KNEE IMPAIRMENT OF

LESLEY A. REIN · 2026 · Case ID: 26001394

MIXED

Summary

The veteran, who served from December 1973 to December 1999 with multiple periods of service, appeals the denial of service connection for bilateral leg and foot disabilities, and the remand of his low back disability claim for an increased rating and TDIU. The Board denied service connection for the leg and foot claims, finding that the evidence did not demonstrate that these conditions manifested during service, were related to an in-service injury, or were secondary to his service-connected low back condition. While the veteran reported leg and foot pain and had some post-service diagnoses of degenerative changes, the Board found his lay statements lacked probative value due to inconsistencies and the absence of specific treatment for these conditions during service. The Board also noted the veteran's failure to attend multiple scheduled VA examinations for these conditions without good cause, which precluded further development. The Board acknowledged the veteran's low back condition was remanded for a supplemental opinion on its severity and potential for ankylosis, and that the TDIU claim was inextricably intertwined with the low back remand. Service connection for the bilateral leg and foot disabilities was denied.

Rationale

No evidence of in-service manifestation or relation to in-service injury; Lay statements lacked probative value due to inconsistencies; No specific treatment for leg issues during service; Failure to attend VA examinations

Special Benefit

TDIU

Docket No.

13-03 384

Full Decision Text

Citation Nr: 26001394
Decision Date: 01/30/26 Archive Date: 01/30/26

DOCKET NO. 13-03 384
DATE: January 30, 2026

ORDER

Entitlement to service connection for a bilateral leg disability, to include as due to service-connected low back disability, is denied.

Entitlement to service connection for a bilateral foot disability, to include as due to service-connected low back disability, is denied.

REMANDED

Entitlement to an initial disability rating in excess of 10 percent for low back disability is remanded.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded.

FINDINGS OF FACT

1. The evidence does not demonstrate that the Veteran's bilateral leg disability, to include degenerative changes in both knees, manifested during active service, within one year of separation, is otherwise etiologically related to an in-service injury or event, or is secondary to the service-connected low back disability.

2. The evidence does not demonstrate that the Veteran's bilateral foot disability, to include degenerative disease of the feet, manifested during active service, within one year of separation, is otherwise etiologically related to an in-service injury or event, or is secondary to the service-connected low back disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral leg disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

2. The criteria for service connection for bilateral foot disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1973 to December 1975, from March 1977 to November 1986, and from September 1990 to September 1999.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This case has been previously remanded by the Board in January 2020, November 2020, August 2022, and October 2023. The Board is satisfied that there was substantial compliance with the prior remand with regards to the service connection claims for bilateral leg disability and bilateral foot disability. See Stegall v. West,?11?Vet. App.?268, 271?(1998);?D'Aries?v. Peake,?22?Vet. App.?97, 105?(2008). Additionally, the Board finds that there has been substantial compliance with its prior remand directives regarding scheduling a VA examination to determine the current nature and severity of the Veteran's low back disability. Id.

Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159.

The Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).

Service Connection

1. Entitlement to service connection for a bilateral leg disability, to include as due to low back disability, is denied.

2. Entitlement to service connection for a bilateral foot disability, to include as due to low back disability, is denied.

Service Connection

1. Entitlement to service connection for a bilateral leg disability, to include as due to low back disability, is denied.

2. Entitlement to service connection for a bilateral foot disability, to include as due to low back disability, is denied.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 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).

For certain chronic diseases, including arthritis, a presumption of service connection arises if the disease is manifested to a compensable degree within one year following discharge from service. That presumption is rebuttable by probative evidence to the contrary. 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). For those listed chronic disabilities, a showing of continuity of symptoms affords an alternative route to service connection when the requirements for application of the presumption are not met. 38 C.F.R. § 3.303 (b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir 2013).

Continuity of symptomatology may establish service connection if a claimant can demonstrate (1) that a disability was "noted" during service; (2) there is post-service evidence of the same symptomatology; and (3) there is medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007).

When entitlement to a benefit cannot be established without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination or reexamination, an original claim for compensation is to be decided based on the evidence of record. 38 C.F.R. § 3.655(b). When a claimant fails to report for an examination scheduled in conjunction with a reopened claim for a benefit which was previously disallowed, the claim shall be denied. Id. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, or death of an immediate family member. 38 C.F.R. § 3.655(a).

In other words, in cases where a Veteran fails to appear without good cause for a necessary VA examination the regulation creates two categories of claims. Turk v. Peake, 21 Vet. App. 565, 56970 (2008). The first is original claims, which must be decided based on the evidence of record despite the failure to appear for the scheduled examination. Id. The second is comprised of other original claims, reopened claims for previously denied benefits and claims for increase, which are to be summarily denied based on the failure to appear. Id.

While it was found in a January 2013 VA memorandum that the Veteran's service treatment records were unavailable, review of the record shows that service treatment records were obtained, to include the Veteran's enlistment and separation examination. The January 1977 enlistment examination showed that the Veteran's feet and lower extremities were normal. The June 1999 separation examination showed that the Veteran's feet and lower extremities were normal and that he had a spinal laminectomy upon clinical evaluation. Further, in the June 1999 report of medical history, the Veteran denied cramps in legs, foot trouble, bone, joint, or other deformities, arthritis, rheumatism, bursitis, and trick or locked knee. However, he did report recurrent back pain. Service treatment records show that the Veteran reported constant back pain radiating down the right leg in September 1998. In May 1997, he reported worsening pain in his upper thighs with exercise and he was diagnosed with severe spinal stenosis. He was put on a physical profile in April 1999 based on his
the Veteran's feet and lower extremities were normal and that he had a spinal laminectomy upon clinical evaluation. Further, in the June 1999 report of medical history, the Veteran denied cramps in legs, foot trouble, bone, joint, or other deformities, arthritis, rheumatism, bursitis, and trick or locked knee. However, he did report recurrent back pain. Service treatment records show that the Veteran reported constant back pain radiating down the right leg in September 1998. In May 1997, he reported worsening pain in his upper thighs with exercise and he was diagnosed with severe spinal stenosis. He was put on a physical profile in April 1999 based on his low back pain. He was seen for an insect bite in January 1999.

In the December 2008 claim, the Veteran generally asserted that his feet and leg pain began in April 1999.

In a November 2009 VA examination, the Veteran reported pain in his legs, feet, and back, specifically pain that traveled from his back to his legs. He denied paresthesia and numbness. Upon physical examination, the examiner noted that the Veteran's posture was within normal limits, his gait was within normal limits, his walking was steady, and he did not require assistive devices for ambulation. A neurological examination showed no sensory deficits from the lumbosacral spine and no lumbosacral motor weakness. The Veteran's bilateral lower extremity reflexes were knee and ankle jerk at 1+. The examiner found that the lower extremities showed no signs of pathologic reflexes, there were normal cutaneous reflexes, and no signs of lumbar intervertebral disc syndrome with chronic and permanent nerve root involvement.

In the March 2010 notice of disagreement, the Veteran contended that no "thoughtfulness" was given to his legs and feet claims. He reported that he could not stand for a long period of time after his back surgery.

In the January 2013 VA Form 9, the Veteran asserted that he had been discharged due to not passing his physical due to his back and leg injuries.

According to Social Security Administration records associated with the claims file in November 2020, the Veteran reported that he could not stand up for long due to his back and knees in May 2016.

Post-service VA treatment records show that the Veteran reported pain, swelling, and numbness in the bilateral lower extremities. X-ray studies showed symmetric degenerative changes in the knees with no evidence of fracture, dislocation, or osseous destructive lesion in October 2008, bilateral mild symmetric hallux valgus and mild first MTP joint degenerative changes in October 2008, bilateral mild hallux valgus and minimal osteoarthritic changes of first MTP joint in the left foot in April 2009, mild degenerative joint disease of the left knee in April 2010, mild to moderate hallux valgus with mild to moderate degenerative change involving first MTP joint of the right foot in February 2015, and bilateral knee degenerative changes without acute fracture or subluxation in April 2017. In April 2005, the Veteran complained of right leg pain. In October 2008, the Veteran reported having feet pain for the past two years with swelling and numbness. In December 2011, the Veteran reported having had pain in his knees over the past three weeks and an in-service 1999 back surgery with good result. In February 2015, it was noted that his leg pain was due to a gout flare up in the right foot and ankle. In May 2015, the Veteran's right knee joint swelling was noted to be likely due to acute gouty arthroplasty. In August 2015, the Veteran had left knee osteoarthritis secondary to his body habitus. In August 2016, it was noted he had no gross motor or sensory deficit. In March 2020, his bilateral foot numbness was attributed to peripheral neuropathy versus radiculopathy with the Veteran's history of alcohol abuse noted. In October 2021, physical examination showed grossly intact "SN" and "motor 5/5" globally.

Based on a careful review of the subjective and clinical evidence, the Board finds that the evidence persuasively weighs against finding that service connection is warranted for the Veteran's bilateral leg and foot disabilities.

As an initial matter, the Board notes that VA examinations addressing the nature and etiology of the Veteran's bilateral leg and feet disabilities have not been obtained. Review of the record shows that there were multiple attempts by the RO to ascertain the Veteran's current address and phone number. Most recently
his bilateral foot numbness was attributed to peripheral neuropathy versus radiculopathy with the Veteran's history of alcohol abuse noted. In October 2021, physical examination showed grossly intact "SN" and "motor 5/5" globally.

As an initial matter, the Board notes that VA examinations addressing the nature and etiology of the Veteran's bilateral leg and feet disabilities have not been obtained. Review of the record shows that there were multiple attempts by the RO to ascertain the Veteran's current address and phone number. Most recently, in January 2024, the Veteran was called to determine his availability and in February 2024, notification of his VA examination appointment was sent by courier to his address in Riverdale, Georgia - his then current address. The RO has attempted to schedule VA examinations for the Veteran since December 2022, but he has failed to attend any or provide good cause.

VA's duty to assist is not always a one-way street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Veteran must cooperate in VA's efforts to obtain evidence needed to adjudicate his claims. In this case the Veteran has failed to attend every scheduled VA examination to determine the nature and etiology of his bilateral leg and feet disabilities. 38 C.F.R. § 3.655 (a). Further, the Veteran has not provided good cause for this cancellation or requested that the examination be rescheduled. As such, the Board finds that a remand for another examination is not warranted in this case.

The evidence does not show any evidence that the Veteran's degenerative changes or disease of the bilateral knees and feet manifested within one year of separation from service. Rather, the Veteran was diagnosed with these degenerative changes or disease in 2008 and 2009. Therefore, the Board finds that the Veteran is not entitled to service connection on a presumptive basis under either 38 C.F.R. § 3.307 (a)(3) or under 38 C.F.R. § 3.303 (b) for continuity of symptomatology.

The Board acknowledges that the Veteran reported having bilateral feet and leg pain during and after service. In determining the weight to be assigned to evidence, credibility can be affected by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor. Caluza v. Brown, 7 Vet. App. 498, 511 - 12 (1995), aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996). As noted above, service treatment records show that the Veteran reported upper thigh pain in May 1997 and back pain radiating down the right leg in September 1998. However, they do not show that the Veteran had leg problems throughout service. In fact, the Veteran reported and was treated for other issues throughout service, such as his back. The Veteran was continuously treated for his low back problems and was eventually put on a physical profile for only his low back pain in April 1999. However, the records do not show that the Veteran was treated for his feet at all during service or that he was treated for his leg pain throughout service. Further, the June 1999 separation examination showed that the Veteran's feet and lower extremities were normal upon clinical evaluation and that he denied cramps in legs, foot trouble, bone, joint, or other deformities, arthritis, rheumatism, bursitis, and trick or locked knee while reporting recurrent back pain.

The Board acknowledges that the Veteran is competent to report his history of bilateral leg and feet symptoms. However, he has not demonstrated that he has the requisite specialized knowledge and training to provide a medically complex opinion. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Davidson v. Shinseki,581 F.3 d 1313, 1316 (Fed. Cir. 2009). Therefore, the Board finds that the Veteran's lay assertions are not competent to provide an etiological opinion for his bilateral leg and feet disabilities, and thus offers little probative value. The Veteran has not presented any competent and credible evidence that his left shoulder disability is etiologically related to his active duty service. Accordingly, the Veteran's service connection claims for bilateral leg and feet disabilities are not warranted.

For the above reasons, the evidence is neither evenly
to provide a medically complex opinion. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Davidson v. Shinseki,581 F.3 d 1313, 1316 (Fed. Cir. 2009). Therefore, the Board finds that the Veteran's lay assertions are not competent to provide an etiological opinion for his bilateral leg and feet disabilities, and thus offers little probative value. The Veteran has not presented any competent and credible evidence that his left shoulder disability is etiologically related to his active duty service. Accordingly, the Veteran's service connection claims for bilateral leg and feet disabilities are not warranted.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for bilateral leg disability and bilateral feet disability is warranted. Rather, the evidence persuasively weighs against finding in favor of the Veteran's service connection claims. The benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), is therefore not for application as to these claims. 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).

REASONS FOR REMAND

1. Entitlement to an initial disability rating in excess of 10 percent for low back disability is remanded.

2. Entitlement to a TDIU is remanded.

As noted above, the Board finds that the Veteran has not provided good cause for his failure to appear for the VA examination scheduled to determine the current nature and severity of his low back disability. As such, a remand is not warranted to schedule another such examination. However, in the October 2023 remand, the Board directed that even if the Veteran declined the in-person examination, the RO was to provide the claims file to an appropriate clinician to render a retrospective medical addendum opinion to adjudicate the increased rating for the low back disability. However, that was not completed. As such, a remand is warranted to comply with the October 2023 Board remand. See Stegall v. West,?11?Vet. App.?268, 271 (1998).

The Board finds that the claim of entitlement to TDIU is inextricably intertwined with the remanded claim. The appropriate remedy for an inextricably intertwined issue is to remand it pending resolution of the inextricably intertwined issues. Harris v. Derwinski, 1 Vet. App. 180 (1991).

The matters are REMANDED for the following action:

Obtain a supplemental VA medical opinion from an appropriate clinician regarding the severity of the Veteran's service-connected low back disability. Provide the claims file, including a copy of this REMAND, to the examiner for review.

After review of the claims file, the examiner must provide a retrospective opinion regarding where pain began in all planes of range of motion that was present during the period from December 18, 2008, to the present.

The examiner should review the December 2009 VA examination report, which acknowledged the Veteran's reports of flare-ups, where he experiences functional impairment, described as pain when sitting down, an inability to walk or stand up, and limitation of motion of the joint where he must be laying down in his bath. Estimate the extent to which, during flare-ups that occurred from December 18, 2008, to the present, the Veteran's spinal motion was additionally limited.

State whether at any point during the period on appeal (from December 18, 2008, to the present), the Veteran's lumbar spine disability caused symptoms that would constitute the functional equivalent of ankylosis. The Veteran reported that during flare-ups episodes, he experiences an inability to walk or stand up, and limitation of motion of the joint where he must be laying down in his bath. See 12/3/2009 C&P Examination.

A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion.

If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training).

LESLEY A. REIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board

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