970s. Active service is reported on the DD-214 to have been 8/23/1976 - 8/22/1979

-Lumbar condition diagnosed on 7/25/2022, 'Recurrent back pain' noted on the 7/17/1979 Separation Report of Medical History.

-Right hip strain diagnosed 5/1/2023, no hip issues reported on the 7/17/1979 Separation Report of Medical History.

-HTN diagnosed 12/7/2021

-Hearing loss and tinnitus are not physiologically connected to erectile dysfunction. Hearing loss first noted in 7/5/1979 in the left ear only. In 10/1988 the hearing loss was still only in the left ear. Tinnitus is typically associated with hearing loss.

12/23/1988 Enlistment Report of Medical History for the Army National Guard reported health as "Excellent" with no medications taken at that time, including for HTN. There was no back or hip issues reported at that time. Indicating that the reported back symptoms were not impactful at that time, or had resolved completely. 5/11/2005 clinic visit reports " MR REIL IS A 47 Y/O W/M WITH NO COMPLAINTS. STATES HE IS A NONSMOKER & IS PAINFREE. TAKES NO MEDS..." Documentation that he back and hip conditions/pain did not cause the 1970s ED. There was no report of hypertension on 12/23/1988. Blood pressure at that time, as recorded on the 12/23/1988 Report of Medical Exam, was 106/70. BP on 7/17/1979 was 134/86, 3/29/1988 was 120/80. While there are some studies that suggest a correlation with ED and hearing loss. The hearing loss is this case is typically sudden and with deafness or at least mild to moderate, which was not the case until 7/5/1979, at the end of the "1970s". And at that time the hearing loss was mild and only in 3000 - 4000 Hz. The rest of the hearing ranges were normal.

The veteran reported that the ED began "Probably back in the 70s when I was stationed in Panama". This was prior to consistent back issues of diagnosis, prior to hip strain and HTN diagnosis. Since the ED was reported by the veteran to have began prior to the SC conditions, it could not have been caused by them.

While the Veteran believes there is a current diagnosis of ED, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

Entitlement to service connection for left knee strain as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1

The Veteran contends that his left knee strain is secondary to his service-connected condition of lumbar spine DDD and spinal stenosis.

In May 2023, the Veteran attended a VA Knee Conditions examination. The examiner diagnosed left knee strain. Upon examination, the Veteran reported that the cause of the knee pain was due to "Used to do a lot of heavy labor, I might have fell down or something. I hurt my knee in the service too but I never complained of it. In the Infantry when you complain they make fun of you." The examiner opined that the Veteran's left knee strain was less likely as not due to his active service. The rationale provided was:

The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. Rationale is that the veteran's medical records were reviewed. The veteran served in the Army from Aug 23, 1976 Aug 22, 1979-Peacetime. His records showed that he had an injury that involved his left leg in 1977. Records are silent for a left knee injury or treatment until 2022. Based on the records reviewed, a nexus could not be established.

In a December 2024 VA addendum opinion, the examiner stated:

MEDICAL OPINION 1 OF 2) DO THE VETERAN'S MEDICAL RECORDS SUPPORT THAT THE CLAIMED **LEFT** KNEE STRAIN, IS AT LEAST AS LIKELY AS NOT (LIKELIHOOD IS AT LEAST APPROXIMATELY BALANCED OR NEARLY EQUAL, IF NOT HIGHER) PROXIMATELY DUE TO OR THE RESULT OF THE VETERAN'S DISABILITIES, TO INCLUDE:

A) RIGHT HIP TROCHANTERIC PAIN SYNDROME

B) RIGHT HIP TROCHANTERIC PAIN SYNDROME WITH LIMITED EXTENSION

C) RIGHT HIP TROCHANTERIC PAIN SYNDROME WITH LIMITED ABDUCTION, ADDUCTION, AND ROTATION

Right hip trochanteric pain syndrome... was diagnosed on 6/8/2023 and reported on the
NEE STRAIN, IS AT LEAST AS LIKELY AS NOT (LIKELIHOOD IS AT LEAST APPROXIMATELY BALANCED OR NEARLY EQUAL, IF NOT HIGHER) PROXIMATELY DUE TO OR THE RESULT OF THE VETERAN'S DISABILITIES, TO INCLUDE:

A) RIGHT HIP TROCHANTERIC PAIN SYNDROME

B) RIGHT HIP TROCHANTERIC PAIN SYNDROME WITH LIMITED EXTENSION

C) RIGHT HIP TROCHANTERIC PAIN SYNDROME WITH LIMITED ABDUCTION, ADDUCTION, AND ROTATION

Right hip trochanteric pain syndrome... was diagnosed on 6/8/2023 and reported on the 9/11/2024 Hip DBQ to have started. Details of onset: Due to the ruggedness of my life, lifting furniture, being a trucker, in the military, lifting the LE began to be painful. There was no specific injury but started around military service.' There is also left hip pain reported at the time of that DBQ.

On the 9/11/2024 Hip DBQ the right hip ROM was near normal.

D) LUMBAR SPINE DEGENERATIVE DISC DISEASE AND SPINAL STENOSIS

The 6/8/20223 Back DBQ reports that the DDD and spinal stenosis was diagnosed on 7/25/2022 and the onset was in 1979 when Details of onset: Veteran suffered an injury while on active duty in 1979. He reports he was hit directly on his low back by another player when playing tackle football. He was given pain medication but returned to duty. Since then, he continued to have low back that was exacerbated his duties. he admits to not medical care for this. The 9/11/2024 Back DBQ retained the diagnoses and added right neural foraminal narrowing that was diagnosed in 4/2022. On that DBQ the veteran reported that the pain began in 1979 and was due to ' Details of onset: Due to the ruggedness of my life, lifting furniture, being a trucker, in the military, lifting the back began to be painful. He notes that being a trucker for 7-8 years was hard on the back. He also reports that he experienced an injury in 1979 when the back was injured. He was hit directly in the back by another player while playing football. Since this time, he has continued to have low back pain. Despite this, he reports that he did not seek medical care.'

***The claimed condition of left knee strain is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the Veteran's:

A) RIGHT HIP TROCHANTERIC PAIN SYNDROME

B) RIGHT HIP TROCHANTERIC PAIN SYNDROME WITH LIMITED EXTENSION

C) RIGHT HIP TROCHANTERIC PAIN SYNDROME WITH LIMITED ABDUCTION, ADDUCTION, AND ROTATION

D) LUMBAR SPINE DEGENERATIVE DISC DISEASE AND SPINAL STENOSIS

Left knee strain diagnosed on the 5/1/2023 on the 5/1/2023 Knee DBQ exam. The condition reported at that time to have began in 2020. The veteran, on the DBQ exam, reports that the cause of the knee pain was due to 'Used to do a lot of heavy labor, I might have fell down or something. I hurt my knee in the service too but I never complained of it. In the Infantry when you complain they make fun of you.'

7/17/1979 Term Leave Report of Medical Record reported 'back Disorder'. No knee pain reported.

9/1/1984 Reports of Medical History was silent for back, knee hip complaints or condition.

The 1988 National Guard Enlistment was negative for back, hip or knee conditions and his health was noted as 'Excellent'. This was 9 years after exiting active service, which no reports of back, hip or knee complaints in the interim. It appears that any back, hip, knee complaints/conditions resolved after leaving active service. Report of Medical Exam dated 12/23/1988 was also negative for finding, complaint or diagnosis.

7/5/2024 visit note documents 'Veteran states that he has longstanding history of chronic bilateral knee pain and attributes this to her arthritis.' The pain in both legs has an equal and identifiable cause.

Left knee strain diagnosed on 5/1/2023, on the day of a Knee DBQ exam.

11/29/1977 seem for injury affecting the left tibia, including the knee. This is the only report of left knee pain in the service and appears to have resolved.

5/13/
in the interim. It appears that any back, hip, knee complaints/conditions resolved after leaving active service. Report of Medical Exam dated 12/23/1988 was also negative for finding, complaint or diagnosis.

Left knee strain diagnosed on 5/1/2023, on the day of a Knee DBQ exam.

11/29/1977 seem for injury affecting the left tibia, including the knee. This is the only report of left knee pain in the service and appears to have resolved.

5/13/2022 complaint of left knee pain.

5/5/2022 acupuncture for the left knee pain.

Separation exam showed no findings related to the claimed knee pain. The examiner noted, 'The veteran served in the Army from Aug 23, 1976 Aug 22, 1979-Peacetime. His records showed that he had an injury that involved his left leg in 1977. Records are silent for a left knee injury or treatment until 2022.'

4/19/2005 visit reported 'Ambulation: gait steady.'

5/12/2005 visit reported no assistive device with 'Normal gait'.

1/23/2018 reported 'antalgic gait' related to the right knee. This was due to the knee injury at that time. The orthopedic visit at that time reported 'Gait: unsteady due to pain' when seen.

8/9/2023 clinic visit documents, 'Gait coordinated and smooth.'

It is the change in gait and biomechanics that will cause additional joints to become affected. Per the available records, there has been no change in gait due to the back or hips. The right knee has had injury since leaving active service and diagnosis of right knee gout with recurrent flares, that more likely that not have changed the gait intermittently. This is related to the right knee, however, and not the back or the hips.

The veteran reports that 'Due to the ruggedness of my life, lifting furniture, being a trucker, in the military, lifting the back began to be painful. He notes that being a trucker for 7-8 years was hard on the back.' which would be more likely the cause of the left knee pain at this time than the hip or back conditions.

Further, the examiner opined that the Veteran's left knee strain was less likely than not aggravated beyond its natural progression by his service-connected conditions. The rationale provided was:

11/29/1977 seem for injury affecting the left tibia, including the knee. This is the only report of left knee pain in the service and appears to have resolved.

Separation exam showed no findings related to the claimed knee pain.

5/13/2022 complaint of left knee pain. Reported grinding under the knee cap, R>L. Pain 7/10, lateral.

5/5/2022 acupuncture for the left knee pain.

'The examiner noted, 'The veteran served in the Army from Aug 23, 1976 Aug 22, 1979-Peacetime. His records showed that he had an injury that involved his left leg in 1977. Records are silent for a left knee injury or treatment until 2022.'

4/19/2005 visit reported 'Ambulation: gait steady.'

5/12/2005 visit reported no assistive device with 'Normal gait'.

1/23/2018 reported 'antalgic gait' related to the right knee. This was due to the knee injury at that time. The orthopedic visit at that time reported 'Gait: unsteady due to pain' when seen.

8/9/2023 clinic visit documents, 'Gait coordinated and smooth.'

Knee strain diagnosis is not included on the 9/11/2024.

ER visit note dated 9/6/2024, when the veteran was seen for right knee pain from a gout flare, documents 'He has right knee swelling with effusion. Denies any left knee pain.'

The veteran reports that 'Due to the ruggedness of my life, lifting furniture, being a trucker, in the military, lifting the
to become affected. Per the available records, there has been no change in gait due to the back or hips. The right knee has had injury since leaving active service and diagnosis of right knee gout with recurrent flares, that more likely that not have changed the gait intermittently. This is related to the right knee, however, and not the back or the hips.

ER visit note dated 9/6/2024, when the veteran was seen for right knee pain from a gout flare, documents 'He has right knee swelling with effusion. Denies any left knee pain.'

Based on the foregoing evidence of record, service connection on a secondary basis is not warranted.

The Board acknowledges the Veteran's contention that his current left knee disability was aggravated by his service-connected low back disability. Lay persons are competent to provide opinions on some medical issues. Kahana, 24 Vet. App. at 435.

However, determining the etiology of the Veteran's left knee disability requires medical inquiry into the Veteran's anatomical and physiological functioning. With regard to the specific issue in this case, whether his left knee disability was aggravated by his service-connected low back disability, falls outside the realm of knowledge of the Veteran in this case. See Jandreau, 492 F.3d at 1377 n.4. Such internal processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have medical training or skills. As a result, the probative value of his lay assertions is low.

The December 2024 VA medical opinion is of significantly more probative value since the examiner reviewed the Veteran's complete claims file.

The Board concludes that the preponderance of the evidence is against the claim for service connection for the Veteran's left knee disability. The benefit of the doubt rule therefore does not apply, and service connection for this disability is not warranted.

Entitlement to service connection for degenerative arthritis, right knee as secondary to lumbar spine DDD and spinal stenosis with right neural foraminal narrowing at L5-S1

The Veteran contends that his right knee condition is secondary to his service-connected condition of lumbar spine DDD and spinal stenosis.

In September 2024, the Veteran attended a VA Knee Conditions examination. The examiner diagnosed bilateral patellofemoral pain syndrome and right degenerative arthritis. Veteran reported onset of right knee pain reportedly when he was always hitting his right knee on the ground getting into his 3-point stance to fire his weapon. Veteran also reports that he had a twisting injury during active service. Then on 1/4/2018 he fell, injuring the right knee. The examiner stated:

The claimed condition of degenerative arthritis of the right knee is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of right hip trochanteric pain syndrome.

On the VA Butler Healthcare, PA record, there is no record of the veteran being seen for, diagnosed or treated for a hip complaint is found. On the 12/7/2021 there is no diagnosis for a hip condition. There is a visit on 7/1/2022 that reports "LBP. Knee pain" but no hip information. Since the knee condition (2018) is found to have been present prior to the right hip (2023), the hip could not have caused the knee condition. On all of the exams today, the veteran reported that the symptoms began during military service with no dates of documentation. Because of this there really can be no cause and effect from one part of the body to the other, because all conditions reported began at the same time.

In a February 2025 VA addendum opinion, the examiner stated:

Was the right knee degenerative arthritis aggravated by service connected right hip trochanteric pain syndrome and/or lumbar spine degenerative disc disease? No, the right knee degenerative arthritis was NOT aggravated beyond its natural progression by right hip trochanteric pain syndrome and/or lumbar spine degenerative disc disease.

Right knee degenerative arthritis diagnosed on 1/8/2018. On the 6/8/2023 Knee DBQ the veteran reported that the start of the right knee condition is "Unknown, has been ongoing for 'years' but started while in service." There is no documentation of right knee complaint during active service or on the 12/23/1988 Enlistment Report of Medical History for the Army National Guard where he reported his health as "Excellent" with no knee, hip or back complaint, history, diagnosis, treatment. 5/11/2005 clinic visit reports " MR REIL IS A 47 Y/O W/M WITH NO COMPLAINTS. STATES HE IS A NONSMOKER & IS PAINFREE. TAKES NO MEDS..."

There is no baseline established as to when the right knee condition/arthritis started outside of the 2018 diagnosis from imaging. Despite the veteran reporting that the back pain started in 1979 and the hip pain starting in 1970, the 12/23/1988 report of Medical History was silent for back or hip issues and the back condition was not diagnosed until 2022 and the hip in 2023, after the diagnosis of the right knee arthritis in 2018.

*There is no updated right knee x-ray to show that the right knee degenerative arthritis has progressed.

5/12/2005 "normal gait"

1/19/2018 "Pt has antalgic gait.", this is related to the right knee related to 1/4/2018 acute right knee injury.

8/27/2021 "Gait stead"

10/28/2021 "gait independent"

4/14/2022 " OTHER: Denied any new or worsening numbness, balance/gait problems"

6/27/2022 hobbies are reported as "walking, hiking". On that date the following is documented, " NEUROLOGIC: Denies headaches, tremors, loss of memory, paresthesia's, gait disturbance, focal weakness, vertigo or confusion." There was no gait disturbance reported on 6/27/2022. This supports that walking and hiking was tolerated, most likely indicating a normal gait.

7/25/2022 Back DBQ reports pain on palpation of the back but " Not resulting in abnormal gait or abnormal spinal contour".

10/3/2022 visit note documents " Gait: Decreased hip and thoracic rotation with ambulation"

10/12/2022 visit note reports " 5. Gait/Transferring: Impaired" when presenting for a LESI for back pain.

5/31/2023 the gait is documented as " Gait: reciprocal, no ataxia.", this indicates a normal gait.

There is not consistent abnormal gait documented which is the premise that there is secondary joint condition (or progression of), right knee, related to a primary condition, right hip trochanteric pain syndrome and/or lumbar spine degenerative disc disease, or aggravation thereof. The first indication of abnormal gait was related to the right knee.

Considering that the right knee condition was diagnosed prior to the SC conditions, and that antalgic gait was first caused by the knee, and that there is not consistent documentation of abnormal gait related to the back and hip, and that there is no updated imaging to support that the right knee degenerative arthritis has worsened, it is unlikely that the right knee degenerative arthritis has been aggravated by the SC right hip trochanteric pain syndrome and/or lumbar spine degenerative disc disease

Based on the foregoing evidence of record, service connection on a secondary basis is not warranted.

The Board acknowledges the Veteran's contention that his current right knee disability was aggravated by his service-connected low back disability. Lay persons are competent to provide opinions on some medical issues. Kahana, 24 Vet. App. at 435.

However, determining the etiology of the Veteran's right knee disability requires medical inquiry into the Veteran's anatomical and physiological functioning. With regard to the specific issue in this case, whether his left knee disability was aggravated by his service-connected low back disability, falls outside the realm of knowledge of the Veteran in this case. See Jandreau, 492 F.3d at 1377 n.4. Such internal processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have medical
aggravated by his service-connected low back disability. Lay persons are competent to provide opinions on some medical issues. Kahana, 24 Vet. App. at 435.

However, determining the etiology of the Veteran's right knee disability requires medical inquiry into the Veteran's anatomical and physiological functioning. With regard to the specific issue in this case, whether his left knee disability was aggravated by his service-connected low back disability, falls outside the realm of knowledge of the Veteran in this case. See Jandreau, 492 F.3d at 1377 n.4. Such internal processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have medical training or skills. As a result, the probative value of his lay assertions is low.

The February 2025 VA medical opinion is of significantly more probative value since the examiner reviewed the Veteran's complete claims file.

L. M. BARNARD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Elliott II, R. A.

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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