KNEE IMPAIRMENT OF

RAY BARTO SLABBEKORN, JR. · 2026 · Case ID: A26017778

MIXED

Summary

The veteran, who served in the United States Air Force from May 1974 to May 1995, appealed the denial of service connection for bilateral knee, ankle, and foot conditions, as well as abdominal pain. The veteran claimed these conditions were secondary to a service-connected lumbar spine disorder. The Board reviewed evidence including service treatment records, a VA examination, and a private chiropractor's evaluation submitted after a Board hearing. The VA examiner opined that the Veteran's right foot condition was less likely than not related to service. However, the private chiropractor found it more likely than not that the bilateral knee, ankle, and foot pain were secondary to the service-connected lumbar spine disorder, citing an antalgic gait and weight-shifting. The Board gave significant weight to the private chiropractor's opinions, finding them well-reasoned and supported by the evidence. Consequently, service connection for the bilateral knee, ankle, and foot conditions was granted on a secondary basis. For the abdominal pain claim, the Board noted the Veteran had favorable findings for viral enteritis in service treatment records but found no current diagnosis of an abdominal disorder. Despite considering the benefit-of-the-doubt rule, the evidence persuasively weighed against a current abdominal disorder, leading to denial of that claim.

Rationale

Private chiropractor opined condition is more likely than not secondary to lumbar spine disorder.; Chiropractor cited antalgic gait and weight-shifting due to lumbar spine disorder.; Private opinion given great weight due to reliance on medical history and clear conclusions.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200414-81965

Full Decision Text

Citation Nr: A26017778
Decision Date: 02/26/26 Archive Date: 02/26/26

DOCKET NO. 200414-81965
DATE: February 26, 2026

ORDER

Entitlement to service connection for a right knee disorder is granted.

Entitlement to service connection for a left knee disorder is granted.

Entitlement to service connection for a right ankle disorder is granted.

Entitlement to service connection for a left ankle disorder is granted.

Entitlement to service connection for a right foot disorder is granted.

Entitlement to service connection for a left foot disorder is granted.

Entitlement to service connection for abdominal pain is denied.

FINDINGS OF FACT

1. The Veteran's right knee disorder is caused or aggravated by service-connected lumbar spine disorder.

2. The Veteran's left knee disorder is caused or aggravated by his service-connected lumbar spine disorder.

3. The Veteran's right ankle disorder is caused by service-connected lumbar spine disorder.

4. The Veteran's left ankle disorder is caused by service-connected lumbar spine disorder.

5. The Veteran's right foot disorder is caused or aggravated by service-connected lumbar spine disorder.

6. The Veteran's left foot disorder is caused or aggravated by service-connected lumbar spine disorder.

7. The Veteran does not have a current diagnosis of an abdominal disorder.

CONCLUSIONS OF LAW

1. The criteria for service connection for a right knee disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for a left knee disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a right ankle disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for a left ankle disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for a right foot disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for service connection for a left foot disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

7. The criteria for service connection for abdominal pain have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from May 1974 to May 1995.

The Veteran's intent to file was received on February 7, 2019. In March 2019, the Veteran filed a claim for service connection for bilateral knee pain, bilateral ankle pain, bilateral foot pain, and for abdominal pain. In a May 2019 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO), denied service connection for a right knee condition, a left knee condition, a right ankle condition, a left ankle condition, a right foot condition, a left foot condition and for abdominal pain.

In April 2020, the Veteran appealed the May 2019 rating decision to the Board of Veterans' Appeals (Board) via a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement). He requested the hearing lane. As an appeal in which the appellant requested, on the Notice of Disagreement, a Board hearing, the Board's decision is based on a review of the evidence of record at the time of the decision on the issue on appeal, evidence submitted by the appellant or his representative at the hearing, to include testimony provided at the hearing, and evidence submitted by the appellant or his representative within 90 days following the hearing. 38 C.F.R. § 20.302(a).

In October 2024, the Veteran testified at a hearing before the undersigned Veterans Law Judge. This decision reflects the Board's consideration of the testimony, evidence, and information presented at the hearing, and a transcript of
requested the hearing lane. As an appeal in which the appellant requested, on the Notice of Disagreement, a Board hearing, the Board's decision is based on a review of the evidence of record at the time of the decision on the issue on appeal, evidence submitted by the appellant or his representative at the hearing, to include testimony provided at the hearing, and evidence submitted by the appellant or his representative within 90 days following the hearing. 38 C.F.R. § 20.302(a).

It was noted at the October 2024 Board hearing that there was an outstanding Freedom of Information Act (FOIA) request. However, in subsequent October 2024 correspondence from the Board, and in November 2024 correspondence from the RO, it was shown that the Veteran's FOIA request had been processed.

Moreover, the Board acknowledges that in addition to the current issues on appeal, the Veteran appealed the issue of entitlement to service connection for an acquired psychiatric disorder in a separate April 2021 Notice of Disagreement. This issue will be addressed in a separate Board decision.

Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting service, was aggravated therein. 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 may be granted on a secondary basis for a disability which would not have resulted, if it were not for (due to or caused by) a service-connected disease or injury. See 38 C.F.R. § 3.310(a). Additionally, service connection of a nonservice-connected disease or injury will be established if an increase in the severity of the that disability or injury would not have resulted if it were not for (aggravated by) a service-connected disease or injury. See 38 C.F.R. § 3.310(b); see also Allen v. Brown, 7 Vet. App. 439, 448-49 (1995).

To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Proof of a current disability is a threshold to establishing service-connection for any claimed disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

1. Entitlement to service connection for a right knee disorder is granted.

2. Entitlement to service connection for a left knee disorder is granted.

3. Entitlement to service connection for a right ankle disorder is granted.

4. Entitlement to service connection for a left ankle disorder is granted.

5. Entitlement to service connection for right foot disorder is granted.

6. Service connection for a left foot disorder is granted.

The Veteran contends that his bilateral knees, bilateral ankles and bilateral feet pain are secondary to his service-connected lumbar spine disorder. See October 2024 Board hearing.

In the May 2019 rating decision on appeal, the RO made the following favorable findings: that the service treatment records show that the Veteran had a right foot callus and a recurrent right heel lipoma; and that a VA examiner diagnosed the Veteran with right metatarsalgia and calcaneal spur.

In an April 2019 report, a VA examiner opined that the right foot condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that there is documentation of callouses or growth on the lateral aspect of the right heel and lipectomy in service. He explained that current examination did not reveal growth on the heel or tenderness in the heel on the right foot. Moreover, the examiner opined that the metatarsalgia is less likely due to growth on the right heel that was seen in 1989. The examiner explained that calcaneal spur is due to inflammation of plantar fascia. The examiner also noted that periarticular osteopenia suggest inflammation of the joint resulting in bone loss around the metatarsophalangeal joint and that this is more related to metatarsalgia and less likely due to growth on the right heel documented in service.

During the 90-day evidence window following the October 2024 hearing, the Veteran submitted a December 2024 medical evaluation from a private chiropractor. The Veteran was diagnosed with the following: osteoarthritis and minor ligament sprain of the knees; osteoarthritis and muscle atrophy due to chronic pain and compensation, achilles tendinosis of the ankles; plantar fasciitis and pes planus of the feet.

The examiner opined that it is more likely than not that the Veteran's bilateral knee pain is secondary to his lower back condition, exacerbated by an antalgic gait and weight-shifting. The examiner noted that the Veteran's knee pain began in the 1980s while working in the dormitories, where his duties involved moving heavy furniture up and down stairs. The examiner explained that the Veteran's lower back pain with sciatica led to weight shifting to avoid further irritation, which placed additional stress on his knees.

The examiner opined that that it is more likely than not that the Veteran's bilateral ankle pain is secondary to his lower back condition due to his antalgic gait and weight shifting. The examiner noted that the Veteran's ankle pain began shortly after the onset of his back pain while working in the dormitories. The pain, localized around the Achilles tendons, has progressively worsened over time.

The examiner opined that it is more likely than not that the Veteran's bilateral foot pain is secondary to his lower back condition, worsened by his antalgic gait and weight shifting. The examiner noted that the Veteran's foot pain began following the onset of his back pain and is localized in the arches. On examination, the examiner determined that the Veteran has pes planus and tenderness over the plantar fascia, bilaterally. His gait is shuffling and his foot muscle strength was significantly diminished.

The Board affords the private examiner's opinions great weight, as they are based upon a review of the Veteran's medical treatment records and medical history; and they adequately relied upon the relevant lay and medical evidence of record and contains clear conclusions based on supporting data connected by reasoned medical explanations. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Moreover, with respect to the right foot, considering the favorable decision to grant service connection on a secondary basis, a discussion of any other theory of entitlement is not necessary. Thus, service connection for a right knee disorder, a left knee disorder, a right ankle disorder, a left ankle disorder, a right foot disorder, and a left foot disorder is warranted. See 38 C.F.R. § 3.310.

In reaching this conclusion, the Board has considered the benefit-of-the-doubt rule. However, in this case, the evidence persuasively favors a finding that the Veteran's disorders of the right knee, left knee, right ankle, left ankle, right foot, and left foot are caused or aggravated by service-connected low back disorder. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Accordingly, the appeals are granted.

7. Entitlement to service connection for abdominal pain is denied.

As noted above, in an April 2020
In reaching this conclusion, the Board has considered the benefit-of-the-doubt rule. However, in this case, the evidence persuasively favors a finding that the Veteran's disorders of the right knee, left knee, right ankle, left ankle, right foot, and left foot are caused or aggravated by service-connected low back disorder. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Accordingly, the appeals are granted.

7. Entitlement to service connection for abdominal pain is denied.

As noted above, in an April 2020 Notice of Disagreement, the Veteran appealed the May 2019 rating decision to the Board and requested the hearing lane. One of the issues listed in the Notice of Disagreement was "GERD." While the May 2019 rating decision did not specifically deny a claim for service connection for GERD, there was a denial of service connection for abdominal pain. Thus, the Board will treat the Veteran's listed issue of GERD as a disagreement with denial of service connection for abdominal pain. However, aside from raising this issue on the April 2020 NOD, there was no discussion of this issue at the October 2024 Board hearing. At the hearing, the Veteran's attorney agreed that the issues on appeal were service connection for left and right feet, left and right ankles, and left and right knees. See October 2024 Board hearing transcript. Based on this evidence, the Board finds forfeiture of the right to a hearing for the claim for service connection for abdominal pain. Thus, the claim has been adjudicated based on the evidence of record at the May 2019 rating decision.

The Veteran is seeking service connection for abdominal pain. In the May 2019 rating decision on appeal, the following favorable finding was made: The service treatment records show that the Veteran was treated for viral enteritis in March 1977 and mild enteritis in February 1989. The Board is bound by this favorable finding.

However, there is no evidence of a current abdominal disorder. The Veteran has not submitted any lay statements or medical evidence in support of his claim for an abdominal disorder. Therefore, in the absence of a current diagnosis of an abdominal disorder, the claim for service connection mut be denied. Brammer, supra.

In sum, service connection for abdominal pain is not warranted. In reaching this conclusion, the Board considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, supra; Ortiz v. Principi, supra. In this case, the evidence persuasively weighs against a finding that the Veteran has a current diagnosis of an abdominal disorder. Thus, the benefit-of-the-doubt rule does not change the outcome of this issue.

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Henriquez, J.

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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