KNEE IMPAIRMENT OF

B. D. WATSON · 2025 · Case ID: 25013433

DENIED

Summary

The veteran, who served in the U.S. Air Force from May 1984 to March 1988, appeals the denial of service connection for multiple conditions, including a right knee condition, bilateral shoulder conditions, a left knee condition, a low back condition with right leg pain, hypertension, headaches, a respiratory condition, and a psychiatric disorder. The veteran also sought secondary service connection for all these conditions to a right knee condition. The Board denied all claims, finding the persuasive weight of the evidence against service connection for the primary conditions. For the right knee, the Board noted that service treatment records were silent regarding in-service complaints or treatment, and the veteran did not seek treatment for right knee pain until nearly 20 years after separation. VA examinations in 2018 and 2020 found the condition less likely than not related to service, citing the lack of continuity of symptomatology and intervening injuries or conditions as more likely causes. The Board found the veteran competent to report symptoms but not to medically attribute them to service. For the secondary claims, the Board denied them because the veteran was not service-connected for the primary right knee condition, rendering secondary service connection unavailable. The Board also found that the veteran failed to provide sufficient specifics describing an in-service event for the bilateral shoulders, left knee, or low back conditions, and thus did not meet the McLendon test for remand to obtain further examinations. For hypertension, headaches, and respiratory conditions, the Board found the evidence against service connection, noting the lack of in-service complaints and the significant time lapse before symptoms appeared. While TERA examinations were conducted, the Board found the medical literature did not support a link between the veteran's noted exposures and these conditions. The Board also denied the psychiatric claim, finding the veteran's depression was more likely related to post-service ankle and knee injuries rather than service, and that her claims of in-service depression lacked detail and corroboration.

Rationale

Service treatment records silent regarding in-service complaints or treatment for right knee condition.; Veteran sought treatment for right knee pain nearly 20 years after service.; VA examinations found condition less likely than not related to service due to lack of continuity and intervening injuries.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

13-31 705

Full Decision Text

Citation Nr: 25013433
Decision Date: 10/29/25 Archive Date: 10/29/25

DOCKET NO. 13-31 705
DATE: October 29, 2025

ORDER

Entitlement to service connection for a right knee condition is denied.

Entitlement to service connection for a right shoulder condition, to include as secondary to a right knee condition, is denied.

Entitlement to service connection for a left shoulder condition, to include as secondary to a right knee condition, is denied.

Entitlement to a low back condition with right side leg pain, to include as secondary to a right knee condition, is denied.

Entitlement to service connection for a left knee condition, to include as secondary to a right knee condition, is denied.

Entitlement to service connection for hypertension, to include as secondary to a right knee condition, is denied.

Entitlement to service connection for headaches, to include as secondary to a right knee condition, is denied.

Entitlement to service connection for a respiratory condition, to include as secondary to a right knee condition, is denied.

Entitlement to service connection for a psychiatric disorder, to include as secondary to a right knee condition, is denied.

FINDINGS OF FACT

1. The persuasive weight of the evidence is against finding the Veteran's current right knee condition is related to her service.

2. The persuasive weight of the evidence is against finding the Veteran had an in-service injury, event, or disease that resulted in a right shoulder condition, and she is not service connected for a right knee condition; thus, secondary service connection cannot be considered.

3. The persuasive weight of the evidence is against finding the Veteran had an in-service injury, event, or disease that resulted in a left shoulder condition, and she is not service connected for a right knee condition; thus, secondary service connection cannot be considered.

4. The persuasive weight of the evidence is against finding the Veteran had an in-service injury, event, or disease that resulted in a low back condition with right leg pain, and she is not service connected for a right knee condition; thus, secondary service connection cannot be considered.

5. The persuasive weight of the evidence is against finding the Veteran had an in-service injury, event, or disease that resulted in a left knee condition, and she is not service connected for a right knee condition; thus, secondary service connection cannot be considered.

6. The persuasive weight of the evidence is against finding the Veteran's hypertension is related to her service, to include in-service toxic exposures. Additionally, as she is not service connected for a right knee condition, secondary service connection cannot be considered.

7. The persuasive weight of the evidence is against finding the Veteran's headaches are related to her service, to include in-service toxic exposures or as secondary to a right knee condition. Additionally, as she is not service connected for a right knee condition, secondary service connection cannot be considered.

8. The persuasive weight of the evidence is against finding the Veteran's respiratory conditions, to include asthma and chronic sinusitis, are related to her service, to include in-service toxic exposures. Additionally, as she is not service connected for a right knee condition, secondary service connection cannot be considered.

9. The persuasive weight of the evidence is against finding the Veteran's psychiatric condition is related to her service, and she is not service connected for a right knee condition, thus secondary service connection cannot be considered.

CONCLUSIONS OF LAW

1. The criteria for service connection for a right knee condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a right shoulder condition, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a left shoulder condition, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection fora low back condition, to include as secondary to a right knee condition, with right side leg pain have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for a left knee condition, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 510
. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for a left knee condition, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for hypertension, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for headaches, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a respiratory condition, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for Entitlement to service connection for a psychiatric disorder, to include as secondary to a right knee condition, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Air Force from May 1984 to March 1988. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

These matters were last before the Board in April 2025, at which time they were remanded in order for the RO to resend the April 2024 Board Remand, May 2024 letter regarding outstanding private treatment records, the November 2024 Statement of the Case, and all other pertinent correspondence to the address listed in the December 2024 Report of General Information. The Board notes that the RO complied with these instructions in April 2025. Additionally, the Board further notes the RO has substantially complied with its previous instructions to obtain any outstanding military personnel records, VA treatment records, and community care records, as well as medical examinations regarding the claims for hypertension, a respiratory condition, and headaches. See Stegall v. West, 11 Vet. App. 268, 271 (1998).

Service Connection

Service connection will be granted if the evidence in the record demonstrates that a current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) an in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Briefly, the threshold legal requirements for a successful secondary service connection claim are: (1) Evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. 38 C.F.R. § 3.310.

The Veteran is competent to report symptoms experienced. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, she is not considered competent to medically attribute such symptoms to any particular disability because such is a complicated medical issue that requires medical knowledge and expertise that the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428. 435 (2011); Buchanan v. Nicholson, 451 F.3d
secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. 38 C.F.R. § 3.310.

38 U.S.C. § 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006).

Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Saunders elements is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309 (a). Arthritis is subject to presumptive service connection. Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service within one year at separation. 38 C.F.R. § 3.303 (d).

1. Entitlement to service connection for a right knee condition is denied.

The Veteran contends that her right knee degenerative joint disease is related to her service.

Service treatment records (STRs) are silent regarding any in-service treatment for or complaints of a right knee condition. The Board does note that while the veteran's November 1983 prescreening form shows she reported experiencing a previous right knee injury that had since resolved, it ultimately concluded that there was no clear and unmistakable evidence that the Veteran had a preexisting right knee condition upon entry into service. Thus, the Veteran was sound upon her entry into the Air Force.

VA treatment records show the Veteran first reported experiencing right knee pain in December 2004 for a week, and a June 2008 treatment note shows the Veteran had a 3-year history of right knee pain, which is almost 17 years after separation. She was also diagnosed with degenerative joint disease in March 2008, a right knee meniscus tear in June 2008, right knee arthralgia in July 2008, and deep vein thrombosis of the lower extremity (behind the right knee) in January 2010. In a June 2008 VA treatment note, the Veteran reported experiencing increased right knee pain, and she explained that she was on her feet all day due to working at Six Flags, although she wore orthotic shoes with inserts to try and absorb any impact. Additionally, in a July 2008 treatment note discussing imaging results for the Veteran's right knee, she reported having twisted her knee and hearing a loud pop while at the grocery store in December 2005, and she had been experiencing right knee pain ever since.

Social Security Administration (SSA) records show the Veteran reported experiencing bilateral knee pain following her right ankle fracture and resulting complications, including deep vein thrombosis behind her right knee. These records also show the Veteran reported working for multiple seasons at Six Flags prior to her right ankle fracture.

The Veteran underwent VA examinations in November 2010, January 2018 and October 2020. The Board previously found the November 2010 and January 2018 examinations to be inadequate due to the examiner's finding the Veteran had a right knee condition prior to service. However, the Board notes that this does not automatically render the entirety of either examination inadequate, and future examinations can correct for any inadequacies.

While the January 2018 examiner found the Veteran had a preexisting right knee injury, they also
bilateral knee pain following her right ankle fracture and resulting complications, including deep vein thrombosis behind her right knee. These records also show the Veteran reported working for multiple seasons at Six Flags prior to her right ankle fracture.

While the January 2018 examiner found the Veteran had a preexisting right knee injury, they also provided rationale in support of their negative nexus opinion that can stand on its own, regardless of whether the Veteran had a preexisting injury. The examiner noted that the Veteran's STRs were silent with respect to any complaints of or treatment related to her right knee, including upon separation. Additionally, the examiner pointed to the Veteran's VA treatment records where she first began complaining of bilateral knee pain around 2006 and was diagnosed with right knee degenerative joint disease in 2008, almost 20 years after separation. Moreover, the examiner noted the Veteran was obese, which puts increased stress on the joints and increased the likelihood of developing osteoarthritis.

In the October 2020 VA examination, the Veteran reported that she slipped on either ice or snow around 1985 and twisted her knee. She stated that she was treated with Tylenol for a possible contusion on her right knee. She further reported that she began to experience chronic knee pain after she separated from service. The examiner ultimately found that the Veteran's right knee condition was less likely than not related to her service. They noted that the Veteran's STRs did not show any complaints of or treatments related to a right knee condition. The examiner also found the Veteran's fall in 2009 was more likely than not the cause of her meniscus tear. The examiner further noted that VA treatment records show the Veteran reported experiencing right knee pain around 2005, nearly 20 years after service.

Upon review of the record, the Board finds the persuasive weight of the evidence is against finding the Veteran's current right knee condition is related to her service. Regarding the January 2018 and October 2020 examinations, while the examiners point to the fact that the Veteran's STRs are silent regarding right knee conditions during service, this is not the sole basis for their negative nexus opinions. Both examiners note that the Veteran did not seek treatment for right knee pain until around 2006, indicating a lack of continuity of symptomatology, while the October 2020 examiner pointed to the Veteran's 2009 fall, right ankle fracture, and resulting impacts on her right knee as a more likely cause for her current knee conditions. The Board notes that the October 2020 examiner focused more on the Veteran's right knee issues following her 2009 right ankle injury; however, this does not negate the examiner's findings that the Veteran did not complain of knee pain until nearly 20 years following service. Additionally, with respect to the Veteran's reports that her knee pain began around 2005 and her diagnosis of right knee meniscus tear in June 2008, the Board notes that VA treatment records clearly show an intervening injury as the direct cause of this condition. A June 2008 treatment note shows the Veteran reported being on her feet all day at her job at Six Flags, although she wore orthotic shoes to help with any impact. A July 2008 VA treatment note during an imaging appointment shows the Veteran had a three year history of knee pain after she twisted her right knee and heard a loud pop while at the grocery store in December 2005. The imaging results confirmed the Veteran had a right knee linear tear of the posterior horn meniscus. Therefore, the Board finds that the culmination of the VA treatment notes and the January 2018 and October 2020 examinations supports the conclusion that the Veteran's current right knee condition is less likely than not related to her service.

The Board acknowledges the Veteran's lay statements that she injured her right knee in a fall in 1985 and that she has experienced right knee pain since separation. However, while the Veteran is competent to provide testimony relating to the aforementioned, she is not competent to medically attribute such symptoms to any particular disability because such is a complicated medical issue that requires medical knowledge and expertise that the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428. 435 (2011); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006).

In sum, the Board finds that the persuasive weight of the evidence is against finding that the
.

In sum, the Board finds that the persuasive weight of the evidence is against finding that the Veteran's right knee condition is related to her service. As the evidence persuasively weighs against the claim, the benefit-of- the-doubt doctrine does not apply, and entitlement to service connection for a right knee condition is denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for a right shoulder condition, to include as secondary to a right knee condition, is denied.

3. Entitlement to service connection for a left shoulder condition, to include as secondary to a right knee condition, is denied.

4. Entitlement to a low back condition with right side leg pain, to include as secondary to a right knee condition, is denied.

5. Entitlement to service connection for a left knee condition, to include as secondary to a right knee condition, is denied.

The Veteran contends that her bilateral shoulder conditions, left knee condition, and low back condition with right leg pain are either related to her service or are otherwise secondary to a right knee condition.

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, while the Veteran has diagnoses of degenerative joint disease of the left knee, bilateral shoulder pain, and anterolisthesis with sciatica, the evidence of record persuasively weighs against finding that any of these conditions began during active service, or are otherwise related to an in-service injury, event, or disease.

While the Veteran believes the above disabilities are related to her service, she failed to provide any statements regarding an in-service injury, event, or illness that resulted in any of these conditions. Additionally, although the Veteran mentioned suffering an in-service fall in 1985, she indicated that only her right knee was injured and reported no additional pain or other symptoms related to her left knee, shoulders, back, or right leg sciatica. Thus, this fall would not constitute an in-service event with respect to these claimed conditions.

The Veteran has also raised the theory that the above claimed conditions are all secondary to her right knee condition. As noted earlier in this decision, secondary service connection is warranted when a current disability is found to be either caused or aggravated by a service-connected condition. However, in this instance, the Veteran is not service connected for a right knee condition and thus is ineligible for service connection on a secondary basis.

The Board notes the Veteran has not been afforded a VA examination for her left knee, bilateral shoulders, or low back with sciatica. In McLendon v. Nicholson, 20 Vet. App. 79 (2006), the United States Court of Appeals for Veterans Claims indicated that there was a four-part test to determine whether an examination was necessary under 38 C.F.R. § 3.159 (c)(4). Id. at 81. Under this test, VA will provide a medical examination or obtain a medical opinion where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence to make a decision on the claim. Id.; see also 38 C.F.R. § 3.159 (c)(4).

As noted above, the Veteran has current diagnoses of degenerative joint disease of the left knee, bilateral shoulder pain, and anterolisthesis with sciatica. Thus, the first element is met. Regarding the second and third elements, the Veteran has not provided enough specifics describing an in-service event, illness, or disease related to her claimed conditions. Additionally, although she also contends that these conditions are secondary to a right knee condition, she is not currently service connected for any conditions, let alone a right knee condition. Thus, the second and third McLendon elements are not met. As such, the Veteran's claim fails the McLendon
. Id.; see also 38 C.F.R. § 3.159 (c)(4).

Accordingly, the Board finds that the persuasive weight of the evidence is against finding that the Veteran's bilateral shoulder conditions, left knee condition, or low back condition with right leg pain are related to her service. As the evidence persuasively weighs against these claims, the benefit-of- the-doubt doctrine does not apply, and the claims must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

6. Entitlement to service connection for hypertension, to include as secondary to a right knee condition, is denied.

7. Entitlement to service connection for headaches, to include as secondary to a right knee condition, is denied.

8. Entitlement to service connection for a respiratory condition, to include as secondary to a right knee condition, is denied.

The Veteran contends that her hypertension, headaches, and respiratory conditions are related to service.

The Veteran's STRs show that she was treated for several upper respiratory infections and sinusitis during service. However, they are silent with respect to any blood pressure readings indicative of or treatment for hypotension, as well as any complaints of or treatment related to headaches. VA treatment records show the Veteran was diagnosed with hypertension around 1999, chronic sinusitis and allergic rhinitis around 2002, asthma around 2004, and with migraines around 2006.

The Veteran was afforded VA respiratory examinations in February 2015 and October 2020, with the Board previously finding the February 2015 examination to be inadequate.

In the October 2020 examination, the examiner noted the Veteran's diagnosis of sinusitis and rhinitis in 2002 occurred 14 years following separation, and they referenced an asthma diagnosis from 2011, which was 23 years following separation. After reviewing the record, the examiner concluded that the Veteran's current respiratory conditions were less likely than not related to her service because her in-service respiratory infections, bronchitis, and sinusitis were acute or viral, self-limited, and usually resolved without residuals. They further noted the Veteran's record was silent regarding any exposure to airborne pollutants that may have predisposed the Veteran to developing asthma, rhinitis, or sinusitis. However, the Board notes that since the October 2020 examination, Congress passed the PACT Act, which expands the toxins and other exposures to be considered when providing a medical opinion. Thus, the Board finds the October 2020 examination to be inadequate with respect to whether the Veteran's respiratory conditions are related to in-service exposures.

VA issued toxic exposure risk activity (TERA) memoranda in March 2023 and May 2024. In the March 2023 memorandum, the RO noted the Veteran was exposed to hazardous cargo and packing explosives as part of her job duties. The May 2024 memorandum specified the Veteran was exposed to noise, exhaust, fumes, gasoline, mixed dust, exhausted mineral oils, liquid aerosol, vapor from solvents, and fuels from driving and maintaining vehicles.

TERA examinations were conducted in April 2023, August 2023, and October 2024.

In the April 2023 opinion, the examiner noted the Veteran's headaches and respiratory conditions were "gulf war presumptive condition" and her hypertension was a presumptive condition related to agent orange exposure. However, they found it was less likely than not that any of these conditions were related to the Veteran's non-deployment related exposures.

The August 2023 addendum TERA opinion noted that the Veteran's STRs were silent regarding exposure to airborne pollutants that could predispose her to developing asthma, sinusitis, or rhinitis. They explained they were unable to find any literature or documentation showing a relationship between the Veteran's exposures as a crating prevention specialist and the development of asthma, sinusitis, rhinitis, headaches, or hypertension.

In the October 2024 TERA opinions, the examiner referenced the exposures noted in the May 2024 T
" and her hypertension was a presumptive condition related to agent orange exposure. However, they found it was less likely than not that any of these conditions were related to the Veteran's non-deployment related exposures.

In the October 2024 TERA opinions, the examiner referenced the exposures noted in the May 2024 TERA memorandum. However, they again found that the medical literature did not support the conclusion that any of these exposures could lead to the development of the Veteran's respiratory conditions, headaches, or hypertension.

After reviewing the record, the Board finds that the persuasive weight of the evidence is against finding the Veteran's respiratory conditions, hypertension, or headaches are related to her service. Although the Veteran was noted as having upper respiratory infections, bronchitis, and sinusitis during service, the Board finds the October 2020 examiner's opinion that these in-service occurrences were acute and viral in nature to be persuasive, especially seeing as the Veteran did not report any respiratory-related symptoms until almost 15 years after she separated from service. As for whether any of these conditions were due to in-service exposures related to the Veteran's duties, the Board finds the August 2023 and October 2024 TERA opinions to be probative, seeing as both examiners reference both the Veteran's exposures and a noted lack of medical literature supporting a relationship between any of these kinds of exposures and the development of the Veteran's asthma, rhinitis, sinusitis, hypertension, or headaches.

As for the Veteran's assertions that her respiratory conditions, hypertension, and headaches are secondary to her right knee condition, the Board notes that she is not service connected for a right knee condition. Thus, secondary service connection is not available for any of her claimed conditions.

The Board acknowledges the Veteran's contentions that her respiratory conditions are related to her service However, while the Veteran is competent to provide testimony relating to the aforementioned, she is not competent to medically attribute such symptoms to any particular disability because such is a complicated medical issue that requires medical knowledge and expertise that the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428. 435 (2011); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006).

Therefore, for the reasons above, the Board finds that the persuasive weight of the evidence is against finding that the Veteran's hypertension, headaches, or respiratory conditions are related to her service. As the evidence persuasively weighs against the claims, the benefit-of- the-doubt doctrine does not apply, and these claims must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

9. Entitlement to service connection for a psychiatric disorder, to include as secondary to a right knee condition, is denied.

The Veteran contends that her depression is either related to her service or is secondary to her right knee condition.

The Veteran reported that she was treated for depression during service. However, STRs are silent regarding any complaints of or treatment for a psychiatric condition, to include depression. The Veteran has provided no lay statements discussing experiences during service that could be the cause of her current depression.

In an August 2010 SSA psychiatric evaluation, the Veteran reported experiencing the onset of significant medical problems after falling and breaking her ankle in March 2009, which eventually led to deep vein thrombosis behind her right knee in October 2009 and a surgery in November 2009. She also described continuing to experience extreme pain, even after attending physical therapy in 2010. The examiner noted a diagnosis of depression and a pain disorder, stating that the Veteran's depressive features are compounded by her pain perception related to her broken ankle and associated residuals.

In the February 2011 VA mental health examination, the examiner found a diagnosis of adjustment disorder with depressed mood. The Veteran reported no military disciplinary action, adjustment problems, substance use disorders, or combat experience during service. The examiner stated that the Veteran's depression was secondary to having broken her ankle in March 2009 and her belief that she was not afforded adequate care and attention following that injury in order to recover. The examiner further noted that the Veteran also reported having depression while in the military, although she explained that her current experience with depression was much worse than what she had previously experienced. However, the Veteran did not describe any experiences she had while in the military that resulted in feelings of or treatment for depression
her broken ankle and associated residuals.

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, while the Veteran has a current diagnosis of depression, the evidence of record persuasively weighs against finding that her depression began during active service or is otherwise related to an in-service injury, event, or disease.

While the Veteran believes her depression is related to her service, she failed to provide any statements regarding an in-service injury, event, or illness that resulted in her developing depression or another psychiatric condition. The two statements that she was treated for depression during service, made in November 2010 and during the February 2011 examination, are insufficient to constitute an in-service event, especially seeing as the Veteran's STRs fail to reflect any in-service treatment, and the Veteran has failed to provide any details related to her depression during service.

Additionally, the Board finds the August 2010 SSA psychiatric evaluation and the February 2011 VA examination findings that the Veteran's depression is secondary to breaking her right ankle in 2009 and the resulting right knee deep vein thrombosis and other associated residuals to be persuasive. When discussing her depression with both examiners, the Veteran repeatedly discussed how it was related to her right ankle break and the insufficient medical care she received that has since led to additional medical issues and continued pain. While the Board expresses sympathy for the Veteran and her overall situation, the evidence of record does not support finding that her depression is directly related to her service. As for the theory that the Veteran's depression is secondary to her right knee condition, while this may be true due to the pain and limitations she experiences as a result of her right ankle break and residuals related to right knee deep vein thrombosis, the Veteran is not currently service connected for a right knee condition. Therefore, service connection on a secondary basis is not available.

(continued on next page)

Accordingly, for the reasons above, the Board finds that the persuasive weight of the evidence is against finding that the Veteran's depression is related to her service. As the evidence persuasively weighs against the claim, the benefit-of- the-doubt doctrine does not apply, and the claim must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ongies, Gabrielle L.

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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