KNEE IMPAIRMENT OF

D. MARTZ AMES · 2026 · Case ID: A26017238

MIXED

Summary

The veteran, who served in the United States Air Force in various capacities including during Operation African Lion in Morocco and Operation Desert Storm in Saudi Arabia, appeals the denial of service connection for several conditions. The Board reviewed claims for left and right knee disabilities, a positive TB test, pulmonary arteriovenous malformation (AVM), and headaches. The Board found that new and relevant evidence had been submitted since prior denials, warranting readjudication under AMA standards. For the knee conditions, the Board found the evidence evenly balanced and resolved doubt in the veteran's favor, granting service connection based on in-service injuries reported in Morocco and corroborated by service records and a private medical opinion. Service connection for a positive TB test was also granted, with a private medical opinion linking it to exposures during deployments, and resolving doubt in the veteran's favor. Similarly, service connection for pulmonary arteriovenous malformation was granted, with a private opinion suggesting a link to deployment exposures and doubt resolved in the veteran's favor. Headaches were granted service connection, with a VA examination noting their persistence since an in-service head injury and finding the evidence evenly balanced, with doubt resolved in the veteran's favor. However, the claim for residuals of traumatic brain injury (TBI) was remanded due to a duty to assist error, as the VA failed to schedule a proper TBI examination, instead providing a mental disorders examination.

Rationale

Current disability for left knee chondromalacia patella; In-service injury reported in Morocco in March 2006; Evidence evenly balanced, doubt resolved in veteran's favor

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200219-95290

Full Decision Text

Citation Nr: A26017238
Decision Date: 02/25/26 Archive Date: 02/25/26

DOCKET NO. 200219-95290
DATE: February 25, 2026

ORDER

New and relevant evidence has been received, readjudication of the claim of service connection for left knee chondromalacia patella (claimed as both knees) is warranted.

New and relevant evidence has been received, readjudication of the claim of service connection for right knee osteoarthritis with medial meniscus derangement (claimed as both knees) is warranted.

New and relevant evidence has been received, readjudication of the claim of service connection for positive tuberculosis (TB) test is warranted.

New and relevant evidence has been received, readjudication of the claim of service connection for pulmonary arteriovenous malformation (claimed as AVM) is warranted.

New and relevant evidence has been received, readjudication of the claim of service connection for residuals of traumatic brain injury (TBI) is warranted.

New and relevant evidence has been received, readjudication of the claim of service connection for headaches as secondary to residuals of TBI is warranted.

Entitlement to service connection for left knee chondromalacia patella (claimed as both knees) is granted.

Entitlement to service connection for right knee osteoarthritis with medial meniscus derangement (claimed as both knees) is granted.

Entitlement to service connection for a positive TB test is granted.

Entitlement to service connection for pulmonary arteriovenous malformation (claimed as AVM) is granted.

Entitlement to service connection for headaches is granted.

REMANDED

Entitlement to service connection for residuals of traumatic brain injury is remanded.

FINDINGS OF FACT

1. New evidence that is relevant to the claim of entitlement to service connection for left knee chondromalacia patella (claimed as both knees) has been received since the October 2015 denial of service connection for that disability or during a time when the evidentiary record was closed.

2. New evidence that is relevant to the claim of entitlement to service connection for right knee osteoarthritis with medial meniscus derangement (claimed as both knees) has been received since the October 2015 denial of service connection for that disability or during a time when the evidentiary record was closed.

3. New evidence that is relevant to the claim of entitlement to service connection for a positive TB test has been received since the December 2013 denial of service connection for that disability or during a time when the evidentiary record was closed.

4. New evidence that is relevant to the claim of entitlement to service connection for pulmonary arteriovenous malformation (claimed as AVM) has been received since the October 2015 denial of service connection for that disability or during a time when the evidentiary record was closed.

5. New evidence that is relevant to the claim of entitlement to service connection for residuals of TBI has been received since the October 2015 denial of service connection for that disability or during a time when the evidentiary record was closed.

6. New evidence that is relevant to the claim of entitlement to service connection for headaches as secondary to residuals of TBI has been received since the October 2015 denial of service connection for that disability or during a time when the evidentiary record was closed.

7. Resolving reasonable doubt in the Veteran's favor, her left knee disability is related to an in-service injury.

8. Resolving reasonable doubt in the Veteran's favor, her right knee disability is related to an in-service injury.

9. Resolving reasonable doubt in the Veteran's favor, her positive TB test was related to an in-service injury, event, or illness.

10. Resolving reasonable doubt in the Veteran's favor, her pulmonary arteriovenous malformation was related to an in-service injury, event, or illness.

11. Resolving reasonable doubt in the Veteran's favor, her headaches were related to an in-service injury.

CONCLUSIONS OF LAW

1. The criteria for readjudication of the claim for service connection for left knee chondromalacia patella (claimed as both knees) have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501(a).

2. The criteria for readjudication of the claim for service connection for right knee osteoarthritis with medial meniscus derangement (claimed as both knees) have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501(a).

3. The criteria for readjudication of the claim for service connection for positive TB test have been
judication of the claim for service connection for left knee chondromalacia patella (claimed as both knees) have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501(a).

3. The criteria for readjudication of the claim for service connection for positive TB test have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501(a).

4. The criteria for readjudication of the claim for service connection for pulmonary arteriovenous malformation (claimed as AVM) have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501(a).

5. The criteria for readjudication of the claim for service connection for residuals of TBI have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501(a).

6. The criteria for readjudication of the claim for service connection for headaches as secondary to residuals of TBI have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501(a).

7. The criteria for service connection for left knee disability are met. 38 U.S.C. §§ 106, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for right knee disability are met. 38 U.S.C. §§ 106, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for service connection for a positive TB test are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for service connection for pulmonary arteriovenous malformation disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

11. The criteria for service connection for a headache disability are met. 38 U.S.C. §§ 106, 1110, 1131, 5107; 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 January 1991 to July 1991, and from September 2001 to October 2002. She also served a period of active duty for training in the United States Air Force from July 1977 to May 1978.

In February 2020, after issuance of a Statement of the Case (SOC) in January 2020, the Veteran opted the claims into the modernized review system, also known as the Appeals Modernization Act (AMA). 38 C.F.R. § 19.2(d). At that time, she requested a hearing before the Board of Veterans' Appeals (Board) and an opportunity to submit evidence at the hearing and within 90 days following the hearing. 38 C.F.R. § 20.202. On July 1, 2024, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record.

Therefore, the Board may only consider the evidence of record at the time of the January 2020 SOC, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). Evidence was submitted either (1) during the period after the AOJ issued the January 2020 SOC and prior to the Board hearing, or (2) more than 90 days following the hearing, and the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As
of record at the time of the January 2020 SOC, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). Evidence was submitted either (1) during the period after the AOJ issued the January 2020 SOC and prior to the Board hearing, or (2) more than 90 days following the hearing, and the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claims of service connection for bilateral knees, positive TB test, pulmonary arteriovenous malformation, and headache, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim of service connection for residuals of TBI, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

Claims to Reopen

Under the Legacy appeal system, if a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108.

New evidence means existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The credibility of the evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for reopening is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010).

Under the AMA appeal system, VA will readjudicate a previously denied claim if new and relevant evidence is presented or secured. 38 U.S.C. § 5108(a); 38 C.F.R. § 3.156(d). New evidence is evidence not previously part of the actual record before agency adjudicators. Relevant evidence is information that tends to prove or disprove a matter at issue in a claim and includes evidence that raises a theory of entitlement that was not previously addressed. 38 C.F.R. § 3.2501(a)(1). In determining whether new and relevant evidence is presented or secured, VA will consider any VA treatment records reasonably identified by the claimant and any evidence received by VA after VA issued notice of a decision on the claim and while the evidentiary record was closed. 38 C.F.R. § 3.2501. When a supplemental claim has been submitted, the evidentiary record includes evidence received by VA before the issuance of notice of a decision on the supplemental claim. 38 C.F.R. § 3.2501(b).

For claims received prior to March 24, 2015, a "claim" is defined as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. §§ 3.1(p), 3.155(a) (2014); Brannon v. West, 12 Vet. App. 32, 34-5 (1998). Any communication or action indicating an intent to apply for one or more VA benefits, including statements from a Veteran's duly authorized representative, may be considered an informal claim. 38 C.F.R. § 3.155(a) (2015). Such informal claims must identify the benefit sought. Id. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. Id
in entitlement to a benefit. 38 C.F.R. §§ 3.1(p), 3.155(a) (2014); Brannon v. West, 12 Vet. App. 32, 34-5 (1998). Any communication or action indicating an intent to apply for one or more VA benefits, including statements from a Veteran's duly authorized representative, may be considered an informal claim. 38 C.F.R. § 3.155(a) (2015). Such informal claims must identify the benefit sought. Id. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. Id. If received within one year from the date it was sent to the claimant, it will be considered as filed as of the date of receipt of the informal claim. Id.

1. Left Knee

2. Right Knee

By way of background, the Veteran submitted an April 2011 informal claim for the issue of service connection for bilateral knees. However, a completed claim for the bilateral knees was not received within a year of the informal claim.

In December 2012, the Veteran submitted a completed claim of service connection for "both knees." A December 2013 rating decision denied the claim of service connection for left knee chondromalacia patella and right knee osteoarthritis with medial meniscus derangement, finding that the conditions neither occurred in nor was caused by active-duty service.

The Veteran submitted a November 2014 correspondence requesting the reevaluation of the knee claims. A February 2015 rating decision denied the claim of service connection for bilateral knees.

The Veteran then submitted a June 2015 claim to reopen the issue of service connection for bilateral knees. An October 2015 rating decision denied the knee claims finding that the evidence submitted was not new and material. The Veteran was provided notice of this decision and her appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2015).

The Veteran submitted a May 2017 claim to reopen the issue of service connection for bilateral knees. A July 2017 rating decision denied the knee claims because the evidence submitted was not new and material.

The Veteran submitted an April 2018 claim for service connection for bilateral knees, and an August 2018 rating decision denied the issues finding that the evidence submitted was not new and material. The Veteran then submitted an October 2018 claim seeking reconsideration of the August 2018 rating decision.

A November 2018 rating decision denied the claim of service connection for the bilateral knees because the evidence submitted was not new and material. The Veteran submitted November 2019 notice of disagreement seeking review of the November 2018 decision that denied her claims.

The January 2020 SOC, the decision on appeal, was issued which denied the claim of service connection for bilateral knees finding that the evidence does not indicate the conditions were due to or a result of active-duty military service. This appeal followed.

As the claim to reopen the bilateral knee issues was adjudicated in January 2020 and the Veteran opted in the AMA, the new and relevant standards are applicable in this case. The evidence received since the October 2015 rating decision includes evidence that is both new and relevant to the claim. See 38 C.F.R. § 3.2501(a)(1). For example, a December 2019 VA treatment shows treatment for the left knee, and a January 2020 VA treatment shows treatment for the right knee. These are new VA treatment records since the October 2015 rating decision that are relevant to the claim of left and right knee on appeal. Accordingly, the claims should be readjudicated taking into consideration all of the evidence of record.

3. Positive TB Test

By way of background, the Veteran submitted a December 2012 fully developed claim for the issue of service connection for "Positive TB Test." A December 2013 rating decision denied the claim finding that at no time during active military duty was the Veteran treated for or diagnosed with complications from or involving a positive TB test. The Veteran was provided notice of this decision and her appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2013).

The Veteran submitted an April 2018 claim to reopen the issue of service connection for positive TB
background, the Veteran submitted a December 2012 fully developed claim for the issue of service connection for "Positive TB Test." A December 2013 rating decision denied the claim finding that at no time during active military duty was the Veteran treated for or diagnosed with complications from or involving a positive TB test. The Veteran was provided notice of this decision and her appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2013).

The Veteran submitted an April 2018 claim to reopen the issue of service connection for positive TB skin test. An August 2018 rating decision denied the claim of service connection for Positive TB Test finding that the evidence submitted was not new and material. She submitted an October 2018 claim seeking reconsideration of the August 2018 rating decision.

A November 2018 rating decision denied the claim of service connection for Positive TB Test because the evidence submitted was not new and material. The Veteran submitted November 2019 notice of disagreement seeking review of the November 2018 decision that denied the claim.

The January 2020 SOC, the decision on appeal, was issued which denied the claim of service connection for positive TB test finding that the evidence does not indicate that the condition was due to or a result of active-duty military service. This appeal followed.

The evidence received since the December 2013 rating decision includes evidence that is both new and relevant to the claim. See 38 C.F.R. § 3.2501(a)(1). For example, an April 2018 private medical opinion by nurse practitioner S.S. was submitted in support of the positive TB test claim. This opinion is new since the December 2013 decision that is relevant to the claim as it addresses the reported onset of the Veteran's positive TB test claim. Accordingly, the claim should be readjudicated taking into consideration all of the evidence of record.

4. Pulmonary Arteriovenous Malformation

By way of background, the Veteran submitted a December 2012 fully developed claim for the issue of service connection for "AVM." A December 2013 rating decision denied the issue of service connection for pulmonary arteriovenous malformation (claimed as AVM) finding that this condition neither occurred in nor was caused by service.

The Veteran then submitted a June 2015 claim to reopen the issue of service connection for "AVM." An October 2015 rating decision denied the claim of service connection for pulmonary arteriovenous malformation (claimed as AVM) finding that the evidence submitted was not new and material. The Veteran was provided notice of this decision and her appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2015).

The Veteran submitted a May 2017 claim to reopen the issue of service connection for pulmonary arteriovenous fistula. A July 2017 rating decision denied the claim of service connection for pulmonary arteriovenous malformation (claimed as AVM) because the evidence submitted was not new and material.

The Veteran submitted an April 2018 claim for service connection for pulmonary arteriovenous malformation. An August 2018 rating decision denied the issue of service connection for pulmonary arteriovenous malformation (claimed as AVM) finding that the evidence submitted was not new and material. The Veteran then submitted an October 2018 claim seeking reconsideration of the August 2018 rating decision.

A November 2018 rating decision denied the claim of service connection for the pulmonary arteriovenous malformation because the evidence submitted was not new and material. The Veteran submitted November 2019 notice of disagreement seeking review of the November 2018 decision that denied her claim.

The January 2020 SOC, the decision on appeal, was issued which denied the claim of service connection for pulmonary arteriovenous malformation finding that the evidence does not indicate the condition was due to or a result of active-duty military service. She submitted the instant appeal.

The evidence received since the October 2015 rating decision includes evidence that is both new and relevant to the claim. See 38 C.F.R. § 3.2501(a)(1). For example, an April 2018 private medical opinion by nurse practitioner S.S. was submitted in support of the pulmonary arteriovenous malformation claim. This opinion is new since the October 2015 decision that is relevant to the

5. TBI

By way of background, the Veteran submitted an April 2011 informal claim for the issue of service connection for status post head trauma. However, a completed claim for the issue of service connection for status post head trauma was not received within a year of the informal claim.

In December 2012, the Veteran submitted a completed claim for the issue of service connection for "TBI". A December 2013 rating decision denied the issue of service connection for residuals of TBI finding that there was no evidence of permanent residual or chronic disability subject to service connection shown by the service medical records or demonstrated by evidence following service.

In June 2015, the Veteran submitted a fully developed claim to reopen the issue of service connection for TBI. An October 2015 rating decision denied the claim of service connection for residuals of TBI because the evidence submitted was not new and material. The Veteran was provided notice of this decision and her appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2015).

In May 2017, the Veteran submitted a fully developed claim to reopen the issue of service connection for TBI. A July 2017 rating decision denied the issue of service connection for residuals of TBI as the evidence submitted was not new and material. In April 2018, the Veteran requested reconsideration of the July 2017 decision that denied the claim.

An August 2018 rating decision denied the claim of service connection for residuals of TBI because the evidence submitted was not new and material. In October 2018, the Veteran submitted a claim seeking reconsideration of the August 2018 decision.

A November 2018 rating decision denied the claim of service connection for residuals of TBI because the evidence submitted was not new and material. The Veteran submitted a November 2019 notice of disagreement contesting the denial of her claim.

The January 2020 SOC, the decision on appeal, denied the claim of service connection for residuals of TBI finding that a review of the evidence does not indicate that the condition was due to or a result of active-duty military service. The Veteran submitted the instant appeal.

The evidence received since the October 2015 rating decision includes evidence that is both new and relevant to the claim. See 38 C.F.R. § 3.2501(a)(1). For example, a May 2018 VA treatment record showed treatment for TBI. This was new VA treatment since the October 2015 decision that was relevant to the claim on appeal. Accordingly, the claim should be readjudicated taking into consideration all of the evidence of record.

6. Headaches

By way of background, the Veteran submitted an April 2011 informal claim for the issue of service connection for chronic headaches secondary to head trauma. However, a completed claim for the issue of service connection for chronic headaches was not received within a year of the informal claim.

In a June 2015 fully developed claim, the Veteran sought service connection for "add new headaches". An October 2015 rating decision denied the issue of service connection for headaches finding that the condition neither occurred in nor was caused by service. The Veteran was provided notice of this decision and her appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2015).

The Veteran submitted a May 2017 fully developed claim to reopen the issue of service connection for headaches as secondary to TBI. A July 2017 rating decision denied the claim of service connection for headaches as secondary to
connection for "add new headaches". An October 2015 rating decision denied the issue of service connection for headaches finding that the condition neither occurred in nor was caused by service. The Veteran was provided notice of this decision and her appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2015).

In April 2018, the Veteran requested reconsideration of the issue of service connection for headaches as secondary to TBI. An August 2018 rating decision denied the claim of service connection for headaches because the evidence submitted was not new and material.

The Veteran then submitted an October 2018 claim seeking reconsideration of the August 2018 rating decision. A November 2018 rating decision denied the claim of service connection for headaches as secondary to TBI because the evidence submitted was not new and material. She submitted a November 2019 notice of disagreement contesting the decision.

The January 2020 SOC, the decision on appeal, denied the claim of service connection for headaches finding that a review of the evidence does not support findings of headaches that were incurred in or caused by active-duty military service or found to be in the line of duty. The Veteran submitted the instant appeal.

The evidence received since the October 2015 rating decision includes evidence that is both new and relevant to the claim. See 38 C.F.R. § 3.2501(a)(1). For example, an October 2019 VA examination for headaches was provided where it was noted that the Veteran had a diagnosis of posttraumatic headache. This examination is new since the October 2015 decision that is relevant to the claim as it addressed whether the Veteran had a current disability for headaches. Accordingly, the claim should be readjudicated taking into consideration all of the evidence of record.

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, 5107; 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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Service connection may additionally be granted for disability resulting from injury incurred in or aggravated while performing active duty for training (ADT) or inactive duty for training (IADT) or a disease incurred or aggravated while performing ADT. 38 U.S.C. §§ 101(24), 106.

1. Left Knee

2. Right Knee

The Veteran contends that she has bilateral knee disability that was caused by her service.

The Veteran has a current bilateral knee disability. During the October 2013 VA examination, she was diagnosed with osteoarthritis of the right knee, derangement medial meniscus of the right knee, and chondromalacia of the patella left knee. In a November 2019 VA examination, she was diagnosed with bilateral knee strain, bilateral patellofemoral pain syndrome, bilateral degenerative arthritis, right Baker's cyst, right chondromalacia, and right medial meniscus tear. Thus, the question becomes whether the current disability was related to service.

The Veteran assert that she initially injured her knee while on active duty in Agadir, Morocco participating in the Operation African Lion and then again when she slipped on ice while at Sheppard Air Force Base. See October 2018 Correspondence. Specifically, she stated that while on temporary duty assignment (TDY) to Morocco in March 2006, she was running up flight of stairs when she slipped and fell to her knees injuring both knees. See May 2006 Ground Mishap Worksheet; see also July 2011 Informal Line of Duty Determination; see also July 2024 Hearing Tr. at 3, 5.

A
Thus, the question becomes whether the current disability was related to service.

A review of a February 2006 TDY travel documents for the Veteran indicated that she was authorized to travel to attend the African Lion operation in Morocco on March 20, 2006. A September 2006 performance review report for the Veteran indicated that she was selected as the Deployed Joint Medical Commander for African Lion, and she also received a June 2008 Meritorious Service Award as a result of her service for Operation African Lion.

A review of the Veteran's point credit summary shows that she was on "active duty other" in March 2006. See December 2014 STR - Medical.

She also reported injuring her knees on January 31, 2011, while on TDY to Sheppard Air Force Base when she slipped on ice. See January 2011 Ground Mishap Worksheet; see also July 2024 Hearing Tr. at 5.

The medical evidence in favor of the claim includes an October 2013 VA medical opinion where the examiner opined that the claimed condition was incurred in or caused by the claim in-service injury, event, or illness. In support of this conclusion, the examiner noted that the Veteran's service treatment record for September 20, 2006, indicated that the Veteran had left knee pain. The examiner noted that on March 7, 2008, the service treatment record showed right knee pain. The examiner noted that the bilateral knee condition has persisted since service.

A November 2019 private medical opinion was provided by Dr. C.H., who reviewed the record to include the line of duty determinations. Dr. C.H. noted that the Veteran experienced blunt trauma on both knees while on active duty as documented in her medical records as well as on Mishap reports. The Veteran did not have any preexisting conditions indicated in her medical records. Dr. C.H. noted that the knee osteoarthritis is the result of stress and damage to the knee joints over time, and the Veteran's initial damage occurred when she was on active duty in Morocco in 2006. Dr. C.H. noted that after the initial knee injuries, the Veteran was unable to perform her run during her fitness evaluation, an activity she was able to perform prior to her injury. Dr. C.H. noted that the medical records showed multiple interventions from various military medical center treatment of her knees over the 6 years following her initial injury. Thus, Dr. C.H. concluded that the Veteran's osteoarthritis of the knee was caused by the blunt trauma to both her knees that she experienced while she was active duty and are not related to her age.

The medical evidence against the claim includes a February 2015 VA medical opinion where the examiner noted that the Veteran's claimed disability pattern for right knee osteoarthritis with derangement medial meniscus and left knee chondromalacia patella are diagnosable illnesses with known etiologies. They are not undiagnosable and are not due to toxin or exposure events incurred while service in Southwest Asia.

Upon review of the record, the Board finds the evidence to at least be evenly balanced as to whether the Veteran's current bilateral knee disability arose in and is related to service. In making this finding, the Board notes that the first element of service connection is met as the Veteran has a current disability for her bilateral knees. Secondly, the Veteran reported that she sustained a bilateral knee injury during service while she was serving in Morocco in March 2006. A review of the service personnel records indicate that the Veteran was on "active duty other" service in March 2006 and received awards and performance review for her service in Morocco. An informal line of duty determination and mishap report indicates that the Veteran sustained bilateral knee injuries during her deployment. The Board finds that the competent and credible evidence supports an in-service incurrence of a bilateral knee injury in March 2006 during a period of "active duty other" service.

Lastly, the Board gives probative weight to the February 2019 private opinion by Dr. C.H. who reviewed the record and
, the Veteran reported that she sustained a bilateral knee injury during service while she was serving in Morocco in March 2006. A review of the service personnel records indicate that the Veteran was on "active duty other" service in March 2006 and received awards and performance review for her service in Morocco. An informal line of duty determination and mishap report indicates that the Veteran sustained bilateral knee injuries during her deployment. The Board finds that the competent and credible evidence supports an in-service incurrence of a bilateral knee injury in March 2006 during a period of "active duty other" service.

Lastly, the Board gives probative weight to the February 2019 private opinion by Dr. C.H. who reviewed the record and explained that the onset of the Veteran's bilateral knee disability was blunt trauma injuries sustained while deployed to Morocco in March 2006. The Board assigns probative weight to the medical evidence of record, to include the private opinion rendered by a trained medical professional based on a review of the record and reasonably drawn conclusions with supportive rationale. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral knee disability is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Positive TB Test

The Veteran contends that her positive TB test was related to service.

The Veteran has a current disability for a positive tuberculosis (TB) test. During an October 2013 VA examination, she was diagnosed with a positive TB test.

During service, an August 2002 report of medical history noted that the Veteran had a positive TB test. It was noted that she had TB in 1990 and had 6 months of isoniazid (INH).

In a July 2011 screening exam for pulmonary tuberculosis, it was noted that the Veteran had a history of TB treatment in 1991 after deployment to Kuwait and Iraq for Operation Desert Storm. The Veteran and completed a full INH therapy.

In a January 2012 informal line of duty determination, it was noted that on a July 28, 2011, treatment the Veteran was seen for past positive PPD from a chest x-ray.

Thus, the question becomes whether the current disability is related to service.

The evidence in favor of the claim includes October 2013 VA medical opinion where the examiner opined that the claimed condition was incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner noted that an August 2002 report of medical history indicates that the Veteran had positive TB in 1990 and had 6 months of INH treatment. The examiner noted that the Veteran never had symptoms of an active TB infection. She had chest CT scan in 2011 that showed a calcified right middle lobe nodule consistent with prior granulomatous infection which was a common finding on the scan after previous exposure to the infection.

An April 2018 private medical opinion was provided by nurse practitioner S.S., who had treated the Veteran. After interviewing the Veteran and reviewing her medical and military history, nurse S.S. noted that the Veteran's conversion from negative to positive TB skin as well as the appearance of an acquired pulmonary arteriovenous malformation was more likely than not a result of exposures during her numerous military deployments to regions of extreme poverty and marked poor public health conditions. Nurse S.S. noted that the medical findings arose during her military service after documented prior negative screenings.

A review of service personnel records indicate that the Veteran was deployed to Saudi Arabia from January 1991 to June 1991.

Upon review of the record, the Board finds the evidence to at least be evenly balanced as to whether the Veteran's current disability for positive TB test arose in and is related to service. The medical evidence shows that the Veteran had a current disability for positive TB based on her test results. The service record document the Veteran's deployment to Saudi Arabia from January 1991 to June 1991. In the April 2018 private opinion, nurse S.S. interviewed the Veteran and reviewed the record and explained that the Veteran's positive TB was a direct result of her exposure during her deployments, to include to Saudi Arabia. The Board assigns probative weight to the medical evidence of record, to include the April 2018 private opinion rendered by a trained medical professional based on a review of the record and reasonably drawn conclusions with supportive rationale. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a positive TB test is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4
. In the April 2018 private opinion, nurse S.S. interviewed the Veteran and reviewed the record and explained that the Veteran's positive TB was a direct result of her exposure during her deployments, to include to Saudi Arabia. The Board assigns probative weight to the medical evidence of record, to include the April 2018 private opinion rendered by a trained medical professional based on a review of the record and reasonably drawn conclusions with supportive rationale. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a positive TB test is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4. Pulmonary Arteriovenous Malformation

The Veteran contends that her pulmonary arteriovenous malformation was related to her service.

The Veteran has a current disability for pulmonary arteriovenous malformation. For example, during the 90-day evidentiary window, the Veteran submitted a February 2024 VA examination where she was diagnosed with pulmonary arteriovenous malformation (AVM) status post embolization.

A June 28, 2011, chest x-ray impression showed right pulmonary nodule.

In an August 30, 2011, impression, it was noted that the Veteran had 1-centimeter pulmonary arteriovenous malformation in the left lower lobe. The Veteran was assessed as having pulmonary arteriovenous fistula and asymptomatic pulmonary AVM.

In a March 2, 2012, assessment, it was noted that the Veteran had pulmonary arteriovenous. An April 2012 CT chest impression noted that the Veteran had left lower lobe pulmonary AVM status post coil embolization with no evidence of recanalization.

Thus, the question becomes whether the current pulmonary arteriovenous malformation disability was related to service.

The evidence in favor of the claim includes October 2013 VA medical opinion, the same opinion for the TB claim where the examiner also addressed pulmonary arteriovenous malformation. The examiner opined that the claimed condition was incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner noted that an August 2002 report of medical history indicates that the Veteran had positive TB in 1990 and had 6 months of INH treatment. The examiner noted that the Veteran never had symptoms of an active TB infection. She had chest CT scan in 2011 that showed a calcified right middle lobe nodule consistent with prior granulomatous infection which was a common finding on the scan after previous exposure to the infection. The examiner noted that the Veteran had incidental finding of pulmonary arteriovenous malformation in the left lower lobe for which she underwent an angio stenting of AV pulmonary fistula.

Upon review of the record, the Board finds the evidence to at least be evenly balanced as to whether the Veteran's current pulmonary arteriovenous malformation arose in and is related to service. The Veteran had a current disability for pulmonary arteriovenous malformation. Further, similar to the TB claim, the nurse S.S. noted that the Veteran's acquired pulmonary arteriovenous malformation was more likely than not a result of exposures during her numerous military deployments to regions of extreme poverty and marked poor public health conditions. The Board assigns probative weight to the medical evidence of record, to include the April 2018 private opinion rendered by a trained medical professional based on a review of the record and reasonably drawn conclusions with a supportive rationale. There is no medical opinion against the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for pulmonary arteriovenous malformation is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Headaches

The Veteran contends that she has a headache disability that is related to service.

The Veteran has a current headache disability. In an October 2019 VA examination, she was diagnosed with posttraumatic headaches.

During service, a line of
private opinion rendered by a trained medical professional based on a review of the record and reasonably drawn conclusions with a supportive rationale. There is no medical opinion against the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for pulmonary arteriovenous malformation is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Headaches

The Veteran contends that she has a headache disability that is related to service.

The Veteran has a current headache disability. In an October 2019 VA examination, she was diagnosed with posttraumatic headaches.

During service, a line of duty determination found that the Veteran sustained a July 1, 1981, head injury when she hit her head on a cargo door. It was noted that the Veteran had headaches since then. In a September 1981 report of investigation of the line of duty determination, it was determined that the injury occurred in line of duty.

Thus, the question becomes whether the current disability is related to service.

The evidence in favor of the claim includes an October 2019 VA opinion that was part of the headache of examination. In the remarks section of the examination, the examiner noted that the Veteran has been experiencing headaches since July 1981 after she hit her head on a cargo door while she was serving. The examiner noted that the Veteran endured her headache through her military training and service until her headaches were further aggravated in March 2006 when she fell on marble stairs during her deployment to Morrocco. Her headache also intensified in 2010 after she slipped and fell on ice. The examiner noted that her headaches persist and have been gradually worsening despite pharmacological intervention and chiropractic/massage therapy.

Upon review of the record, the Board finds the evidence to at least be evenly balanced as to whether the Veteran's current headache disability arose in and is related to service. The Veteran has a current disability for headache as she was diagnosed with posttraumatic headache. A July 1, 1981, line of duty determination showed that the Veteran sustained a head injury which resulted in headache residuals. The October 2019 VA examiner noted that the Veteran's current headache has occurred since she sustained the head injury in July 1981. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for headache disability is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Service Connection for Residuals of TBI is Remanded.

The issue of entitlement to service connection for residuals of TBI is remanded to correct a duty to assist error that occurred prior to the January 2020 SOC decision on appeal.

The Veteran contends that she has a TBI that was related to her service. See July 2024 Hearing Tr. at 13-20.

The AOJ obtained an October 2013 VA examination prior to the January 2020 SOC decision on appeal where it was noted that the Veteran did not have a TBI diagnosis. In a May 2018 VA treatment, the Veteran was evaluated for possible TBI. However, instead of scheduling a TBI examination, the Veteran was afforded an October 2019 VA mental disorders examination for her TBI claim.

The Board identifies a pre-decisional duty to assist error as the AOJ failed to schedule the Veteran for a TBI examination. The Veteran was scheduled for a mental disorder examination instead. To correct this duty to assist error, a remand is necessary to schedule the Veteran for an examination.

The Board emphasizes that it is not determining whether or not the Veteran's statements that her TBI symptoms are due to service are credible at this time, as the additional development set forth in the directives below could impact that determination.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination for her TBI claim. The examiner must review the claims file and is asked to determine whether any current TBI disability onset during service or is otherwise related to an in-service injury, event, or disease.

The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which she has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation.

A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings.

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

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