KNEE IMPAIRMENT OF

Summary

The Veteran, a Marine Corps Veteran who served from July 1986 to July 1991, appeals the denial of service connection for bilateral knee disabilities, diagnosed as degenerative joint disease (DJD), claimed as secondary to his service-connected lumbar spine disability. The Veteran testified that his lumbar spine condition caused chronic pain, leading to difficulty moving and a limp, which in turn aggravated his knees. The AOJ found service connection for the lumbar spine disability and a current bilateral knee disability. However, the medical evidence was conflicting. The August 2022 VA examiner opined against a service connection for the knee conditions, attributing them to factors like heredity and obesity, but this opinion was deemed inadequate as it failed to consider aggravation by the service-connected back condition, particularly with obesity as an intermediate step. Conversely, a July 2024 private medical opinion from the Veteran's treating physician, Dr. M.M., found the bilateral knee DJD to be at least as likely as not secondary to the service-connected lumbar spine disability. Dr. M.M. provided a detailed rationale, explaining how the back injury led to a limp, weight gain due to reduced mobility, and subsequent stress on the knees, ultimately causing deterioration. The Board found this private opinion adequate and highly probative, outweighing the negative VA opinion. Given the conflicting evidence and resolving any reasonable doubt in the Veteran's favor, the Board granted service connection for the left and right knee disabilities as secondary to the service-connected lumbar spine disability.

Rationale

Conflicting medical opinions regarding secondary connection.; VA opinion inadequate for failing to consider aggravation by back condition.; Private opinion found adequate and highly probative, linking knee DJD to service-connected back injury and obesity.

Full Decision Text

Citation Nr: A26004803
Decision Date: 01/20/26	Archive Date: 01/20/26

DOCKET NO. 221214-304873
DATE: January 20, 2026

ORDER

Service connection for left knee disability, diagnosed as degenerative joint disease (DJD), as secondary to the service-connected lumbar spine disability, is granted.

Service connection for a right knee disability, diagnosed as DJD, as secondary to the service-connected lumbar spine disability, is granted.

FINDING OF FACT

The Veteran's current bilateral knee disabilities, diagnosed as DJD, are proximately due to or aggravated by chronic pain from the service-connected lumbar spine disability.

CONCLUSIONS OF LAW

1. The criteria are met for service connection for a left knee disability, diagnosed as DJD, as secondary to chronic pain from the service-connected lumbar spine disability. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria are met for service connection for a right knee disability, diagnosed as DJD, as secondary to chronic pain from the service-connected lumbar spine disability. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from July 1986 to July 1991.

This appeal comes before the Board of Veterans' Appeals (Board) from an October 2022 rating decision by the Agency of Original Jurisdiction (AOJ) under the modernized appeals system known as the Appeals Modernization Act (AMA). 

In the December 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. The Veteran testified at a Board virtual hearing in June 2024, before the undersigned Veterans Law Judge (VLJ). A transcript is of record. Therefore, the Board may only consider the evidence of record at the time of the AOJ's decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service.? 38?U.S.C. §?1110; 38?C.F.R. §?3.303(a).? As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a relationship or nexus between the current disability and any injury or disease during service.? Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 

Service connection may be also granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Per a 2017 VA General Counsel (GC) precedential opinion, obesity may be an "intermediate step" between a service-connected disability and a current disability that may be service connected on a secondary basis under 38 C.F.R. § 3.310 (a). See VAOPGCPREC 01-17 (Jan. 6, 2017), at 2-3. Service connection may accordingly be granted on a secondary basis where the claimed disability would not have occurred but for obesity caused or aggravated by a service-connected disability. Id.; 38 C.F.R. § 3.310. Walsh v. Wilkie, 32 Vet. App. 300 (2020).

If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56
 obesity caused or aggravated by a service-connected disability. Id.; 38 C.F.R. § 3.310. Walsh v. Wilkie, 32 Vet. App. 300 (2020).

If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990).

1. Service connection for left knee condition.

2. Service connection for right knee condition.

The Veteran contends that chronic back pain caused or aggravated his bilateral knee conditions. The Veteran explained experiencing difficulty moving around due to his back disability. See June 2024 hearing transcript, at 4-5. 

The AOJ made favorable findings of an underlying primary disability that is service-connected. That is, the Veteran has established service-connection for a lumbar spine disability, characterized by the AOJ as degenerative arthritis of the lumbar spine with intervertebral disc syndrome (IVDS), as well as associated sciatic nerve radiculopathies of the bilateral lower extremities.

The AOJ made a favorable finding of a current bilateral knees disability. Concerning this, the August 2022 VA knee examination diagnosed left knee strain and right knee joint osteoarthritis with a history of a partial knee replacement. A July 2024 private physician additionally diagnosed bilateral knee DJD/osteoarthritis.

The evidence includes conflicting medical opinions assessing this claim.

Initially, the August 2022 VA examiner opined against the possibility that the Veteran's bilateral knee disabilities were caused by service-connected back disability, instead attributing his bilateral knee disabilities to factors such as heredity, obesity, joint overuse and injury. However, the examiner's opinion was inadequate, as it did not consider the possibility that the Veteran's bilateral knee disabilities were aggravated by service-connected lumbar spine disability, including consideration of obesity as an intermediate step. See Nieves-Rodriguez v. Peake, 22 Vet. App. at 295; El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (finding medical opinion relating to secondary service connection claim inadequate because it addressed causation but not aggravation). Thus, the Board assigns this negative opinion minimal probative weight.

On the other hand, a July 2024 positive medical opinion by Dr. M.M., M.D., a private physician who had been the Veteran's treating physician for many years, determined that the Veteran's bilateral knee disabilities were secondary to service-connected lumbar spine disability. The private physician stated, "It is my medical opinion, as a family medical provider, that the veteran's current diagnosis of bilateral degenerative joint disease is least as likely as not, (more than 51 percent probability) due to or the result of [the Veteran's] service connected back injury."

Dr. M.M.'s rationale indicated that the Veteran's bilateral knee disabilities were aggravated by his service-connected lumbar spine disability, including consideration of obesity as an intermediate step. In this regard, Dr. M.M. stated that, "The [V]eteran's current symptoms are consistent with the above diagnoses. [The Veteran] developed a limp following a back injury in 2005 that has since been ruled service connected. This limp was a direct result of a pelvic shift to the right used as a guarding mechanism to reduce pain to his lower back. [The Veteran] has also had significant weight gain due to his lack of mobility from his back pain. [The Veteran] had a partial knee replacement to the right knee June 20, 2016. Following this procedure resulted in [the Veteran] producing additional stress to his left knee causing deterioration of the left knee joint. Also, the [V]eteran's current symptoms are logically related to and consistent with the medical problems being reported. The [V]eteran has multiple reports of knee/joint pain that have worsened over time. The condition is permanent and progressive in nature." 

Given the private physician's review of the relevant medical records, personal interview of the Veteran, and physical evaluation, the Board finds this private opinion is adequate. Consequently, the private opinion constitutes highly probative evidence weighing in favor of finding secondary service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion.").
 with the medical problems being reported. The [V]eteran has multiple reports of knee/joint pain that have worsened over time. The condition is permanent and progressive in nature." 

Given the private physician's review of the relevant medical records, personal interview of the Veteran, and physical evaluation, the Board finds this private opinion is adequate. Consequently, the private opinion constitutes highly probative evidence weighing in favor of finding secondary service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion."). 

For the above reasons, the evidence for and against the claim is at least evenly balanced. After resolving any reasonable doubt in the Veteran's favor, the finds that service connection for the Veteran's bilateral knee disability, diagnosed as DJD, as secondary to chronic pain from the service-connected lumbar spine disability, is warranted.

 

SHAUN S. SPERANZA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Chatterjee, B.

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.