KNEE IMPAIRMENT OF

JIMMY L. BARDIN · 2025 · Case ID: 25011930

MIXED

Summary

The Veteran, a veteran who served from July 1966 to July 1968, including service in Vietnam, appeals the denial of service connection for a bilateral eye disability and the grant of service connection for a right leg disability. The Board granted service connection for the right leg disability, finding the evidence in equipoise and resolving all reasonable doubt in the Veteran's favor. The Board noted current diagnoses of right knee osteoarthritis, strain, and patellofemoral pain syndrome, and found the second element (in-service injury) met due to conceded combat service, herbicide exposure, and the theory of cumulative service impact. While acknowledging conflicting medical opinions, the Board found the September 2024 VA opinion, which linked the leg disability to service and noted herbicide agents' link to peripheral neuropathy, persuasive enough to grant service connection. For the bilateral eye disability, claimed as secondary to service-connected diabetes, the Board denied the claim. Current diagnoses of dry eye syndrome and residuals of bilateral cataracts were noted, meeting the first element. The second element (in-service injury/aggravation or secondary to service-connected diabetes) was met due to conceded combat service, herbicide exposure, and service connection for diabetes. However, all medical opinions were against the claim. VA examiners opined that the eye conditions were less likely than not related to service, citing age-related changes, lack of in-service documentation, and the controlled nature of the Veteran's diabetes. The Board found these opinions adequate and probative, outweighing the Veteran's lay assertions, and therefore denied service connection for the bilateral eye disability.

Rationale

Current diagnoses of right leg disability; In-service injury/aggravation conceded (combat, herbicide exposure, cumulative service impact); Conflicting medical opinions, but Board found September 2024 VA opinion persuasive for nexus

Special Benefit

NO SPECIAL BENEFIT

Docket No.

19-00 064

Full Decision Text

Citation Nr: 25011930
Decision Date: 09/22/25 Archive Date: 09/22/25

DOCKET NO. 19-00 064
DATE: September 22, 2025

ORDER

Entitlement to service connection for a right leg disability is granted.

Entitlement to service connection for a bilateral eye disability, to include bilateral cataracts, as secondary to service-connected type 2 diabetes mellitus (diabetes), is denied.

FINDINGS OF FACT

1. The Veteran's right leg disability is etiologically related to service.

2. The evidence demonstrates that the Veteran's bilateral eye disability is not attributable to his active-duty service or secondary to his diabetes.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a right leg disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

2. The criteria for entitlement to service connection for a bilateral disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1966 to July 1968, to include service in Vietnam.

These matters initially came to the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) that, among other things, denied the claims of service connection for a right leg condition and vision impairment.

This case was previously before the Board in January 2020, April 2023, March 2024, and March 2025. In the most recent Board decision, it fully granted the Veteran's claim for a total disability rating based on individual unemployability and remanded the issues before us today for follow-on VA medical examinations. After careful consideration of the record and the examinations procured, the Board finds the AOJ substantially complied with our remand directives and we shall proceed with adjudication.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection generally requires evidence showing (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38C.F.R. §3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

When there is an approximate balance of evidence for and against an issue, all reasonable doubt will be resolved in the Veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Of note, the Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that every piece of the considerable evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

1. Entitlement to service connection for right leg disability is granted.

Here, the Veteran has current diagnoses of right knee joint osteoarthritis, knee strain, and patellofemoral pain syndrome. See September 2024 and May 2025 VA examinations
Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

1. Entitlement to service connection for right leg disability is granted.

Here, the Veteran has current diagnoses of right knee joint osteoarthritis, knee strain, and patellofemoral pain syndrome. See September 2024 and May 2025 VA examinations reports. Thus, element one of service connection is met.

Regarding the second element, in-service injury, herbicide agent exposure is conceded, and combat service is conceded. Additionally, the theory of in-service injury due to the effects of the cumulative impact of his service and his military occupational specialty (MOS) is raised. Thus, element two of service connection is met.

Regarding the third element, medical nexus, there are opinions in favor of and against the claim. For the claim, is the September 2024 VA opinion wherein the examiner opines that the Veteran's right leg disability is at least as likely as not incurred or caused by service, noting the Veteran's right leg symptoms of cramps and pain (presumably) rising to the level of functional impairment to constitute a disability. The examiner goes on to state that herbicide agents are linked to peripheral neuropathy that can cause a leg disability. The examiner also notes osteoarthritis of the knee and that those changes can contribute to pain and decreased mobility of the knee and lower leg.

Against the claim is the January 2025 VA opinion wherein the examiner opines that the claimed right knee joint arthritis and degenerative arthritis are less likely than not related to service. The examiner reasons that if the in-service injury were the cause there would likely be symptoms during or soon after service; however, there is a significant gap in documentation that does not reflect the condition originating in service, and instead, the condition is likely to be due to his post-discharge lifestyle, activities, medical history, and age. The examiner also cites the fact that also the Veteran asserts his MOS and/or exposure to herbicide agents caused his leg disability, objective evidence from the period of service shows the Veteran denied any such leg issue.

Also against the claim is a May 2025 VA opinion wherein the examiner opines that the Veteran's leg disability is not related to service as there is no medical record or evidence during service of right knee pain or right leg cramping. The examiner notes the current diagnoses are mechanical in nature, are medically well-known to be caused by excessive use and wear and tear, and no medical literature demonstrates these disabilities are related to herbicide agent exposure.

Based on the above opinions and review of the file, the Board finds that the evidentiary record is at least in equipoise as to whether or not the Veteran has a current right leg disability related to service. However, the Board is able to ascertain from the record that the Veteran has a current diagnosis and that the record is in relative equipoise as to whether or not his current diagnosis of a right leg disability is related to service. In resolving all reasonable doubt in favor of the Veteran, the Board finds that the third element of service connection is met for the Veteran's right leg disability.

As reasonable doubt must be resolved in favor of the Veteran, entitlement to service connection for a right leg disability, is GRANTED. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303.

2. Entitlement to service connection for a bilateral eye disability, to include bilateral cataracts, as secondary to service-connected diabetes, is denied.

Here, the Veteran has current diagnoses of dry eye syndrome and residuals of bilateral cataracts, to include, bilateral pseudophakia and bilateral intraocular lenses. See December 2016, June 2024, and May 2025 VA examination reports. Thus, element one of service connection on a direct and secondary basis is met.

Regarding the second element, in-service injury, herbicide agent exposure is conceded, and combat service is conceded. Additionally, the Veteran is service connected for diabetes. Thus, element two of service connection on a direct and secondary basis is met.

Regarding the third element, medical nexus, all of the opinions are against the claim. A December 2016 VA opinion was written wherein the examiner notes that the Veteran's bilateral pseudophakia is a condition due to his cataract lens extraction during surgery performed in 2016 and opined that it is therefore not likely that the diabetes mellitus caused his pseudophakia. The examiner goes on to state that the clinical literature relates cataract formation with uncontrolled diabetes, and, since the Veteran's diabetes condition is controlled (and there is no evidence of diabetic neuropathy on either eye upon examination), it is not likely that the diabetes condition caused the cataracts on the Veteran's eyes.

In a June 2024 VA opinion, the examiner opines that the Veteran's eye condition is less likely than not related to service, reasoning the Veteran has chronic dry eye syndrome and that that diagnosis does not show a correlation and/or have supporting evidence confirming that dry eye syndrome is related to herbicide agent exposure. The examiner reasons that the Veteran did not have dry eye syndrome prior to military service, there was no record of dry eye syndrome during military service or within one year of separation from service to state that since he did not have dry eye syndrome during military service, his dry eye syndrome could not be the same now as it was then.

In a May 2025 VA opinion, the examiner states that nuclear sclerosis, a type of cataract, is a natural age-related hardening and clouding of the eye's nucleus lens and is a common condition and has a complex relationship with diabetes. The Board is able to extrapolate from the opinion that the examiner opines that the Veteran's eye condition is not proximately related to or aggravated by his diabetes, as this is an age-related condition and because the Veteran's diabetes is controlled. See Bufkin v. McDonough, 75 F.4th 1368 (Fed. Cir. 2023) citing Jackson v. Virginia, 443 U.S. 307, 319 (1979) (stating it is "the responsibility of the trier of fact fairly to . . . draw reasonable inferences from basic facts to ultimate facts"); Bastien v. Shinseki, 599 F.3d 1301, 1306 (Fed. Cir. 2010) ("The evaluation and weighing of evidence and the drawing of appropriate inferences from it are factual determinations committed to the discretion of the fact finder."). The examiner also opines that there is no evidence seen for aggravation of nuclear sclerosis documents in medical records. Finally, the examiner opines that there is no relationship between herbicide agent exposure and nuclear sclerosis.

When read together, the Board finds these opinions adequate and probative, as the examiners considered the pertinent medical history and included a cogent rationale for their conclusion.

There is no competent opinion to the contrary. To the extent that the Veteran asserts that his eye condition is the result of service or secondary to his diabetes, the Board finds that while he is competent to report observed symptomatology, he is not competent to opine as to the etiology of an eye condition, as such a determination is a complex medical question that is beyond the ken of a layperson. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

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Accordingly, the greater weight of evidence is against the claim of entitlement to service connection for an eye disability. As such, the benefit of the doubt doctrine is not for application, and service connection on a direct and secondary basis must be DENIED. See 38 U.S.C. § 5107(b).

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. J. Rogers, Associate Counsel

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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