KNEE IMPAIRMENT OF

Summary

The veteran, who served in the United States Navy Reserve from September 2009 to August 2011 with periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA), appeals the denial of service connection for left and right knee disorders. The veteran also claimed these conditions as secondary to a right ankle disorder. The Board noted that while the veteran is competent to report functional impairments, the record lacked a definitive diagnosis for the knee conditions at the time of the initial rating decision. The veteran first reported a theory of entitlement at a May 2024 hearing, stating a pre-existing right ankle disorder from ACDUTRA led to a right knee strain, which in turn caused a left knee strain. A fellow service member's statement corroborated difficulty with the right ankle during ACDUTRA. However, the Board found the veteran lacked the medical expertise to diagnose the etiology of the knee disorders. Furthermore, since the theory was raised after the initial rating decision, it did not create a pre-decisional duty to assist error. As the veteran is not service-connected for a right ankle disorder, the secondary claims for the knees could not be granted. The Board found the weight of the evidence against the claims, rendering the benefit of the doubt doctrine inapplicable. Service connection for both left and right knee disorders was denied.

Rationale

No service connection for left knee disorder; Claimed as secondary to right ankle disorder; Theory of entitlement raised after initial rating decision

Full Decision Text

Citation Nr: A26010098
Decision Date: 02/03/26	Archive Date: 02/03/26

DOCKET NO. 200831-107751
DATE: February 3, 2026

ORDER

Service connection for a left knee disorder is denied.

Service connection for a right knee disorder is denied.

FINDINGS OF FACT

1. A left knee disorder is not shown to be causally or etiologically related to a disease or injury incurred or aggravated during period of active duty for training (ACDUTRA) or an injury incurred or aggravated during a period of inactive duty for training (INACDUTRA), or caused or aggravated by a service-connected disability.

2. A right knee disorder is not shown to be causally or etiologically related to a disease or injury incurred or aggravated during period of ACDUTRA or an injury incurred or aggravated during a period of INACDUTRA, or caused or aggravated by a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 101 (24), 1110, 5107; 38 C.F.R. §§ 3.1 (d), 3.6 (a), 3.102, 3.303, 3.310.

2. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 101 (24), 1110, 5107; 38 C.F.R. §§ 3.1 (d), 3.6 (a), 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant served in the United States Navy Reserve from September 2009 to August 2011 with periods of ACDUTRA, to include from September 29, 2009, to February 10, 2010, and June 22, 2010, to July 8, 2010, and INACDUTRA.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in October 2019 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA).  In July 2020, the appellant timely appealed such rating decisions by filing a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested a Board hearing, which was held before the undersigned Veterans Law Judge in May 2024. A transcript of the hearing is associated with the record. 

Therefore, the Board may only consider the evidence of record at the time of the October 2019 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the appellant or his representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the appellant would like VA to consider any evidence that was submitted that the Board could not consider, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

1. Entitlement to service connection for a left knee disorder, to include as secondary to a right ankle disorder.

2. Entitlement to service connection for a right knee disorder, to include as secondary to a right ankle disorder.

A Veteran is a person who served in the active military, naval, or air service and who was discharged or released under conditions other "than dishonorable." 38 C.F.R. § 3.1 (d). The term "active military, naval, or air service" includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of INACDUTRA during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C.
 disorder, to include as secondary to a right ankle disorder.

A Veteran is a person who served in the active military, naval, or air service and who was discharged or released under conditions other "than dishonorable." 38 C.F.R. § 3.1 (d). The term "active military, naval, or air service" includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of INACDUTRA during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). ACDUTRA includes full-time duty performed by members of the National Guard of any State or the Reserve. 38 C.F.R. § 3.6 (c).

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.  38 C.F.R. § 3.310(a).  Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).  Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability.  38 C.F.R. § 3.310(b); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding all that is needed is a "but for" causation or aggravation to show entitlement to secondary service connection).

Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). 

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time, he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for
 "pain alone can serve as a functional impairment and therefore qualify as a disability"). 

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time, he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

As an initial matter, the Board notes that while the record does not contain a definitive diagnosis of a left or right knee disorder, the appellant is competent, as a lay person, to report experiencing bilateral knee functional impairments, which he described at the May 2024 hearing as an inability to perform manual or physical labor.  See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required); Saunders, supra. As such, for the limited purpose of the analysis of the claims on appeal, the Board will assume the existence of a current bilateral knee disorder.  

However, at the time of the issuance of the October 2019 rating decision on appeal, the appellant had not advanced any theory of entitlement or otherwise indicated why he believed his claimed bilateral knee disorder was related to his military service. Additionally, his service treatment records were negative for any complaints, treatment, or diagnoses referable to a left or right knee disorder, and he did not identify any post-service treatment records. 

Rather, at the May 2024 Board hearing, the appellant, for the first time, reported that, during his initial period of ACDUTRA, he reinjured a pre-existing right ankle disorder while performing physical training in combat boots, which, in turn, caused him to strain his right knee, and, as of result of compensating for his right knee strain, he strained his left knee.  In support thereof, he submitted a July 2024 statement from a fellow service members statement wherein she recounted the difficulty he had with his right ankle during such period of ACDUTRA. However, the appellant, as a lay person, lacks the requisite training and experience necessary to address the etiology of his bilateral knee disorder as such is a complex medical matter concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). 

Furthermore, as the appellant did not advance the foregoing theory of entitlement until his May 2024 Board hearing, which is after the issuance of the October 2019 rating decision on appeal, such allegations cannot serve to support a pre-decisional duty to assist error in the AOJ's failure to obtain a VA examination and/or opinion in regard to such contentions. Moreover, the appellant is not service-connected for  a right ankle disorder, and service connection for such claimed disorder is denied in a separate appeal, service connection for a bilateral knee disorder on a secondary basis may not be awarded as a matter of law.

Consequently, the Board finds that a left and/or right knee disorder is not shown to be causally or etiologically related to a disease or injury incurred or aggravated during period of ACDUTRA or an injury incurred or aggravated during a period of INACDUTRA, or caused or aggravated by a service-connected disability. Thus, service connection for such claimed disorders must be denied.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the appellant's claim for service connection for left and right knee disorders, such doctrine is not applicable the instant appeal and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.  

 

A. J
 be causally or etiologically related to a disease or injury incurred or aggravated during period of ACDUTRA or an injury incurred or aggravated during a period of INACDUTRA, or caused or aggravated by a service-connected disability. Thus, service connection for such claimed disorders must be denied.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the appellant's claim for service connection for left and right knee disorders, such doctrine is not applicable the instant appeal and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.  

 

A. JAEGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. Northcutt

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.