DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

TIFFANY DAWSON · 2026 · Case ID: 26004953

MIXED

Summary

The veteran served from February 1968 to September 1971, including service in Vietnam. He appealed the denial of service connection for right shoulder, right hand, left hand, right knee, left knee, and right ankle disorders, but sought service connection for a lumbar spine disorder. The Board granted service connection for the lumbar spine disorder, finding that the veteran's in-service back injury, documented by service treatment records and subsequent medical opinions, resulted in a chronic low back disability, with reasonable doubt resolved in his favor. The Board denied service connection for the remaining conditions. For the right shoulder, hand, knee, and ankle claims, the Board found no evidence of in-service complaints, diagnoses, or continuity of symptomatology, and noted that the veteran attributed current symptoms to post-service injuries or age-related degeneration. The Board found the veteran's claims of continuous symptoms since service not credible due to the lack of contemporaneous medical evidence and the significant delay in filing claims. The Board also noted that the VA examinations, while sometimes containing questionable nexus language, were ultimately deemed adequate or supplemented by other opinions that persuasively weighed against service connection for these denied conditions.

Rationale

In-service injury documented; Recurrent pain and suspected spondylosis; Benefit of the doubt resolved in veteran's favor

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-67 184

Full Decision Text

Citation Nr: 26004953
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 17-67 184
DATE: April 27, 2026

ORDER

Service connection for a lumbar spine disorder, to include unilateral spondylosis, is granted.

Service connection for a right shoulder disorder is denied.

Service connection for a right hand disorder is denied.

Service connection for a left hand disorder is denied.

Service connection for a right knee disorder is denied.

Service connection for a left knee disorder is denied.

Service connection for a right ankle disorder is denied.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his lumbar spine disorder began during service.

2. The Veteran's right shoulder disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disorder is not otherwise etiologically related to an in-service injury or disease.

3. The Veteran's right and left hand disorders were not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disorders are not otherwise etiologically related to an in-service injury or disease.

4. The Veteran's right and left knee disorders were not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disorders are not otherwise etiologically related to an in-service injury or disease.

5. The Veteran's right ankle disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disorder is not otherwise etiologically related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a lumbar spine disorder, to include unilateral spondylosis, have 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 disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for a right hand disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for a left hand disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

6. The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

7. The criteria for service connection for a right ankle disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1968 to September 1971, to include service in the Republic of Vietnam.

These matters were previously before the Board of Veterans' Appeals (Board) on appeal from November 2016 and March 2017 rating decisions of the Department of Veterans Affairs (VA). The Board most recently rem
a right ankle disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1968 to September 1971, to include service in the Republic of Vietnam.

These matters were previously before the Board of Veterans' Appeals (Board) on appeal from November 2016 and March 2017 rating decisions of the Department of Veterans Affairs (VA). The Board most recently remanded the matters in July 2024 to obtain scanned records located in VistA Imaging noted in VA treatment records and to provide the Veteran with examinations for the disabilities on appeal. To the extent there remain outstanding scanned records pertinent to the lumbar spine disorder and the VA medical opinion is inadequate, in light of the favorable decision in this case, the Board finds that the Veteran is not prejudiced by the Board's adjudication of that claim. Review of the obtained VA examination reports and opinions for the other disorders on appeal reflects substantial compliance with the remand requests. While the AOJ may not have obtained all the requested records, upon further review, the Board finds that the outstanding scanned records are not pertinent to the remaining claims on appeal. Thus, the Board finds that it can proceed without further remand to obtain those scanned records. Dyment v. West, 13 Vet. App. 141 (1999).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Where a Veteran served for 90 days or more of active service, service incurrence shall be presumed for certain chronic diseases, including arthritis, if the disease manifested to a compensable degree within one year from the date of separation from active service. While the disease does not need to be diagnosed within the presumption period, it must be shown by acceptable lay or medical evidence that there were characteristic manifestations of the disease to the required degree during that time. The presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.

Service connection for a lumbar spine disorder

On the original claim for service connection for a lumbar spine disorder, filed in February 1974, the Veteran indicated that he injured his back in June or July 1970 and was treated in Germany. On a February 1987 claim, he indicated that his low back disorder began in 1978 and has gotten progressively worse. On a December 1989 claim, he indicated that he was treated for his back in 1971. The current appeal stems from a supplemental claim filed in August 2016.

Service treatment records show that in July 1971 the Veteran sprained his back diving the previous day. X-rays revealed nothing abnormal in the lumbar spine or sacroiliac joints. He was prescribed bedrest for three days. A September 1971 Report of Medical Examination at separation reflects a normal clinical evaluation of the spine and includes a signed statement by the Veteran that he was in good health. A Report of Medical History at separation is not of record. See March 27, 1974 STR - Medical.

A January 1974 private orthopedic consult reflects that the Veteran was in the armed services from 1968 to 1971 and was considering reenlistment but he injured his back in a diving mishap in 1971. He stated that while he recovered from the initial pain he has had recurrent episodes of back pain since discharge, usually in the morning after waking up and after trivial amounts of exercise. Examination revealed full range of motion of the lumbar and dorsal segments of the spine. There was some minimal pain on palpation of the spinous process of L-5. Deep tendon reflexes and sensation to light touch were normal. X-rays reportedly revealed unilateral spondylosis on the left side involving the S-1 articulation. The physician noted that the Veteran has had recurrent episodes of low back pain for two years. The physician stated that by X-ray the Veteran has unilateral spondylosis but the diagnosis can only be made with laminography. The physician concluded that by X-ray unilateral spondylosis is strongly suspected and for this reason the Veteran is not a suitable candidate for military service as he is subject to recurrent low back pain. See February 1, 1974 Medical Treatment Record - Non-Government Facility.

At an April 1974 VA examination, the Veteran indicated that his back was not bothering him when he saw a specialist in January 1974 but since he returned to work at a shake mill, where he has to lift bundles of shakes, he has been having back problems. He indicated that he has not missed any work though, working through the pain, because he has a lot of bills to pay. He indicated that he severely injured his back in service while diving from a 75-foot high diving board, hitting the water with his back hyperextended, and that he sought treatment in service. He indicated having no difficulty with his back prior to that injury. He noted that as he was in a hurry to leave service, little attention was paid to his back problems and he subsequently worked as a forklift operator. He stated that he recently underwent chiropractic manipulations which were of no significant benefit. He complained of intermittent pain in the low back near the lumbosacral junction. Examination was within normal limits with full range of motion of the lumbar spine. The examiner reported that X-rays revealed no definite abnormality but there was a question of a defect in the left pars interarticularis and a laminogram was needed to determine whether an abnormality truly is present. The examiner indicated that the defect was noted before by the orthopedist. [The Board observes that a pars interarticularis defect is also known as spondylosis.] The examiner concluded that there was no definite evidence of an abnormality of the lumbar spine and further comment will be made if the Veteran undergoes the scheduled laminogram. [There is no evidence that the Veteran underwent a laminogram.] See April 13, 1974 VA Examination.

In a February 1987 letter to a state vocational rehabilitation program, a private physician indicated that the Veteran has had difficulties due to his low back since September 1977 when he was lifting a head block at work and felt a sudden strain across his low back. The physician noted that the Veteran worked the rest of that day, but the pain gradually worsened toward evening with radiation into the legs, and worked one more day, but quit after that and sought treatment at his hospital where the Veteran was treated with bedrest, pelvic traction, muscle relaxers, pain medication, and physical therapy. The physician noted that a lumbar myelogram revealed bulging of the L4-5 and S1 discs. The physician stated that the Veteran recovered to the point where he was able to return to work, working off and on, most of the time in a shake mill, until quitting in December 1986 and he has not returned because of increased back pain. The physician noted that examination revealed limited forward flexion and reduced sensation at the right calf, and X-rays showed minor degenerative changes in the dorsal and lumbar segments of the spine with some minimal disc narrowing at the L4-5 and S1 levels. The physician noted a diagnosis of dorsal and lumbosacral spondylosis with early disc degeneration. The physician stated that the Veteran is having considerable difficulty and is not able to return to any work that involves a substantial amount of walking, bending, stooping, lifting, or turning, and is probably going to be limited in his physical activity. The physician concluded that it is very doubtful whether the Veteran will ever return to work in a shake mill. See April 8, 1987 Medical Treatment Record - Non-Government Facility.

At an April 1987 VA examination, the Veteran reported the in-service back
and lumbar segments of the spine with some minimal disc narrowing at the L4-5 and S1 levels. The physician noted a diagnosis of dorsal and lumbosacral spondylosis with early disc degeneration. The physician stated that the Veteran is having considerable difficulty and is not able to return to any work that involves a substantial amount of walking, bending, stooping, lifting, or turning, and is probably going to be limited in his physical activity. The physician concluded that it is very doubtful whether the Veteran will ever return to work in a shake mill. See April 8, 1987 Medical Treatment Record - Non-Government Facility.

At an April 1987 VA examination, the Veteran reported the in-service back injury from diving, going to sick call and being placed on a profile for a short time, but that he had full healing with no back problems. He indicated that his primary back problem began in 1975 or 1976 when he injured his back working for a railroad company. He reported that he was unable to work and was hospitalized for several weeks. He indicated that he received compensation as part of a settlement with the railroad company. X-rays revealed scoliosis of the lumbar spine convexity to the left with narrowing at the L5-S1 interspace raising the possibility of degenerative disc disease and minimal spurring of the lumbar spine. The examiner provided a diagnosis of chronic low back pain with probable herniated disc syndrome. The examiner noted that the Veteran has a history of a work-related injury in 1975 with no chronic back problems prior to that time. See April 21, 1987 VA Examination.

A May 1989 VA examination report reflects that the injury at the railroad occurred in 1978. See May 18, 1989 VA Examination. Subsequent VA examination reports reflect that the injury occurred in 1978 or 1979.

At a February 2025 VA examination, the Veteran reported that his back disorder started many years ago. See February 27, 2025 C&P Exam. While the examiner provided a medical opinion, it was not based on an accurate factual background. Thus, the AOJ requested another medical opinion.

In April 2025, another VA examiner reviewed the claims file and concluded that the Veteran's low back disorder was not incurred in or caused by service. The examiner noted the July 1971 service treatment record showing back pain after spraining it diving the day before but indicated that there was no evidence of chronic pain thereafter in the service treatment records or in the immediate post-service period. The examiner noted the Veteran's report that his low back disorder began with an injury in 1979, which is 9 years after separation from service and further supports the conclusion that the low back disorder did not begin during service. The examiner indicated that the Veteran denied having low back problems at separation. The examiner stated that the Veteran's degenerative arthritis and intervertebral disc syndrome are due to age-appropriate and cumulative activity-related degeneration. The examiner concluded that although an acute lumbosacral spine condition is noted in the service treatment records, no permanent residual or chronic disability is shown by the service treatment records or evidence from the period immediately following separation. See April 30, 2025 C&P Exam.

Given the above, service treatment records show that the Veteran injured his back diving, with post-service medical records showing that it was from a high diving board and he hit the water with his back hyperextended. Service treatment records also show that he was prescribed bedrest for three days, indicating that it was more than a minor injury. While the September 1971 Report of Medical Examination at separation revealed a normal spine, and the Veteran reported that he was in good health, there is no Report of Medical History to definitively find that he did not report having recurrent back pain. The record reflects that the Veteran wanted to reenlist and underwent evaluation by an orthopedist. The January 1974 orthopedic consult reflects the Veteran's report that he injured his back in a diving mishap in 1971 and while he recovered from the initial pain he has had recurrent episodes of back pain since discharge. The orthopedist noted that X-rays indicated unilateral spondylosis and concluded that the Veteran was not suitable for service as he is subject to recurrent low back pain. At the April 1974 VA examination, the Veteran described the in-service back injury as severe and indicated that he has been having back problems while working at a shake mill where he has to lift heavy items.

The above suggests that the Veteran's in-service injury resulted in a chronic low back disability. While the January 1974 orthopedic consult revealed normal range of motion of the lumbar spine, there was pain on palpation at L-5, the Veteran reported pain after even minimal exercise, and the orthopedist concluded that the Veteran was not fit for service as he is subject to recurrent low back pain. Such indicates that the Veteran had some, albeit slight, functional impairment due to his low back disorder at that time. Similarly, the Veteran's report of working through the pain because he has a lot of bills to pay at the April 1974 VA examination also suggests that he had some functional impairment due to his low back disorder. The Board notes that the Veteran suffered a significant work-related low back injury in September 1977 and even he has related his impairment to that injury. However, that post-service injury does not negate a low back disorder that may have existed prior to that injury. In that regard, the evidence indicates that he had unilateral spondylosis prior to that injury.

While the Board appreciates the April 2025 VA examiner's opinion, it is not based on an accurate factual background. While the examiner indicated that the Veteran did not report back problems at his separation examination, as indicated above, without a Report of Medical History, the Board is unable to find that he did not report having recurrent back pain at that time. The examiner also did not address the January 1974 private treatment record showing the Veteran's report that he has had recurrent back pain since separation from service or the X-rays taken at that time indicating unilateral spondylosis. The examiner also did not address the April 1974 VA examination report, which reflects a history of intermittent low back pain since the in-service injury and X-ray findings corroborating unilateral spondylosis.

In light of the circumstances in this case, and resolving reasonable doubt in the Veteran's favor, the Board finds that his lumbar spine disorder began during service. See 38 U.S.C. § 5107. Accordingly, the Board concludes that service connection for a lumbar spine disorder, to include unilateral spondylosis, is warranted.

Right shoulder disorder

In August 2016, the Veteran filed a claim for service connection for arthritis that he clarified included a right shoulder disorder. See August 18, 2016 VA 21-526b, Veteran Supplemental Claim; November 10, 2016 VA 21-4138 Statement In Support of Claim.

Service treatment records do not show any complaints, findings, or diagnoses of a right shoulder disorder. A September 1971 separation examination report reflects that clinical evaluation of the upper extremities was normal and includes a signed statement by the Veteran that he was in good health. See March 27, 1974 STR - Medical.

After discharge, a January 1974 private treatment record reflects that the Veteran's only concern with reenlisting was his back that he injured in 1971. See February 1, 1974 Medical Treatment Record - Non-Government Facility. A January 2007 VA treatment record reflects complaints of right shoulder pain that in October 2007 he attributed to a motorcycle accident in 1981 or 1982. See March 21, 2017 CAPRI.

Given the above, the evidence of record does not show that the Veteran's right shoulder disorder began during service or for many years thereafter. There also is no evidence of arthritis within one year of separation from service. Indeed, the evidence shows an intercurrent injury as the cause of his current disability.

At a February 2025 VA examination, the Veteran reported that his right shoulder disorder began in 1982 when he fell off his motorcycle and suffered a separation of the shoulder. The examiner provided a diagnosis of degenerative arthritis, other than posttraumatic, of the right shoulder. See February 27, 2025 C&P Exam.

In a separate medical opinion, the VA examiner concluded that the Veteran's right shoulder disorder was not incurred in or caused by service. The examiner stated that service treatment records contain no mention of a right shoulder condition and the Veteran sustained no injuries to the right shoulder during service. The examiner noted that after service the Veteran worked for many years in manual labor which contributed to his current symptoms. The examiner further noted that the Veteran sustained a right shoulder separation in a motorcycle accident in 1982 and he has had pain in the shoulder since that
off his motorcycle and suffered a separation of the shoulder. The examiner provided a diagnosis of degenerative arthritis, other than posttraumatic, of the right shoulder. See February 27, 2025 C&P Exam.

In an April 2025 medical opinion, a VA examiner concluded that the Veteran's right shoulder disorder was not caused by any toxic exposure risk activity (TERA), to include herbicide exposure in Vietnam. The examiner noted that the Veteran has right shoulder degenerative arthritis, which is a condition in which the cartilage lining the joint is damaged due to injury or overuse. The examiner stated that there is no evidence that this overuse inflammatory/degenerative condition is somehow due to an exposure event. The examiner noted that the Veteran has attributed the condition to a motorcycle injury. See April 30, 2025 C&P Exam.

The Board notes that a lay person is competent to give evidence about observable symptoms such as shoulder pain. Layno v. Brown, 6 Vet. App. 465 (1994). The Board notes that lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent regardless of the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

To the extent that the Veteran is claiming to have experienced continuous pain in the right shoulder since active service, those reports are not found to be credible. There is no evidence of a right shoulder disorder in service. There is no medical evidence of a right shoulder disorder in the years following service and the Veteran has attributed the disability to a post-service motorcycle accident. If the Veteran had experienced shoulder problems continuously since any in-service injuries, it would be reasonable to expect that he would have sought treatment much earlier or he would have filed a disability claim much sooner than in August 2016, almost 45 years after separation from service.

Given the above, the Board finds that any statements alleging or implying a continuity of right shoulder symptoms since service are not credible in this case. Therefore, continuity of symptomatology is not established by either the competent evidence or the Veteran's statements. Moreover, the probative medical evidence of record does not relate the right shoulder disorder to service.

Accordingly, the Board concludes that service connection for a right shoulder disorder is not warranted. As the evidence of record persuasively weighs against the claim, the claim must be denied. 38 U.S.C. § 5107(b).

Right hand disorder

Left hand disorder

In August 2016, the Veteran filed a claim for service connection for arthritis that he clarified included disorders of the hands. See August 18, 2016 VA 21-526b, Veteran Supplemental Claim; November 10, 2016 VA 21-4138 Statement In Support of Claim.

Service treatment records do not show any complaints, findings, or diagnoses of a disorder of either hand. A September 1971 separation examination report reflects that clinical evaluation of the upper extremities was normal and includes a signed statement by the Veteran that he was in good health. See March 27, 1974 STR - Medical.

After discharge, a January 1974 private treatment record reflects that the Veteran's only concern with reenlisting was his back that he injured in 1971. See February 1, 1974 Medical Treatment Record - Non-Government Facility. Medical records from 1990 and 1991 also do not show any complaints related to either hand. See May 7, 1991 Medical Treatment Record - Government Facility. Then, an October 2015 VA treatment record reflects complaints of bilateral hand pain, which in January 2016 he indicated began over five years ago. See March 21, 2017 CAPRI.

Given the above, the evidence of record does not show that the Veteran's right and left hand disorders began during service or for many years thereafter. The Board notes that there is no Report of Medical History at separation. However, unlike in the case of the low back disorder where service treatment records showed an in-service injury, the Board finds that there is no reason to question whether the Veteran's statement that he was in good health on the separation examination report meant he had no problems with his hands. There also is no evidence of arthritis in either hand
an October 2015 VA treatment record reflects complaints of bilateral hand pain, which in January 2016 he indicated began over five years ago. See March 21, 2017 CAPRI.

In a February 2025 VA examination report, the examiner noted the Veteran's history that his right and left hand disorders began in 2019. The examiner then noted, "Onset during service, manifested within one year after service separation, or are otherwise etiologically related to service, to include exposure to herbicide agents in Vietnam." [Given the phrasing of the sentence, and the prior statement noting onset in 2019, the Board observes that the examiner was simply reciting the requested opinion, not actually providing an opinion.] The examiner provided a diagnosis of degenerative arthritis, other than posttraumatic, for both hands. See February 27, 2025 C&P Exam.

In a separate medical opinion, the VA examiner concluded that the Veteran's right and left hand disorders were not incurred in or caused by service. The examiner stated that service treatment records contain no mention of a hand condition and the Veteran sustained no hand injuries during service. The examiner also stated that after service the Veteran worked for many years in manual labor which could have contributed to his current symptoms. The examiner noted that the medical literature indicates an increased risk for arthritic conditions from manual labor. See February 27, 2025 C&P Exam.

While the medical opinion was adequate, given the questionable note regarding nexus in the examination report, "Onset during service, manifested within one year after service separation, or are otherwise etiologically related to service, to include exposure to herbicide agents in Vietnam," the AOJ obtained another opinion.

In an April 2025 medical opinion, another VA examiner concluded that the Veteran's right and left hand disorders were not incurred in or caused by service. The examiner indicated that the service separation examination report shows that the Veteran denied having any hand problems. The examiner noted the Veteran's statements made 33 years after separation to establish a nexus but stated that the Veteran's hand conditions are due to age-appropriate and cumulative activity-related degeneration. The examiner observed that no permanent residual or chronic disability is shown by the service treatment records or evidence from the period immediately following separation from service. See April 30, 2025 C&P Exam.

In a separate April 2025 opinion, the VA examiner concluded that the Veteran's hand disorders were not caused by any TERA, to include herbicide exposure in Vietnam. The examiner noted that the Veteran has right and left hand degenerative arthritis, which is a condition in which the cartilage lining the joint is damaged due to injury or overuse. The examiner then stated that there is no evidence that this overuse inflammatory/degenerative condition is somehow due to an exposure event. See April 30, 2025 C&P Exam.

A lay person is competent to give evidence about observable symptoms such as hand pain. Layno, 6 Vet. App. 465. Also, lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent regardless of the lack of contemporaneous medical evidence. Buchanan, 451 F.3d 1331.

To the extent that the Veteran is claiming to have experienced continuous pain in the right and left hands since active service, those reports are not found to be credible. There is no evidence of a hand disorder in service. There is no medical evidence of a disorder of either hand in the years following service. In January 2016 he dated his hand disorders to over five years ago, which would be around 2010, with no indication that they began in service. If the Veteran had experienced hand problems continuously since any in-service injuries, it would be reasonable to expect that he would have sought treatment much earlier or he would have filed a disability claim much sooner than in August 2016, almost 45 years after separation from service.

Given the above, the Board finds that any statements alleging or implying a continuity of right and left hand symptoms since service are not credible in this case. Therefore, continuity of symptomatology is not established by either the competent evidence or the Veteran's statements. Moreover, the probative medical evidence of record does not relate the right and left hand disorders to service.

Accordingly, the Board concludes that service
would be around 2010, with no indication that they began in service. If the Veteran had experienced hand problems continuously since any in-service injuries, it would be reasonable to expect that he would have sought treatment much earlier or he would have filed a disability claim much sooner than in August 2016, almost 45 years after separation from service.

Accordingly, the Board concludes that service connection for right and left hand disorders is not warranted. As the evidence of record persuasively weighs against the claims, the claims must be denied. 38 U.S.C. § 5107(b).

Right knee disorder

Left knee disorder

In August 2016, the Veteran filed a claim for service connection for arthritis that he clarified included disorders of the knees. See August 18, 2016 VA 21-526b, Veteran Supplemental Claim; November 10, 2016 VA 21-4138 Statement In Support of Claim.

Service treatment records show that in July 1971 the Veteran fell and injured his left shoulder and leg. He had abrasions and contusions over the shoulder area and thigh and he was prescribed pain medication and given light duty for five days. A September 1971 separation examination report reflects that clinical evaluation of the lower extremities was normal and includes a signed statement by the Veteran that he was in good health. See March 27, 1974 STR - Medical.

Given the above, service treatment records do not show any complaints, findings, or diagnoses of a disorder of the knees. While the Veteran injured his left leg, he only had abrasions and contusions on the thigh, not the knee. Even if the left knee were injured, the separation examination report revealed no abnormality of the left knee and there is no evidence of a continuity of symptoms in the medical records following separation from service. A January 1974 private treatment record reflects that the Veteran's only concern with reenlisting was his back that he injured in 1971. See February 1, 1974 Medical Treatment Record - Non-Government Facility. Medical records from 1990 and 1991 also do not show any complaints related to the either knee. See May 7, 1991 Medical Treatment Record - Government Facility. A February 2004 VA examination report reflects complaints of bilateral knee pain. See February 25, 2004 VA Examination.

Given the above, the evidence of record does not show that the Veteran's right and left knee disorders began during service or for many years thereafter. The Board notes that there is no Report of Medical History at separation. However, unlike in the case of the low back disorder where there was an in-service injury, the Board finds that there is no reason to question whether the Veteran's statement that he was in good health on the separation examination report meant he had no problems with his knees. There also is no evidence of arthritis within one year of separation from service.

In a February 2025 VA examination report, the examiner noted the Veteran's history that his right and left knee disorders started in 2019, diagnosed in 2020. The examiner then noted, "Onset during service, manifested within one year after service separation, or are otherwise etiologically related to service, to include exposure to herbicide agents in Vietnam." [Given the phrasing, and the prior statement noting onset in 2000, the Board again observes that the above was not an opinion.] The examiner provided a diagnosis of degenerative arthritis, other than posttraumatic, for both knees. See February 27, 2025 C&P Exam.

In a separate medical opinion, the VA examiner concluded that the Veteran's right and left knee disorders were not incurred in or caused by service. The examiner stated that service treatment records contain no mention of a knee condition and the Veteran sustained no knee injuries during service. The examiner noted that after service the Veteran worked for many years in manual labor which contributed to his current symptoms. See February 27, 2025 C&P Exam.

Again, given the questionable note regarding nexus in the examination report, the AOJ obtained another medical opinion.

In an April 2025 medical opinion, another VA examiner concluded that the Veteran's right and left knee disorders were not incurred in or caused by service. The examiner indicated that the service separation examination report shows that the Veteran denied having any knee problems. The examiner noted the Veteran's statements made 33 years after separation to establish a nexus but stated that the Veteran's knee conditions are due to age-appropriate and cumulative activity-related degeneration
sustained no knee injuries during service. The examiner noted that after service the Veteran worked for many years in manual labor which contributed to his current symptoms. See February 27, 2025 C&P Exam.

Again, given the questionable note regarding nexus in the examination report, the AOJ obtained another medical opinion.

In an April 2025 medical opinion, another VA examiner concluded that the Veteran's right and left knee disorders were not incurred in or caused by service. The examiner indicated that the service separation examination report shows that the Veteran denied having any knee problems. The examiner noted the Veteran's statements made 33 years after separation to establish a nexus but stated that the Veteran's knee conditions are due to age-appropriate and cumulative activity-related degeneration. The examiner observed that no permanent residual or chronic disability is shown by the service treatment records or evidence from the period immediately following separation from service. See April 30, 2025 C&P Exam.

In a separate medical opinion, the VA examiner concluded that the Veteran's knee disorders were not caused by any TERA, to include herbicide exposure in Vietnam. The examiner noted that the Veteran has bilateral knee degenerative arthritis, which is a condition in which the cartilage lining the joint is damaged due to injury or overuse, and stated that there is no evidence that this overuse inflammatory/ degenerative condition is somehow due to an exposure event. See April 30, 2025 C&P Exam.

A lay person is competent to give evidence about observable symptoms such as knee pain. Layno, 6 Vet. App. 465. Also, lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent regardless of the lack of contemporaneous medical evidence. Buchanan, 451 F.3d 1331.

To the extent that the Veteran is claiming to have experienced continuous pain in the right and left knees since active service, those reports are not found to be credible. There is no evidence of a knee disorder in service. There is no medical evidence of a disorder of either knee in the years following service. If the Veteran had experienced knee problems continuously since any in-service injuries, it would be reasonable to expect that he would have sought treatment much earlier or he would have filed a disability claim much sooner than in August 2016, almost 45 years after separation from service.

Given the above, the Board finds that any statements alleging or implying a continuity of right and left knee symptoms since service are not credible in this case. Therefore, continuity of symptomatology is not established by either the competent evidence or the Veteran's statements. Moreover, the probative medical evidence of record does not relate the right and left knee disorders to service.

Accordingly, the Board concludes that service connection for right and left knee disorders is not warranted. As the evidence of record persuasively weighs against the claims, the claims must be denied. 38 U.S.C. § 5107(b).

Right ankle disorder

In August 2016, the Veteran filed a claim for service connection for arthritis that he clarified included a right ankle disorder. See August 18, 2016 VA 21-526b, Veteran Supplemental Claim; November 10, 2016 VA 21-4138 Statement In Support of Claim.

Service treatment records show that in March 1970 the Veteran tripped over a beer can and hurt his ankle. There was no swelling but he was prescribed Burow's soaks and given an Ace wrap. There are no further complaints related to the ankle. A September 1971 separation examination report reflects that clinical evaluation of the lower extremities and feet was normal and includes a signed statement by the Veteran that he was in good health. See March 27, 1974 STR - Medical.

Thus, while service treatment records show an injury to the ankle, the right ankle is not specified. However, even if the right ankle had been injured, the separation examination report revealed a normal clinical evaluation of both ankles. The Board notes that there is no Report of Medical History at separation. However, unlike in the case of the low back which was injured with less than three months left in service, the Veteran had a year and a half to report any further problems with his right ankle and he did not, indicating that it resolved. Thus, the Board finds that there is no reason to question whether the Veteran's statement that he was in good health on the separation examination report meant he had no problems with his right ankle. There also is no objective evidence of a continuity of symptoms in the medical records dated shortly after separation. A January 1974 private treatment record reflects that the Veteran's only concern with reenlisting was his back. See February 1, 1974 Medical Treatment Record - Non-Government Facility. Medical records from 1990 and 1991 also do not show any ankle complaints. See May 7, 1991 Medical Treatment Record - Government
a half to report any further problems with his right ankle and he did not, indicating that it resolved. Thus, the Board finds that there is no reason to question whether the Veteran's statement that he was in good health on the separation examination report meant he had no problems with his right ankle. There also is no objective evidence of a continuity of symptoms in the medical records dated shortly after separation. A January 1974 private treatment record reflects that the Veteran's only concern with reenlisting was his back. See February 1, 1974 Medical Treatment Record - Non-Government Facility. Medical records from 1990 and 1991 also do not show any ankle complaints. See May 7, 1991 Medical Treatment Record - Government Facility. There is no evidence of ankle problems until the August 2016 claim for service connection for arthritis.

Given the above, the evidence of record does not show that the Veteran's right ankle disorder began during service or for many years thereafter. There also is no evidence of arthritis within one year of separation from service.

In a February 2025 VA examination report, the examiner noted the Veteran's history that his right ankle disorder began in 2019 or 2020. The examiner then noted, "Onset during service, manifested within one year after service separation, or are otherwise etiologically related to service, to include exposure to herbicide agents in Vietnam." [Given the phrasing, and the prior statement noting onset in 2019 or 2020, the Board again observes that the above was not an opinion.] The examiner provided a diagnosis of degenerative arthritis, other than posttraumatic, of the right ankle. See February 27, 2025 C&P Exam.

In a separate medical opinion, the VA examiner concluded that the Veteran's right ankle disorder was not incurred in or caused by service. The examiner stated that the service separation examination report contains no mention of ankle complaints. The examiner noted that after service the Veteran worked for many years in manual labor which contributed to his current symptoms. The examiner noted that the medical literature indicates an increased risk for arthritic conditions from manual labor. See February 27, 2025 C&P Exam.

Again, given the questionable note regarding nexus in the examination report, and as the examiner did not address the documented in-service ankle injury, the AOJ obtained another medical opinion.

In an April 2025 medical opinion, another VA examiner concluded that the Veteran's right ankle disorder was not incurred in or caused by service. The examiner noted the March 1970 service treatment record showing ankle pain but stated that ankle pain is not noted chronically thereafter in the service treatment records or in the immediate post-service period. The examiner indicated that the service separation examination report shows that the Veteran denied having any ankle problems. The examiner noted the Veteran's statements made 33 years after separation to establish a nexus but stated that the Veteran's right ankle condition is due to age-appropriate and cumulative activity-related degeneration. The examiner observed that no permanent residual or chronic disability is shown by the service treatment records or evidence from the period immediately following separation from service. See April 30, 2025 C&P Exam.

In a separate medical opinion, the examiner concluded that the Veteran's right ankle disorder was not caused by any TERA, to include herbicide exposure in Vietnam. The examiner noted that the Veteran has right ankle degenerative arthritis, which is a condition in which the cartilage lining the joint is damaged due to injury or overuse. The examiner stated that there is no evidence that this overuse inflammatory/degenerative condition is somehow due to an exposure event. See April 30, 2025 C&P Exam.

To the extent that the Veteran is claiming to have experienced continuous pain in the right ankle since active service, those reports are not found to be credible. While the service treatment records show an injury to an unspecified ankle, the service separation examination report indicates that it resolved, and there is no medical evidence of a right ankle disorder in the years following service. If the Veteran had experienced ankle problems continuously since an in-service injury, it would be reasonable to expect that he would have sought treatment much earlier or he would have filed a disability claim much sooner than in August 2016, almost 45 years after separation from service.

Given the above, the Board finds that any statements alleging or implying a continuity of right ankle symptoms since service are not credible in this case. Therefore, continuity of symptomatology is not established by either the competent evidence or the Veteran's statements. Moreover, the probative medical evidence of
the service treatment records show an injury to an unspecified ankle, the service separation examination report indicates that it resolved, and there is no medical evidence of a right ankle disorder in the years following service. If the Veteran had experienced ankle problems continuously since an in-service injury, it would be reasonable to expect that he would have sought treatment much earlier or he would have filed a disability claim much sooner than in August 2016, almost 45 years after separation from service.

Accordingly, the Board concludes that service connection for a right ankle disorder is not warranted. As the evidence of record persuasively weighs against the claim, the claim must be denied. 38 U.S.C. § 5107(b).

Tiffany Dawson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J.W. Kim

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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