KNEE IMPAIRMENT OF

Summary

The Veteran, who served in the United States Air Force from September 1973 to September 1986, appeals the denial of service connection for right knee osteoarthritis and lumbosacral strain. The Veteran contends that both conditions originated during service due to physical demands, including lifting heavy trailers and participating in loading competitions, and that symptoms have persisted since service. The Board reviewed multiple VA examinations and the Veteran's lay testimony. Early service treatment records indicated knee pain and a trick knee, while later records showed a diagnosis of osteoarthritis. For the knee, the Board found the Veteran's lay statements regarding onset and continuity of symptoms to be competent and credible, outweighing a VA opinion that attributed the condition to age-related wear and tear. The Board resolved doubt in the Veteran's favor, granting service connection for right knee osteoarthritis. For the lumbar spine, service treatment records showed a diagnosis of lumbosacral strain with onset during service, and the Veteran provided competent and credible lay testimony about persistent low back pain and treatment. Despite a VA opinion finding the condition less likely than not related to service and attributing it to age-related wear and tear, the Board gave greater weight to the Veteran's testimony, finding the evidence evenly balanced. Resolving doubt in the Veteran's favor, service connection for lumbosacral strain was granted.

Rationale

Service treatment records show in-service knee injury and pain.; Veteran's lay testimony regarding onset and continuity of symptoms is competent and credible.; Evidence is evenly balanced; doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: 26004980
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 17-42 728
DATE: April 28, 2026

ORDER

Entitlement to service connection for right osteoarthritis is granted.

Entitlement to service connection for lumbosacral strain is granted.

FINDINGS OF FACT

1. Resolving all reasonable doubt in favor of the Veteran, his right knee disability had onset in service and symptomatology has continued since in-service injury.

2. Resolving all reasonable doubt in favor of the Veteran, his lumbar spine disability had onset in service and symptomatology has continued since in-service injury.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for right knee osteoarthritis have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for lumbosacral strain have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from September 1973 to September 1986.

This matter returns to the Board of Veterans' Appeals (Board) after a June 2023 Board remand. This matter originally came before the Board from a May 2014 rating decision by United States Department of Veterans Affairs (VA) Regional Office (RO), also known as the agency of original jurisdiction (AOJ).

In March 2020, a hearing was held before a Veterans Law Judge (VLJ) who is no longer available to participate in the appeal. In February 2026, the Board sent a letter to the Veteran offering him the opportunity to testify before a different VLJ. He did not respond to the letter. In April 2026, his representative provided an Informal Hearing Presentation in support of the Veteran's claims.

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. The three-element test for service-connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be established on a presumptive basis for certain "chronic diseases" listed in 38 C.F.R. § 3.309(a) where the evidence shows a diagnosis manifest to a compensable degree within the presumptive period after service, or a continuity of symptomatology since service. 38 C.F.R. §§ 3.303(b), 3.307; see Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed. Cir. 2013).

Further, where the Veteran asserts entitlement to service connection for a chronic disease but there is insufficient evidence of a diagnosis in service, service connection may be established under 38 C.F.R. § 3.303(b) by demonstrating a continuity of symptomatology since service or diagnosis within the presumptive period after service, but only if the chronic disease is listed under 38 C.F.R. § 3.309(a). Walker, supra, at 1338-39 (Fed. Cir. 2013); 38 C.F.R. § 3.307 (service connection authorized for chronic diseases diagnosed within the presumptive period). As arthritis is listed as a "chronic disease" under 38 C.F.R. § 3.309(a), the provisions of 38 C.F.R. § 3.303(b) pertaining to continuity of symptomatology and of 38 C.F.R. § 3.307 pertaining to presumptive service connection for chronic disease apply to the Veteran's knee disability claim.

In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so
 the provisions of 38 C.F.R. § 3.303(b) pertaining to continuity of symptomatology and of 38 C.F.R. § 3.307 pertaining to presumptive service connection for chronic disease apply to the Veteran's knee disability claim.

In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995).  

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Entitlement to service connection for right knee disability

The Veteran contends that his right knee disability is the result of military service. Specifically, the Veteran contends that his right knee would pop in and out and he would have to put it back in place. See March 2020 Hearing Transcript. He states that such symptomatology has continued since service and he self-treated up to his diagnosis of arthritis, a chronic condition. Id.

His representative argues that the claim should be granted because the evidence demonstrates that joint pain onset during service and has been chronic since. See April 2026 Informal Hearing Presentation. In support of this argument, the representative avers that the VA examinations currently of record are inadequate because the examiners have consistently discounted the probative value of the Veteran's lay statements regarding continuing symptoms simply because they are not documented in a concurrent medical record. Id. 

Upon review of the record as a whole, the Board finds that doubt can be resolved to grant this claim and another remand is unnecessary. 

Turning to the evidence, service treatment records (STRs) show that the Veteran complained of a trick or locked knee in a September 1985 report of medical examination. The Veteran noted that he would have his knee lock up when he does a lot of bending, he has a loss of range of motion (ROM) in his knee, and a history of knee pain for the past 5 years. See September 1985 STR.

Private treatment records show that the Veteran was formally diagnosed with osteoarthritis in his right knee. See November 2020 private treatment record.

In March 2020 a hearing was held regarding the Veteran's right knee disability. During the hearing, the Veteran reported that his right knee disability began during service. He recalled that in 1974 he felt a popping in his right knee when he was pushing heavy trailers to load onto aircrafts. The Veteran reported treating his knee with pain medication and gels. He reported that his right knee disability has persisted and he would have to pop his knee back in place over the years.

The Veteran was afforded a VA examination for his right knee in April 2021. The examiner reviewed the claims file, including a transcript of the March 2020 hearing and conducted an in-person examination of the Veteran. The examiner diagnosed the Veteran with patellofemoral pain syndrome of the right knee. The examiner noted that the Veteran does not have full ROM in the right knee. The examiner opined that the Veteran's right knee disability was less likely than not incurred in or caused by service. In support of this opinion, the examiner acknowledged that the Veteran complained of a trick knee during service, but there were no records to support the existence of a right knee condition. The examiner found that this knee condition is a new condition that is not related to service. Instead, the examiner opined that the right knee condition is due to the left knee osteoarthritis due to favoring and overuse.

In June 2023 the Board issued a remand for the Veteran's right knee disability. The Board found that the April 2021 VA opinion was inadequate for adjudicative purposes. In so finding, the Board noted that the April 202
 the Veteran's right knee disability was less likely than not incurred in or caused by service. In support of this opinion, the examiner acknowledged that the Veteran complained of a trick knee during service, but there were no records to support the existence of a right knee condition. The examiner found that this knee condition is a new condition that is not related to service. Instead, the examiner opined that the right knee condition is due to the left knee osteoarthritis due to favoring and overuse.

In June 2023 the Board issued a remand for the Veteran's right knee disability. The Board found that the April 2021 VA opinion was inadequate for adjudicative purposes. In so finding, the Board noted that the April 2021 examiner did not diagnose arthritis in the right knee and did not provide an explanation as to why the diagnosis was different than the diagnosis found in the private treatment records. Additionally, the Board noted that the April 2021 examiner only considered the September 1985 report of medical history and not the accompanying examination report documenting a history of knee pain for the prior 5 years. The Board found the examiner impermissibly relied on the absence of supporting medical documentation of treatment between separation of service and filing of the claim to opine against the knee disability being related to service. Lastly, the Board noted that the examiner opined that the right knee disability was the result of overuse from the diagnosed disabilities of the left knee but does not consider the prior reports of right knee pain during service before the left knee injury occurred. 

On remand the AOJ obtained a new examination and opinion for the Veteran's right knee in July 2023. The examiner reviewed the claims file and conducted an in-person examination of the Veteran. The examiner noted the Veteran has a diagnosis of right knee osteoarthritis. The examiner noted that the onset of the Veteran's right knee disability was in 1974 when the Veteran reported that his right knee popped out of place while running. The examiner opined that that it was less likely as not that the Veteran's right knee disability began during service, manifested within one year after separation from service, or was noted during service with continuity of symptomatology since service. In support of these opinions, the examiner noted that most recent x-ray findings show mild to moderate osteoarthritis, and osteoarthritis is due to wear and tear over time. This would not be the result of the right knee injury during service. The examiner notes that there is no available evidence to suggest that the right knee osteoarthritis was caused by the reported injury in 1974. The September 1985 report of medical history indicates that the right knee problem manifests when he does a lot of bending, and the record is silent for any other treatment or complaints while on active duty. Lastly, the examiner opined that the Veteran's osteoarthritis is bilateral, consistent with age related wear and tear.

Regarding the first element of service connection, a current disability, the Board notes that the Veteran has a diagnosis of right knee osteoarthritis. Accordingly, the first element of service connection has been met. See Shedden, 381 F.3d at 1166-67 (Fed. Cir. 2004).

The second element of service connection, an in-service incurrence or aggravation of a disease or injury, the Board notes that STRs and the Veteran's competent and credible lay statements regarding the onset of his right knee injury demonstrate a right knee injury during service. Accordingly, the second element of service connection is met.

Lastly, regarding the final element of service connection a nexus between the current disability and injury, disease or illness in service, the Board finds that there is both evidence for and against the claim. The July 2023 VA medical opinion of record provides evidence against the Veteran's claim. However, the Board notes that the July 2023 examiner's opinion should be afforded little probative weight, in so far as it does not consider the Veteran's credible and competent lay statements regarding his right knee pain and symptoms that have persisted ever since service. While the July 2023 examiner considered the Veteran's lay statements regarding the onset of his right knee disability, he does not consider the pain and symptomatology that has persisted ever since. Instead, the July 2023 examiner attributes the Veteran's right knee disability to age related wear and tear. The July 2023 examiner does not consider the physical demands of military service required by the Veteran to be overuse that could have caused the Veteran's right knee osteoarthritis. By contrast, the Board is giving greater weight to the Veteran's competent lay statements. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a
 right knee disability, he does not consider the pain and symptomatology that has persisted ever since. Instead, the July 2023 examiner attributes the Veteran's right knee disability to age related wear and tear. The July 2023 examiner does not consider the physical demands of military service required by the Veteran to be overuse that could have caused the Veteran's right knee osteoarthritis. By contrast, the Board is giving greater weight to the Veteran's competent lay statements. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a veteran is competent to testify regarding continuous pain since service, and lay evidence when credible, is competent to establish the presence of continuous symptoms for a claimed disability during and since separation from military service). The Veteran is competent to report that he has experienced right knee pain beginning with the injury in 1974, the popping and locking of the right knee, and continued right knee pain that has persisted ever since. Thus, the Veteran's reports are competent and credible. Moreover, they are consistent with the record and there is nothing to explicitly contradict them.

For the above reasons, the evidence is at least evenly balanced as to whether the Veteran's right knee disability had its onset in service. As the reasonable doubt created by this approximate balance in the evidence must be resolved in favor of the Veteran, entitlement to service connection for the right knee disability, on a direct basis is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Entitlement to service connection for lumbar spine disability

The Veteran contends that his lumbar spine disability is the result of military service. Specifically, the Veteran contends that his low back pain in November 1982 with a sudden onset during lifting. See March 2020 Hearing Transcript. He states that such symptomatology has continued since service and he has self-treated since service. Id.

His representative argues that the claim should be granted because the evidence demonstrates that joint pain onset during service and has been chronic since. See April 2026 Informal Hearing Presentation. In support of this argument, the representative avers that the VA examinations currently of record are inadequate because the examiners have consistently discounted the probative value of the Veteran's lay statements regarding continuing symptoms simply because they are not documented in a concurrent medical record. Id.

Upon review of the record as a whole, the Board finds that doubt can be resolved to grant this claim and another remand is unnecessary.

STRs show that the Veteran complained of low back pain in November 1982. The Veteran was diagnosed with low back strain and was given limited duty for three days. See November 1982 STR. The Veteran reported low back pain in a July 1983 sick call. The Veteran was diagnosed with mechanical back pain.

Post service treatment records show that the Veteran has a diagnosis of chronic low back pain without sciatica. See November 2020 private treatment records.

In March 2020 a hearing was held regarding the Veteran's lumbar spine disability. During the hearing, the Veteran reported that his lumbar spine disability began during service. He recalled that in November 1982 he sought treatment for low back pain that had a sudden onset while lifting. The Veteran reported his job required loading very heavy trailers on to aircraft as a part of a five-man crew. Additionally, the Veteran reported that he was a member of the Giant Sword competition team, where he would compete against other bases loading trailers for aircraft. The Veteran compared the competition to the strong man competition. The Veteran reported that he tried not to complain too much about his back pain, but when it was too bad, he sought treatment for it. Regarding treatment for his back pain, the Veteran reported being put on ibuprofen and using heat, like heating blankets and the sauna at the gym.

The Veteran was afforded a VA examination for his lumbar spine disability in April 2021. The examiner reviewed the claims file, including a transcript of the March 2020 hearing and conducted an in-person examination of the Veteran. The examiner confirmed the diagnosis of lumbosacral strain. The examiner noted that the Veteran does not have full ROM in the lumbar spine and exhibits painful motion during forward flexion, right lateral flexion, and right lateral rotation. No x-ray imaging was done in connection with this examination. The examiner opined that the Veteran's lumbar spine disability was less likely than not incurred in or caused by service. In support of this opinion, the examiner acknowledged that the Veteran complained of low back pain during service, but there were no records to support continuity of symptomatology. 

In June 2023 the Board issued a remand for the Veteran's lumbar spine disability. The Board
 hearing and conducted an in-person examination of the Veteran. The examiner confirmed the diagnosis of lumbosacral strain. The examiner noted that the Veteran does not have full ROM in the lumbar spine and exhibits painful motion during forward flexion, right lateral flexion, and right lateral rotation. No x-ray imaging was done in connection with this examination. The examiner opined that the Veteran's lumbar spine disability was less likely than not incurred in or caused by service. In support of this opinion, the examiner acknowledged that the Veteran complained of low back pain during service, but there were no records to support continuity of symptomatology. 

In June 2023 the Board issued a remand for the Veteran's lumbar spine disability. The Board found that the April 2021 VA opinion was inadequate for adjudicative purposes. In so finding, the Board noted that the April 2021 examiner impermissibly relied on a lack of documentary evidence of treatment since service to find that his current condition is not related to service. Additionally, the examiner did not discuss the credible lay statements from the Veteran and his wife regarding the reports of low back pain since leaving service and treatment throughout the period of service due to repeated injury and flare-ups of his back pain in loading competitions. On remand the Board directed the AOJ to obtain an adequate etiological opinion. 

On remand the AOJ obtained a new examination and opinion for the Veteran's lumbar spine in July 2023. The examiner reviewed the claims file and conducted an in-person examination of the Veteran. The examiner noted the Veteran has a diagnosis of lumbar strain. The examiner noted that the onset of the Veteran's lumbar spine disability was during service due to wear and tear. The examiner opined that it was less likely as not that the Veteran's lumbar spine disability was caused by the in-service heavy lifting and competing in loading competitions during service. In support of this opinion, the examiner noted that the record is silent for any other treatment or complaints while on active duty, the Veteran marked no for recurrent back pain during the separation examination and the records do not show chronic or ongoing treatment for the back during active duty or following discharge. Instead, the examiner opined that the Veteran's lumbar spine disability, consistent with age related wear and tear. The examiner also notes that while there were no diagnostic studies to confirm that, the Veteran had gone almost 40 years without treatment since his original injury and therefore there is not enough evidence to suggest the current pain is related to military service.

Regarding the first element of service connection, a current disability, the Board notes that the Veteran has a diagnosis of lumbosacral strain. Accordingly, the first element of service connection has been met. See Shedden, 381 F.3d at 1166-67 (Fed. Cir. 2004).

The second element of service connection, an in-service incurrence or aggravation of a disease or injury, the Board notes that STRs and the Veteran's competent and credible lay statements regarding the onset of his low back pain demonstrate lumbar spine disability occurred during service. Accordingly, the second element of service connection is met.

Lastly, regarding the final element of service connection a nexus between the current disability and injury, disease or illness in service, the Board finds that there is both evidence for and against the claim. The July 2023 VA medical opinion of record provides evidence against the Veteran's claim. However, the Board notes that the July 2023 examiner's opinion should be afforded little probative weight, in so far as it does not consider the Veteran's credible and competent lay statements regarding his low back pain and symptoms that have persisted ever since service. While the July 2023 examiner considered the Veteran's lay statements regarding the onset of his lumbar spine disability, he does not consider the pain and symptomatology that has persisted ever since. Instead, the July 2023 examiner attributes the Veteran's lumbar spine disability to age related wear and tear. The July 2023 examiner does not consider the physical demands of military service required by the Veteran to be overuse that could have caused the Veteran's lumbar spine disability. By contrast, the Board is giving greater weight to the Veteran's competent lay statements. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a veteran is competent to testify regarding continuous pain since service, and lay evidence when credible, is competent to establish the presence of continuous symptoms for a claimed disability during and since separation from military service). The Veteran is competent to report that he has experienced low back pain beginning with the report of low back pain in November 1982, the subsequent diagnosis of mechanical back pain in July 1983, and the continued
 the Board is giving greater weight to the Veteran's competent lay statements. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a veteran is competent to testify regarding continuous pain since service, and lay evidence when credible, is competent to establish the presence of continuous symptoms for a claimed disability during and since separation from military service). The Veteran is competent to report that he has experienced low back pain beginning with the report of low back pain in November 1982, the subsequent diagnosis of mechanical back pain in July 1983, and the continued low back pain that has persisted ever since. Thus, the Veteran's reports are competent and credible. Moreover, they are consistent with the record and there is nothing to explicitly contradict them.

For the above reasons, the evidence is at least evenly balanced as to whether the Veteran's lumbar spine disability had its onset in service. As the reasonable doubt created by this approximate balance in the evidence must be resolved in favor of the Veteran, entitlement to service connection for lumbosacral strain, on a direct basis is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

C.B. Iwanowski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. King, Associate Counsel

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.