KNEE IMPAIRMENT OF

Summary

The Veteran, a Veteran who served from November 2000 to November 2004, appeals the denial of service connection for a right knee strain, claimed as secondary to his service-connected right ankle disability. The Board reviewed evidence submitted up to March 5, 2021, and testimony from a September 2024 hearing. The primary issue was establishing a nexus between the service-connected right ankle disability and the current right knee strain. The Veteran submitted a private physician's opinion from September 2020, which found the knee pain and swelling were more likely than not due to the ankle ankylosis, explaining that the altered gait from the ankle disability stressed the knee. The Board found this opinion adequate. The record also included VA medical opinions from August 2020 and March 2021, which found no medical relationship between the knee and ankle disabilities. However, the Board afforded less probative weight to the VA opinions, noting the August 2020 opinion's reliance on the lack of documented knee complaints and the March 2021 opinion's failure to consider the Veteran's report of an altered gait. Citing Lynch v. McDonough, the Board found the evidence in approximate balance and resolved reasonable doubt in the Veteran's favor, granting service connection for the right knee strain as secondary to the right ankle disability.

Rationale

Private physician opinion found knee pain more likely than not due to ankle ankylosis; Altered gait from ankle disability stressed the knee; VA opinions afforded less weight due to reliance on lack of records and failure to consider altered gait

Full Decision Text

Citation Nr: A26020933
Decision Date: 03/09/26	Archive Date: 03/09/26

DOCKET NO. 210323-148281
DATE: March 9, 2026

ORDER

Service connection for right knee strain, as secondary to the right ankle disability, is granted.

FINDING OF FACT

The right knee disability is related to the service-connected right ankle disability.

CONCLUSION OF LAW

The criteria for service connection for right knee strain, as secondary to the right ankle disability, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.  

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 2000 to November 2004.  This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2021 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).  

Following the March 2021 rating decision, the Veteran submitted a VA Form 10182 (Notice of Disagreement) and selected the Hearing docket.  The Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ) in September 2024.  A transcript of the hearing is of record.  Based on selection of the Hearing docket, the Board may consider evidence of record as of March 5, 2021-the date of the rating decision on appeal, and evidence submitted at or within 90 days of the September 9, 2024 Board hearing.  38 C.F.R. § 20.302.  

Service connection for right knee strain, as secondary to the right ankle disability

Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Establishing service connection requires evidence of a current disability, an in-service incurrence, disease or injury and a causal relationship between the current disability and the in-service incurrence, disease or injury.  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). 

Service connection may also be granted where a disability is proximately due to or aggravated by an already service-connected disability.  38 C.F.R. § 3.310.  To establish secondary service connection for a disability there must be (1) a current disability (for which secondary service connection is sought); (2) an existing service-connected disability, and (3) evidence that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability.  38 C.F.R. § 3.310.  See Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).  

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996).  

Initially, the Board is bound by the favorable findings in the March 2021 Rating Decision that the Veteran submitted new and relevant evidence in support of the Supplemental Claim, has a right knee disability and is service connected for the primary right ankle disability.  38 C.F.R. § 3.104(c).  The relevant question is thus whether the current right knee disability was caused or aggravated by the service-connected right ankle disability.  38 C.F.R. § 3.310.  

In support of the nexus element, the Veteran submitted a September 2020 clinical note from his private treating physician.  The private physician indicated that the pain and swelling the Veteran experienced in this right knee was more likely than not due to his right ankle ankylosis.  The private physician explained that the ankle disability changed the way the Veteran walked, resulting in stress to the right knee, which moved differently and resulted in swelling and limited range of motion.  The Board finds the opinion of the private physician adequate for adjudicative purposes as it was based on an examination of the Veteran, described the relevant conditions and included an explanatory rationale.  See Stefl v. Nicholson, 
38 C.F.R. § 3.310.  

In support of the nexus element, the Veteran submitted a September 2020 clinical note from his private treating physician.  The private physician indicated that the pain and swelling the Veteran experienced in this right knee was more likely than not due to his right ankle ankylosis.  The private physician explained that the ankle disability changed the way the Veteran walked, resulting in stress to the right knee, which moved differently and resulted in swelling and limited range of motion.  The Board finds the opinion of the private physician adequate for adjudicative purposes as it was based on an examination of the Veteran, described the relevant conditions and included an explanatory rationale.  See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

The Board acknowledges that the record also contains August 2020 and March 2021 VA medical opinions indicating that the right knee and right ankle disabilities were not related.  The VA examiners indicated that the right knee and right ankle disabilities were not medically related, and that injury to one joint does not "spread" to another joint or cause damage to it. The Board affords the August 2020 VA opinion less probative weight to the extent it relied on the lack of medical records documenting complaints of right knee pain.  See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination is inadequate where the examiner impermissibly predicates the opinion on the lack of documentation in the Veteran's service treatment records).  The March 2021 VA opinion is entitled to less probative weight based on the failure to consider the Veteran's report to the August 2020 examiner that, at times, he had an altered gait.  See id.  As noted, the private physician's opinion was based on the Veteran changing the way he walked due to the ankle disability.  

In any event, in Lynch v. McDonough, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that, under 38 U.S.C. § 5107(b), the benefit-of-the-doubt principle may be triggered where the evidence of record is nearly equal. 21 F.4th 776, 781 (Fed. Cir. 2021) (citations omitted). The Federal Circuit further explained that this interpretation of 38 U.S.C. § 5107(b) "necessarily includes scenarios where the evidence is not in equipoise but nevertheless is in approximate balance." Id.

The Board finds Lynch to be applicable here as the evidence of record is in approximate balance regarding whether the right knee disability is related to the service-connected right ankle disability. Resolving all reasonable doubt in the Veteran's favor, the Board grants the claim. 38 C.F.R. § 3.102. Thus, entitlement to service connection for a right knee disability, as secondary to the right ankle disability, is warranted. 38 C.F.R. § 3.310. 

 

 

S.C. KREMBS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Snyder, M.

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.