OSTEOARTHRITIS

Summary

The Veteran, who served from January 1969 to October 1970, including service in Vietnam, appeals the denial of service connection for left knee arthritis and bilateral hip arthritis, both claimed as secondary to a service-connected right knee disability. The Veteran is recognized as a combat veteran due to receiving the Republic of Vietnam Cross of Gallantry with Palm. The Board found evidence of an in-service injury from a jeep accident in Vietnam, but subsequent medical opinions from a March 2023 VA examiner concluded that the left knee arthritis was less likely than not related to this in-service event. The examiner noted the injury report was silent for limb pain and that the Veteran's arthritis onset was many years post-service, with extensive walking in his postal service career. The Board found this opinion highly probative. Regarding the secondary claim for left knee arthritis, the same examiner opined it was less likely than not aggravated by the service-connected right knee disability, citing a lack of evidence for altered gait or increased treatment due to the right knee issue. Similar reasoning was applied to the bilateral hip arthritis claim, with the examiner finding it less likely than not due to service or aggravated by the right knee disability, citing a lack of evidence for significant gait alteration or increased treatment. The Board found these opinions highly probative and noted the absence of contrary medical evidence. The Veteran's claims were denied as the persuasive evidence weighed against them, and the benefit of the doubt doctrine was not applied.

Rationale

No presumptive service connection for left knee arthritis.; In-service injury from jeep accident found, but no nexus to current arthritis.; March 2023 VA examiner opinion found highly probative, stating less likely than not related to service or aggravated by right knee disability.; Veteran's own statements indicated gradual onset of left knee pain post-service and secondary claim to right knee.

Full Decision Text

Citation Nr: 26000034
Decision Date: 01/05/26	Archive Date: 01/05/26

DOCKET NO. 19-05 820A
DATE: January 5, 2026

ORDER

Entitlement to service connection for a left knee arthritis disability, to include as secondary to a service-connected right knee disability, is denied.

Entitlement to service connection for a bilateral hip arthritis disability, to include as secondary to service-connected right knee disability, is denied.

FINDINGS OF FACT

1. The Veteran's left knee arthritis disability is not secondary to his service-connected right knee disability, and is not otherwise related to an in-service injury or disease.

2. The Veteran's bilateral hip arthritis disability is not secondary to his service-connected right knee disability, and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left knee arthritis disability, to include as due to service or as secondary to service-connected right knee disability, are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for a bilateral hip arthritis disability, to include as due to service or as secondary to service-connected right knee disability, are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1969 to October 1970, with

service in the Republic of Vietnam. The Veteran is in receipt of many awards and

medals, including the Vietnam Service Medal, the Vietnam Campaign Medal, and

the Republic of Vietnam Cross of Gallantry with Palm.  Given the receipt of the Republic of Vietnam Cross of Gallantry with Palm, the Board finds that the Veteran is a combat veteran per 38 U.S.C. § 1154(b).

Unfortunately, the Veteran passed away in July 2021. The Veteran's surviving

spouse has been substituted as the appellant.

These matters come before the Board of Veterans' Appeals (Board) on appeal from

an April 2016 rating decision by a Department of Veterans Affairs (VA) Regional

Office (RO).

The appellant testified before the undersigned Veterans Law Judge (VLJ) at a

March 2022 Board hearing. The transcript of the hearing is associated with the

claims file.

The Board remanded the matters on appeal for additional development in July

2022 and May 2023.  The July 2022 Board remand instructed the RO to obtain treatment information from the Veteran; obtain outstanding VA treatment records; and obtain addendum medical opinions on whether the Veteran's left knee and bilateral hip disabilities are due to his service or service-connected right knee disability.  The May 2023 Board remand instructed the RO to obtain outstanding VA treatment records.  As the RO asked the Veteran for treatment information, obtained addendum March 2023 medical opinions on whether the Veteran's left knee and bilateral hip disabilities are due to his service or service-connected right knee disability, and requested the Veteran's outstanding VA treatment records multiple times from multiple VA facilities, the Board finds there has been substantial compliance with its remand directives.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.  See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995).  Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period)
381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995).  Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309.  Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

In addition, service connection may be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310.  Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability.  38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

Entitlement to service connection for a left knee arthritis disability, to include as secondary to a service-connected right knee disability

The Veteran seeks service connection for a left knee disability, to include as secondary to service-connected right knee disability.  The Board notes that the Veteran specifically stated in a May 2016 statement in support of claim that he did not want this disability to be considered as secondary to PTSD. 

Regarding the element of a current diagnosis, the January 2018 VA knee examination report indicated that the Veteran had left knee osteoarthritis.  

Regarding presumptive service connection, as the Veteran's left knee arthritis was not diagnosed in service, within a year of his separation from service, and he did not have continuity of symptomatology, as he stated in the January 2018 VA examination report that the onset of his left knee pain was in 2007.  Therefore, presumptive service connection for left knee arthritis is not warranted.  38 C.F.R. §§ 3.307, 3.309.

Regarding the element of an in-service event, January 1970 STRs indicate that in December 1969 the Veteran fell out of a jeep while deployed in Vietnam.  The Veteran testified at his March 2022 Board hearing that when this occurred his legs and back hurt. Given the Veteran's status as a combat Veteran, and the January 1970 STRs, the Board finds that an in-service injury occurred. See 38 C.F.R. § 3.304(d), see Reeves v. Shinseki, 682 F.3d 988, 998-99 (Fed. Cir. 2012). 

Regarding a nexus between the Veteran's in service event and his left knee arthritis, the Federal Circuit has held that "[e]ven when the section 1154(b) combat presumption applies, a 'veteran seeking compensation must still show the existence of a present disability and that there is a causal relationship between the present disability and the injury, disease, or aggravation of a preexisting injury or disease incurred during active duty.'" Id. at n.9.  The March 2023 VA examiner stated that it was less likely than not that the Veteran's current left knee arthritis was due to his service.  The examiner indicated that while the Veteran noted an injury during service from being thrown from a vehicle and run over, the hospital report in the claims folder pertaining to this incident notes an eye injury and is silent for any limb pain, evaluations, or diagnosed conditions, and the nursing notes note sleeping well and no complaints related to any limb pain or joint abnormalities. The examiner indicated that the Veteran worked in the postal service for over 30 years, which required extensive walking and standing, and the Veteran's left knee arthritis was not diagnosed until many years after service. 

The Board finds this opinion to be highly probative, as it provided a fully-articulated conclusion adequately supported by medical rationale and citations to the Veteran's claims file and medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008) (holding that conclusions that are fact
 incident notes an eye injury and is silent for any limb pain, evaluations, or diagnosed conditions, and the nursing notes note sleeping well and no complaints related to any limb pain or joint abnormalities. The examiner indicated that the Veteran worked in the postal service for over 30 years, which required extensive walking and standing, and the Veteran's left knee arthritis was not diagnosed until many years after service. 

The Board finds this opinion to be highly probative, as it provided a fully-articulated conclusion adequately supported by medical rationale and citations to the Veteran's claims file and medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008) (holding that conclusions that are factually accurate, fully articulated, and contain sound reasoning contribute to the probative value of a medical opinion).  Moreover, the Veteran has not alleged that his current left knee arthritis stems from his service but rather stated many times that it is secondary to his service-connected right knee disability.  As such, the Board finds that the Veteran's left knee disability is not directly due to his in-service event. 

Regarding the question of whether the Veteran's left knee disability is caused or aggravated by his service-connected right knee disability, the Veteran testified at his March 2022 Board hearing that he thinks his left knee arthritis developed because of the impact his service-connected right knee disability had on his walking and gait.

The Board notes that as the July 2022 Board Remand found the January 2018 VA examiner's medical opinion on this matter to be inadequate for adjudicative purposes, the Board will not consider it.  

The March 2023 VA examiner opined that the Veteran's left knee disability was less likely than not aggravated by his service-connected right knee disability.  The examiner stated that there is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5cm, so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner stated that this level of severity is not supported based on record review, history, or exam. The examiner stated that it is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. The examiner indicated that there was no evidence of significantly altered gait, stance, or weight bearing status due to the Veteran's right knee disability.  The examiner additionally opined that the Veteran's left knee disability was less likely than not aggravated by his service-connected right knee disability. The examiner stated that there is no evidence of significantly altered gait, stance, or weight bearing status due to the Veteran's service-connected right knee disability.  The examiner stated that there is no evidence of flare ups, exacerbations, or increased treatment of the left knee due to the service-connected right knee disability.  The examiner stated that while a slight limp has been noted at one time in the claims folder pertaining to the Veteran's right knee, there is no evidence of a lurching type gait, which would significantly impact the left knee. 

The Board finds these opinions on secondary service connection by the March 2023 VA examiner to be highly probative, as they provide a fully-articulated conclusion adequately supported by medical rationale and citations to the Veteran's claims file and medical history. Id.  

Significantly, neither the Veteran nor his representative has presented or identified any contrary medical opinion that supports the claim for service connection for left knee arthritis.  VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician and are not permitted to substitute their own judgment on a medical matter.  Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991).  While the Veteran is competent to report the onset and continuance of lay observable symptoms, he is not competent to opine as to the etiology of his left knee disability, as to do so requires medical knowledge and training beyond that which may be expected of a lay person.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). 

While the evidence shows that the Veteran participated in a toxic exposure risk activity (TERA) during service, the Board finds that the RO is not obligated to obtain a TERA medical opinion here because the claim is based on physical
 competent to report the onset and continuance of lay observable symptoms, he is not competent to opine as to the etiology of his left knee disability, as to do so requires medical knowledge and training beyond that which may be expected of a lay person.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). 

While the evidence shows that the Veteran participated in a toxic exposure risk activity (TERA) during service, the Board finds that the RO is not obligated to obtain a TERA medical opinion here because the claim is based on physical trauma.  See 38 U.S.C. § 1158(b).  

As the persuasive evidence weighs against the claim, and the benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim, and the claim must be denied.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc)(only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Entitlement to service connection for a bilateral hip arthritis disability, to include as secondary to service-connected right knee disability

The Veteran seeks service connection for a bilateral hip disability, to include as secondary to service-connected right knee disability.  The Board notes that the Veteran specifically stated in a May 2016 statement in support of claim that he did not want this disability to be considered as secondary to PTSD.

Regarding the element of a current diagnosis, the January 2018 VA hip examination report indicated that the Veteran had bilateral hip osteoarthritis.  

Regarding presumptive service connection, as the Veteran's bilateral hip arthritis was not diagnosed in service, within a year of his separation from service, and he did not have continuity of symptomatology, as he stated in the January 2018 VA examination report that he had the gradual onset of left hip pain in 2007 and right hip pain in 2009.  Therefore, presumptive service connection for bilateral hip arthritis is not warranted.  38 C.F.R. §§ 3.307, 3.309

Regarding the element of an in-service event, January 1970 STRs indicate that in December 1969 the Veteran fell out of a jeep while deployed in Vietnam.  The Veteran testified at his March 2022 Board hearing that when this occurred his legs and back hurt. Given the Veteran's status as a combat Veteran and the January 1970 STRs, the Board finds that an in-service injury occurred. See 38 C.F.R. § 3.304(d), see Reeves v. Shinseki, 682 F.3d 988, 998-99 (Fed. Cir. 2012). 

Regarding a nexus between the Veteran's in-service injury and his current diagnosis, the Federal Circuit has held that "[e]ven when the section 1154(b) combat presumption applies, a 'veteran seeking compensation must still show the existence of a present disability and that there is a causal relationship between the present disability and the injury, disease, or aggravation of a preexisting injury or disease incurred during active duty.'" Id. at n.9.  

The March 2023 VA examiner opined that the Veteran's bilateral hip disability is less likely than not due to his service.  The examiner stated that the Veteran noted an injury during service related to being thrown from a vehicle and run over, and the hospital report in the claims folder notes eye injury and is silent for any limb pain, evaluations or diagnosed conditions, and the nursing notes note sleeping well and no complaints related to any limb pain or joint abnormalities. The examiner referred to the 2018 VA hip examination report, where the Veteran indicated that his left hip pain began in 2007 and his right hip pain began in 2009.  The examiner indicated that the Veteran has worked in the postal service for over 30 years, which has required extensive walking and standing.  The examiner noted that the Veteran's bilateral hip arthritis was not diagnosed until many years after service.  

The Board finds this opinion to be highly probative, as it provided a fully-articulated conclusion adequately supported by medical rationale and citations to the Veteran's claims file and medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008) (holding that conclusions that are factually accurate, fully articulated, and contain sound reasoning contribute to the probative value of a medical opinion).  Moreover
 hip pain began in 2009.  The examiner indicated that the Veteran has worked in the postal service for over 30 years, which has required extensive walking and standing.  The examiner noted that the Veteran's bilateral hip arthritis was not diagnosed until many years after service.  

The Board finds this opinion to be highly probative, as it provided a fully-articulated conclusion adequately supported by medical rationale and citations to the Veteran's claims file and medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008) (holding that conclusions that are factually accurate, fully articulated, and contain sound reasoning contribute to the probative value of a medical opinion).  Moreover, the Veteran has not alleged that his current bilateral hip arthritis stems from his service but rather stated that it is secondary to his service-connected right knee disability.

Regarding the question of whether the Veteran's bilateral hip disability is caused or aggravated by his service-connected right knee disability, the Veteran testified at his March 2022 Board hearing that he thinks his bilateral hip arthritis developed because of the impact his service-connected right knee disability had on his walking and gait.

The Board notes that as the July 2022 Board Remand found the January 2018 VA examiner's medical opinion on this matter to be inadequate for adjudicative purposes, the Board will not consider it.  

The March 2023 VA examiner opined that the Veteran's bilateral hip disability is less likely than not due to his service-connected right knee disability.  The examiner stated that there is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5cm, so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner stated that this level of severity is not supported based on record review, history, or exam. The examiner stated that it is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it.  The examiner additionally opined that the Veteran's bilateral hip disability was less likely than not aggravated by his service-connected right knee disability.  The examiner stated that there is no evidence of significantly altered gait, stance, or weight bearing status due to the right knee disability, and there is no evidence of flare ups, exacerbations, or increased treatment of the bilateral hips due to the right knee disability.  The examiner stated that a slight limp has been noted at one time in the claims folder pertaining to the right knee disability, but there is no evidence of a lurching type gait which could significantly impact the bilateral hips. 

The Board finds these opinions of the March 2023 VA examiner to be highly probative, as they provided a fully-articulated conclusion adequately supported by medical rationale and citations to the Veteran's claims file and medical history.  Id. 

Significantly, neither the Veteran nor his representative has presented or identified any contrary medical opinion that supports the claim for service connection for bilateral hip arthritis.  VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician and are not permitted to substitute their own judgment on a medical matter.  Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991).  While the Veteran is competent to report the onset and continuance of lay observable symptoms, he is not competent to opine as to the etiology of his bilateral hip disability, as to do so requires medical knowledge and training beyond that which may be expected of a lay person.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).  

While the evidence shows that the Veteran participated in a toxic-exposure risk activity (TERA) during service, the Board finds that the RO is not obligated to obtain a TERA medical opinion here because the claim is based on physical trauma.  See 38 U.S.C. § 1158(b).  

As the persuasive evidence weighs against the claim, and the benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim, and the claim must be denied.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc)(