KNEE IMPAIRMENT OF

E. I. VELEZ · 2026 · Case ID: 26002587

MIXED

Summary

The veteran, who served from December 1968 to January 1969, appeals the denial of service connection for a back disability and entitlement to TDIU and Special Monthly Compensation (SMC) based on aid and attendance. The veteran also sought an increased rating for his service-connected left knee meniscal tear, status-post total knee replacement. The Board granted an increased rating for the left knee disability to 60 percent, finding that the residuals more nearly approximated severe painful motion and weakness throughout the appeal period, aligning with the maximum rating allowed for such residuals and the amputation rule. Service connection for the back disability was denied, as the veteran failed to attend a scheduled VA examination without good cause, and the evidence of record did not establish a nexus to service or secondary service connection to the left knee. The Board noted the back disability was considered age-related and that lay statements from the veteran were insufficient without medical nexus. Entitlement to TDIU was denied due to a lack of competent objective evidence demonstrating that service-connected disabilities prevented substantially gainful employment, despite the veteran's reported unemployment and SSA disability benefits. The Board also denied SMC for aid and attendance, finding that the veteran's left knee disability, while causing limitations, did not render him so helpless as to require regular aid and attendance, as supported by multiple VA examinations and the veteran's ability to ambulate with a cane.

Rationale

Residuals more nearly approximate severe painful motion or weakness; Intermediate degrees of residual weakness, pain or limitation of motion; Maximum rating of 60 percent allowed due to prosthesis implantation date and amputation rule

Special Benefit

SMC - AID & ATTENDANCE; TDIU

Diagnostic Code

5055

Docket No.

17-56 866

Full Decision Text

Citation Nr: 26002587
Decision Date: 02/25/26 Archive Date: 02/25/26

DOCKET NO. 17-56 866
DATE: February 25, 2026

ORDER

Entitlement to an increased rating of 60 percent, but no higher, for left knee meniscal tear, status-post total knee replacement, is granted.

Service connection for a back disability, including as secondary to the service-connected left knee disability, is denied.

Entitlement to a total disability rating based on individual unemployability (TDIU) is denied.

Entitlement to special monthly compensation (SMC) based on aid and attendance is denied.

FINDINGS OF FACT

1. The Veteran's left knee meniscal tear, status-post total knee replacement, consist of symptoms that more nearly approximates severe painful motion and weakness during the entire appeal period.

2. The Veteran's back disability is not secondary to a service-connected disability and is not otherwise related to an in-service injury or disease.

3. The Veteran's service-connected disabilities alone do not preclude substantially gainful employment.

4. The Veteran's service-connected disabilities alone do not render him so helpless as to need regular aid and attendance from others.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an increased rating of 60 percent, but no higher, for service-connected left knee meniscal tear, status-post total knee replacement, have been met. 38 U.S.C. §§ 1155, 5107 (2024); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5055 (2025).

2. The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2024); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2025).

3. The criteria for entitlement TDIU have not been met. 38 U.S.C. §§ 1155, 5107 (2024); 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19 (2025).

4. The criteria for SMC based on the need for regular aid and attendance have not been met. 38 U.S.C. § 1114 (l) (2024); 38 C.F.R. § 3.350 (b) (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1968 to January 1969. The Veteran also had a period of service in the Reserves.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision by the Department of Veterans Affairs (VA).

This case was remanded in April 2019, November 2022, May 2024, February 2025 and August 2025 for further development.

The Board notes that the Veteran failed, without a showing of good cause, to appear for his scheduled Department of Veterans Affairs (VA) examination in connection with his claim of service connection for a back disability, which was requested in the August 2025 Board remand. The record shows that the Veteran was informed of the examination. As such, with no good cause provided for failing to report to scheduled VA examination, there has been substantial compliance with the remand instructions and no further development based on the Board remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998).

1. Entitlement to an initial disability rating higher than 30 percent for service-connected left knee meniscal tear, status-post total knee replacement

Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4.

When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. If the evidence is not in
based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4.

When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. If the evidence is not in approximate balance or nearly equal, the claim is to be denied. See Lynch v. McDonough, 21 F.4 th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001).

In any claim for an increased rating, "staged" ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999).

The Veteran's service-connected left knee disability is rated 30 percent for the entire appellate period disabling pursuant to Code 5055, for total knee replacement.

During the pendency of this claim, the criteria for rating disabilities of the musculoskeletal system in the VA Schedule for Rating Disabilities was revised effective February 7, 2021. The February 7, 2021 amendments did not result in changes to the applicable diagnostic codes DCs 5055, 5256, 5261, or 5262. Although amendments to DC 5055 changed the time period for the 100 percent rating following implantation of prothesis or resurfacing from one year to four months, this change does not impact the present appeal as the Veteran's knee replacement was completed in 2008, several years prior to the current period on appeal.

Under Code 5055, a 60 percent rating is warranted with prosthetic replacement of the knee joint with chronic residuals consisting of severe painful motion or weakness in the affected extremity or with intermediate degrees of residual weakness, pain or limitation of motion rated by analogy to Codes 5256, 5261, or 5262. There must be a minimum rating of 30 percent. 38 C.F.R. § 4.71a.

The combined rating for disabilities of an extremity shall not exceed the rating for the amputation of that extremity at the elective level, were amputation to be performed. 38 C.F.R. § 4.68. A 60 percent rating is provided for an amputation of the thigh, above the knee, at the middle or lower third. 38 C.F.R. § 4.71a, Codes 5162, 5163, 5164.

Following a review of the evidence of record, the Board finds that a 60 percent rating is more nearly approximated during the entire period on appeal. VA treatment records show that the Veteran was receiving pain management treatment for his back and bilateral knee pain, which includes pain medication of hydrocodone, tramadol and gabapentin. His knee pain was noted to as constant and worsened with ambulation and he was limping due to his knee pain. See June 2013, September 2013, June 2017, June 2021 VA Treatment Records.

The Veteran was afforded several VA examinations during the appeal period. During the February 2016 VA examination, the Veteran reported having constant left knee pain with recurrent swelling. The Veteran's range of motion at that time was 0 degrees extension and 130 degrees flexion, which decreased to 120 degrees flexion with repetition. Pain was noted to cause functional loss and he was noted to have pain on both extension and flexion, weight-bearing, slight to moderate periarticular tenderness and swelling was recurrent and frequent. He constantly used a cane to help improve support and decrease his weight-bearing pain. The examiner noted that the Veteran's total knee joint replacement resulted in intermediate degrees of residual weakness, pain or limitation of motion.

During the July 2024 VA examination, the Veteran reported that he had pain with walking and was "taking Norco 10-325, three times daily for pain control." He also reported that flare-ups of the left knee occurred all the time and are precipitated by walking and activities. His flare-ups were moderate in severity, lasted a few hours, and are alleviated by resting and medication. His range of motion was 0 to 120 degrees, which did not changed with repetition or flare-ups. He had pain on flexion and extension and with weight-bearing, active motion and caused functional loss of being unable to walk for more than 5 minutes without having left knee pain. The examiner indicated that the Veteran's total knee replacement resulted in intermediate degrees of residual weakness, pain, or limitation of motion. The Veteran constantly used a cane for his left knee disability. An April 2025 VA examination showed similar manifestations of the left knee disability as recorded in the June 2024 VA examination with the exception of his flare-ups being reported as severe and that he was unable to walk more than 20 feet without having knee pain.

The Board finds that the evidence of record more nearly approximates severe symptoms, including pain with flare-ups, weight-bearing, and active motion, in the Veteran's left knee throughout the appeal period. Although VA examiners indicated that the Veteran's left knee replacement resulted in intermediate degrees of residual weakness, pain, or limitation of motion, the Board finds that the Veteran's functional limitation caused by his left knee pain, the severity of his flare-ups and the necessity for pain management, which includes taking pain medication to alleviate his pain, the Veteran's left knee disability approximates chronic residuals consisting of severe painful motion or weakness in the affected extremity. Thus, after resolving reasonable doubt in the Veteran's favor, the evidence reflects that total left knee replacement residuals that consist of severe painful motion and weakness during the entire appeal period, and a 60 percent rating pursuant to Code 5055 is warranted.

The Board notes that a 60 percent rating is the maximum rating allowed pursuant to Code 5055 because the Veteran's left total knee replacement was in 2008, prior to the current appeal period. Moreover, a 60 percent rating is the maximum rating allowed pursuant to the amputation rule. See 38 C.F.R. § 4.68. As a result, the Veteran's left knee disability cannot be assigned a rating exceeds 60 percent. Thus, an overall rating in excess of 60 percent must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426 (1994) (where the law is dispositive, a claim should be denied on the basis of the absence of legal merit).

In sum, a 60 percent disability, and no higher, is granted for the Veteran's service-connected left knee meniscal tear, status-post total knee replacement.

2. Service connection for a back disability, including as secondary to the service-connected left knee disability

Service connection may be established 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 requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).

Secondary service connection may be granted for disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). The evidence must 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 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.
service connection may be granted for disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). The evidence must 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 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule does not apply. See Lynch v. McDonough, 21 F.4 th 776, 781-82 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001).

Where lay evidence is competent, the Board must weigh the competent lay evidence against the other evidence of record in determining credibility. Buchanan v. Nicholson, 451 F.3d 1331, 1334-37 (Fed. Cir. 2006). However, the absence of corroborating records is an insufficient basis on which to find lay statements not credible. Id. at 1337.

The Veteran claims that his back disability is caused by his service-connected left knee disability. See June 2017 Notice of Disagreement; March 2019 Brief; April 2025 VA examination.

Service treatment records are silent for any complaints, findings or diagnoses related to the back. Additionally, entrance and separation examinations and reports of medical history show no indication of any complaints, injuries or abnormalities related to the back. The Veteran did have a football injury during service; however, the only injury reported was to his left knee. See August 1967, January 1968, April 1968, January 1969 Service Treatment Records.

VA treatment records show that the Veteran has been diagnosed as having significant rotary levoscoliosis with associated severe multilevel degenerative disk and facet disease and diffuse endplate spondylosis in the lower thoracic and lumbar spine. See April 2013, November 2016 VA Treatment Records. During treatment in July 2019, the Veteran was found to have multiple age-related degenerative changes in low back and right knee.

As noted, the Veteran failed to report for his scheduled VA examination and did not provide good cause for missing the examination. Thus, the Board is required to determine this claim based on the evidence of record, which in this case does not include a nexus between the Veteran's service and his current disability or establishes secondary service connection with his service-connected left knee disability.

Upon review of the above, the Board finds that the competent evidence is not in approximate balance in favor of the Veteran and is against finding that his diagnosed back disability began in service, is otherwise due to service or secondary to a service-connected disability. The record does not reasonably raise entitlement to direct or secondary service connection for the back disability. While the Veteran's representative requests that service connection be granted, neither the Veteran or his representative have submitted any lay statements or evidence supporting this claim. As previously stated, service treatment records are silent for any findings or injury to the back and his back disability was noted to be age-related during VA treatment. While the Veteran believes that his back disability is secondary to his left knee, he does not possess the medical expertise required to provide an opinion as to the etiology of the currently diagnosed back disability. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). As there is no evidence supporting a finding that service connection is warranted, this claim must be denied.

As a preponderance of the evidence is against the claim for the back disability, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991).

3. Entitlement to TDIU

It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. See 38 C.F.R. § 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average
the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991).

3. Entitlement to TDIU

It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. See 38 C.F.R. § 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." See 38 C.F.R. §§ 3.340 (a)(1), 4.15.

The Court has held that, although substantially gainful employment is any occupation that provides an earned income that exceeds the Federal poverty threshold, the Board must ensure that the veteran was capable of carrying out such employment. Indeed, the phrase "unable to secure and follow a substantially gainful occupation" has two components: one economic and one noneconomic. The economic component simply means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The noneconomic component includes a consideration of the veteran's history, education, skill, and training, along with physical and psychological abilities. Ray v. Wilkie, 31 Vet. App. 58 (2019). In Ray, the Court noted that Social Security Administration (SSA) regulations provide guidance regarding what is considered substantial. Such SSA regulations provide that work can be substantial even if it is done on a part-time basis or if claimants do less, get paid less, or have less responsibility than when they worked before. Id. at 72-73.

The Board notes that service connection has been granted for a left knee disability, and a left knee scar.

The Veteran contends that his severe left knee pain interferes with his ability to work. The Veteran has stated that he has not worked since 2003 and is receiving Social Security Benefits. See May 2017 Correspondence; see also July 2025, January 2026 Appellate Briefs.

The Veteran was requested to complete a VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability, on multiple occasions; however, the Veteran did not comply with these requests. See July 2017, August 2017, March 2025 Development Letters. Thus, the Board is required to determine this claim based on the evidence of record, which in this case does not include information regarding the Veteran's history, education, skill, and training.

The Board has considered the Veteran's and the representative's contentions; however, the record is devoid of any competent objective evidence to support these contentions. First, although the SSA found the Veteran is disabled since May 2004 as shown by SSA inquiry results dated May 2024 and February 2025, there is no evidence that the Veteran was found to be disabled due solely to his left knee disability and left knee scar. In March 2025, the SSA responded to the VA's request for records stating that there are no medical records. The Board accepts that the Veteran has not worked since 2003 as he has reported; however, the evidence of record does not demonstrate that his service-connected disabilities prevent substantially gainful employment. VA examinations have noted that the Veteran's left knee disability does cause some functional limitations limiting his physical activity that impact his ability to work. See February 2016, July 2024, April 2025 VA Examinations. During the April 2025 VA examination, the Veteran specifically stated that he cannot walk more than 20 feet without knee pain, which "impairs his work flow." However, such physical limitations do not demonstrate that the Veteran is unable to perform all occupational tasks, including sedentary work. Additionally, the left knee scar has been found to have no functional impact. See July 2024 VA Examination.

Aside from the Veteran and his representative's contentions that his service-connected disabilities cause his unemployment, the record is absent any such finding. Although his left knee disability cause some physical limitations as noted above, the record does not indicate that it alone prevented substantially gainful employment.

Given the lack of evidence showing impairment due to the Veteran's service-connected disabilities which would preclude employment, the Board concludes that the preponderance of the evidence is against this claim. Therefore, there is no reasonable doubt to be resolved. The appeal in the matter must be denied. 38 U.S.C. § 5107(b), 38 C.F.R. § 4.3.

4. Ent
functional impact. See July 2024 VA Examination.

4. Entitlement to SMC based on aid and attendance

SMC based on the need for aid and attendance of others is payable when the veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to need regular aid and attendance. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b).

The Veteran has not lost use of both feet or one hand and one foot, and he is not blind in both eyes due to service-connected disabilities, and he has not contended otherwise. As such, whether SMC is warranted here is determined by whether he is permanently bedridden or so helpless as to need regular aid and attendance.

As directed by 38 C.F.R. § 3.352 (a), the following criteria are to be considered for determining whether a claimant is in need of the regular aid and attendance of another person: (1) the inability of the claimant to dress himself or herself or to keep himself or herself ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliance which, by reason of the particular disability, cannot be done without aid (not to include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); (3) the inability of the claimant to feed himself or herself through the loss of coordination of the upper extremities or through extreme weakness; (4) the inability to attend to the wants of nature; or (5) a physical or mental incapacity that requires care and assistance on a regular basis to protect the claimant from the hazards or dangers incident to his or her daily environment.

"Bedridden," which is a proper basis for the determination, is defined as that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. 38 C.F.R. §§ 3.350 (b)(4), 3.352(a).

It is not required that all of the disabling conditions enumerated be found to exist before a favorable rating may be made. The particular personal functions which a veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless as to need regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others. 38 C.F.R. § 3.352 (a); Turco v. Brown, 9 Vet. App. 222, 224 (1996) (stating it is logical to infer there is a threshold requirement that "at least one of the enumerated factors be present").

Furthermore, the performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance. 38 C.F.R. § 3.352 (c).

Based on a review of the record, the Board finds that the evidence does not show that he is need for aid and attendance due to his service-connected disabilities of left knee meniscal tear, status-post total knee replacement and left knee scar.

While the Board acknowledges that the Veteran experiences some limitations due to his service-connected disabilities and the evidence weighs against the Veteran's claim for SMC based on aid and attendance. The Veteran reported during the February 2016 and April 2025 VA examinations that he had limitations to walking due to his service-connected left knee disability. Additionally, during April 2025 VA examination, the examiner
will not prevent the granting of the additional allowance. 38 C.F.R. § 3.352 (c).

While the Board acknowledges that the Veteran experiences some limitations due to his service-connected disabilities and the evidence weighs against the Veteran's claim for SMC based on aid and attendance. The Veteran reported during the February 2016 and April 2025 VA examinations that he had limitations to walking due to his service-connected left knee disability. Additionally, during April 2025 VA examination, the examiner noted that the Veteran presented to the clinic ambulatory using a cane. Therefore, the evidence demonstrates that he is able to walk short distances with the assistance of a cane. Therefore, the evidence does not show that the Veteran is bedridden. See 38 C.F.R. §§ 3.350 (b)(4), 3.352(a).

In a statement submitted in June 2017, the Veteran's deceased son's partner reported caring for the Veteran and described limitations caused by his left knee disability as well as his back and right knee problems. She stated that the Veteran needs help getting around, she has been attending doctors appointments with him, his pain limits his ability to make it to the bathroom and he has wet himself on several occasions. He is incapable of doing own laundry, carrying groceries in from the car, driving long distances, or cooking his own meals. She has gotten him into an apartment and will goes over to take care of him. Although this statement demonstrates the Veteran's limitations, these limitations are based on the effects of his left and right knee disabilities and his back disability. Although the Veteran is service-connected for a left knee disability, he is not currently service-connected for a right knee or back disability.

Furthermore, the evidence does not support a finding that the Veteran is need for aid and attendance based on his service-connected left knee disability and left knee scar alone. A review of the VA examinations of the left knee disability and left knee scar show that the Veteran's left knee does caused some limitation of mobility and function; however, he is able to walk short distances. See February 2016, July 2024, April 2025 VA Examinations. Significantly, in an April 2025 VA Examination for the left knee, the VA examiner opined that there is no need for regular aid and attendance due solely to the Veteran's service- connected left knee disabilities, which include a left knee meniscal tear and status post left total knee arthroplasty. The examiner provided an in-depth rationale for this opinion stating that, based on examination of the Veteran, although knee pain with prolonged activity may limit extended mobility, the medical evidence does not support that the knee disability alone causes severe functional impairment requiring ongoing assistance. In considering the June 2017 buddy statement from the Veteran's deceased son's partner, the examiner explained that the Veteran's left knee does impact his ability to walk more than 20 feet as he experiences pain; however, this does not indicate a need for regular aid and attendance. The examiner reviewed the findings of the examination of the left knee, which showed no tenderness, swelling, or signs of infection, and full range of motion is preserved. The examiner concluded that while there may be broader factors affecting his mobility, the left knee disability, as an isolated condition, does not warrant such assistance.

In a May 2025 VA opinion regarding the Veteran's service-connected left knee scar, the examiner likewise opined that there is no need of regular aid and attendance due solely to his service-connected left knee scar as the scar was flat, non-tender, well healed and mobile; full range of motion was preserved; and there were no signs of infection or hypersensitivity suggesting that the scar did not impair skin integrity, cause for irritation, or interfere with joint function. The examiner considered the June 2017 buddy statement finding that statement described significant difficulties in mobility due to knee and back pain, not the left knee scar. The examiner concluded that the left knee scar as an isolated disability does not necessitate additional assistance.

Therefore, in light of the above, including the thorough and well-reasoned VA opinions finding that there is no need of regular aid and attendance due solely to the Veteran's service-connected disabilities, the Board concludes that the preponderance of the evidence is against this claim. Therefore, there is no reasonable doubt to be resolved. The appeal in the matter must be denied. 38 U.S.C. § 5107(b), 38 C.F.R. § 4.3.

E. I. VELEZ

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Meawad,

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