KNEE IMPAIRMENT OF

A. ISHIZAWAR · 2026 · Case ID: A26020564

DENIED

Summary

The veteran, who served from June 1966 to June 1969, appeals the denial of service connection for bilateral knee pain. The veteran contends the pain was caused by active service, specifically his duties as a cook involving heavy lifting, bending, and running in combat boots, or alternatively, that it is secondary to pes planus. The Board reviewed the evidence, including the veteran's testimony, VA treatment records, private treatment records, a VA examination from August 2024, and a private nexus opinion from Dr. R.T. The Board found that while the veteran experienced subjective symptoms and functional impairment, the evidence persuasively weighed against a finding that the knee pain began during service or is related to an in-service injury. The VA examiner noted the absence of a specific knee diagnosis in service treatment records and found the claimed bilateral knee pain less likely than not caused by service, citing the silence of records for knee complaints and the fact that some post-service treatment records referred to hip pain rather than knee pain. The Board found the VA examiner's opinion more probative than the private opinion, which acknowledged the veteran's lay testimony but did not adequately address the lack of in-service treatment or provide a strong nexus. The Board also noted the veteran's lay statements were largely not credible due to internal inconsistencies. As the veteran is not service-connected for pes planus, secondary service connection is not possible. Consequently, service connection for bilateral knee pain was denied.

Rationale

Service treatment records are silent for knee pain complaints or diagnosis.; Post-service treatment records are silent for a specific knee diagnosis.; VA examiner found bilateral knee pain less likely than not caused by service.; Private opinion did not adequately address lack of in-service treatment or provide strong nexus.; Veteran's lay statements lacked credibility due to inconsistencies.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250523-548601

Full Decision Text

Citation Nr: A26020564
Decision Date: 03/06/26 Archive Date: 03/06/26

DOCKET NO. 250523-548601
DATE: March 6, 2026

ORDER

Entitlement to service connection for left knee pain is denied.

Entitlement to service connection for right knee pain is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that left knee pain began during active service or is otherwise related to an in-service injury or disease, including a service-connected disability.

2. The evidence of record persuasively weighs against finding that right knee pain began during active service or is otherwise related to an in-service injury or disease, including a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for left knee pain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for right knee pain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from?June 1966 to June 1969.???

These?matters?come before the Board of Veterans' Appeals (Board) on appeal from an January 2025?rating decision issued by a Department of Veterans Affairs (VA)?Regional Office (RO).?

In the?May 2025?VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.? A Board hearing was?scheduled for?December 2, 2025. However, the Veteran, through his representative, withdrew his hearing request?on?November 17, 2025.??

Based on the Veteran's election of the Hearing docket, the Board may only consider the evidence of record at the time of the?January 2025?agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request.? 38?C.F.R. §?20.302(b).? If evidence was?submitted?either (1)?during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.? 38 C.F.R. §§?20.300, 20.302(b), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran 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 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.

As an initial matter, these claims were previously before the Board in June 2024 when they were remanded for additional development.

Entitlement to service connection for left and right knee pain

The Veteran contends his bilateral knee pain was caused by active service, specifically bending and lifting heavy objects as a cook and running in combat boots, or, in the alternative, secondary to pes planus/flat foot. See April 2023 Board Transcript.

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).

Secondary service connection may also be warranted where there is sufficient evidence to show that: (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310. Secondary causation exists when, but for the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

The Board must analyze the?credibility?and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant.? Gabrielson v. Brown,?7?Vet. App.?36, 39-40?(1994).? Competency of evidence differs from weight and?credibility.? Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while?credibility?is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted.? Layno v. Brown,?6?Vet. App.?465, 469?(1994).

When the evidence is in approximate balance in the Veteran's favor or nearly equal 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; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, including a service-connected disability.

The August 2024 VA examiner determined that, while the Veteran experienced subjective symptoms of pain and flare-ups and objective evidence of limited range of motion on flexion and extension, he did not have a left or right knee diagnosis. Further, despite consistent treatment through VA and private treatment, the records do not contain a diagnosis of a left or right knee condition.

However, in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. In this case, it is shown that pain stemming from the Veteran's left and right knees has resulted in functional impairment of earning capacity. Indeed, the August 2024 VA examiner provided that his left and right knee pain resulted in functional loss to include difficulty walking up and down the stairs, walking long distances, kneeling, standing or sitting for long periods of time. Thus, the Board concludes that the Veteran has a diagnosis of left and right knee pain resulting in functional impairment, however, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease.

A review of the Veteran's service treatment records (STRs) are silent for complaints of or treatment for knee pain. The Veteran did report in his June 1969 separation examination that he had cramps in his legs, however, nothing was noted regarding impairments to his lower extremities during clinical evaluation.

The Veteran's postservice treatment records include complaints of pain to the lower extremities. In August 2011 the Veteran sought treatment for bilateral lower leg pain, specifically in the right hip. It was determined that he likely had trochanteric bursitis. He was directed to take NSAIDs and prescribed Vicodin for severe pain
is otherwise related to an in-service injury, event, or disease.

The Veteran's postservice treatment records include complaints of pain to the lower extremities. In August 2011 the Veteran sought treatment for bilateral lower leg pain, specifically in the right hip. It was determined that he likely had trochanteric bursitis. He was directed to take NSAIDs and prescribed Vicodin for severe pain. In a July 2016 treatment record, the Veteran complains of pain in the lower legs and the calves, particularly when doing vigorous exercise.

In a January 2017 VA treatment record the veteran was seen for left hip and upper leg pain that began two days prior. He described the pain as centralized to his outer leg knee and up into his hip. He denied any recent injuries and stated that he had never had this pain before. Upon physical examination there was no redness or swelling noted. The Veteran provided that the pain went away after taking prescribed Vicodin. There were several treatment records where the Veteran reported generalized arthralgias, but examinations were negative for a diagnosis. See January 2015 treatment record, February 2016 treatment record.

As noted above, the Veteran was afforded a VA Knee and Lower Leg Disability Benefits Questionnaire (DBQ) in August 2024. The Veteran reported that his knee pain began in 1974 and was precipitated by lifting and moving heavy objects during active service. He reported flare-ups that occasionally caused his right knee to "lock up". Flare-ups of both knees occurred once or twice a month and lasted approximately 10 minutes. The VA examiner reviewed the claims file and examined the Veteran and opined that his claimed bilateral knee pain was less likely than not caused or incurred by active service. For rationale, the examiner provided that a review of the Veteran's STRs was silent for a diagnosis or any knee issues. A review of the Veteran's postservice treatment records was similarly silent for a diagnosis to the knees. The examiner addressed the May 2006 calf strain and the bilateral knee pain in August 2011 stating that the latter actually referred to the Veteran's hip pain. Other records showed a diagnosis of piriformis syndrome and pes planus but otherwise were silent for knee issues or treatment for the knees. Furthermore, the examiner noted that x-rays completed as part of the August 2024 VA examination were normal. The examiner further addressed the Veteran's lay statements regarding the physical demands of his service along with the negative stereotype associated with those that seek treatment for injuries or illnesses in service. However, the VA examiner pointed to the absence of medical evidence in the file regarding the Veteran's knee pain from active service.

Prior to the June 2024 Board remand, the Veteran testified at an April 2023 hearing. The Veteran described being on his feet everyday serving as a cook. He stated he was constantly carrying and bending down with pans weighing anywhere from 40 to 60 lbs. After a year or so, he began to notice pain in his knees and that they would begin creaking. He also provided that he avoided going to seek treatment out of pride and he saw others seeking treatment for more serious injuries or illnesses. He did state he went for treatment once or twice but was only given ibuprofen. He reported seeking treatment through VA and a private physician within the last 20 years. He also testified that since service he had not experienced constant pain but only at certain times of the day or after exercise.

The Veteran also provided a July 2023 private nexus opinion from Dr. R.T. Dr. R.T. addresses the Veteran's hearing testimony that he spent long hours on his feet as a cook accompanied by significant bending, lifting, twisting and running in combat boots. Moreover, Dr. R.T. acknowledged that the Veteran reported having knee pain in service but avoided seeking treatment as he saw others seeking treatment for more serious injuries or illnesses. Dr. R.T. noted the Veteran's claimed pes planus and reasoned that the claimed pes planus combined with long hours on his feet and running in boots had caused his bilateral knee pain.

The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993).
twisting and running in combat boots. Moreover, Dr. R.T. acknowledged that the Veteran reported having knee pain in service but avoided seeking treatment as he saw others seeking treatment for more serious injuries or illnesses. Dr. R.T. noted the Veteran's claimed pes planus and reasoned that the claimed pes planus combined with long hours on his feet and running in boots had caused his bilateral knee pain.

The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for a medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444, 448-9 (2000).

While both the August 2024 VA examiner and Dr. R.T. possess the requisite knowledge and training to provide a medical opinion, the Board finds the VA examiner's opinion to be more probative. The VA examiner addressed the Veteran's prior lower extremity diagnoses in the claims filed, finding that these diagnoses did not pertain to his now claimed knee pain. Moreover, the VA examiner addressed the Veteran's lay statements and the evidence of record showing the Veteran has sought treatment for several conditions since separation from active service but that treatment records are silent for complaints of knee pain or a knee diagnosis. Dr. R.T. reviewed the evidence of record and addressed the Veteran's lay statements and opined that the Veteran's knee bilateral pain is at least as likely as not related to active service or claimed pes planus; however, the opinion is not probative because the other evidence of record persuasively weighs against finding that his bilateral knee pain is related to active service. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Moreover, Dr. R.T. does not address the absence of treatment for the knees other than to point to a pes planus diagnosis and conclude that the Veteran's knee pain is related to pes planus and his physical activities in service.

While the Veteran is competent to report that he has had bilateral knee pain since service, these reports are largely not credible due to internal inconsistency and inconsistency with other evidence in the record. Specifically, the Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006).

The Board acknowledges the arguments made by the Veteran and his representative and while the Veteran and his representative believe the claimed bilateral knee pain is related to active service or claimed pes planus, the Board reiterates that the evidence of record persuasively weighs against findings that his bilateral knee pain began during active service. Moreover, the Veteran is not competent to provide a nexus opinion in this case as the issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

As for the secondary service connection aspect of the claim, the Veteran is not?service-connected?for pes planus (or any other disability); therefore,?service connection on a secondary basis is a legal impossibility at this time and remand on this basis is not warranted.

In sum, the evidence persuasively weighs against finding that the Veteran's bilateral knee pain?began during service or within one year of his?separation from service, or that it is otherwise related to his military service.? As the evidence persuasively weighs against the claim, there is no benefit of the doubt to resolve in the Veteran's favor.??Accordingly, service connection for bilateral knee pain?is denied.? See?Lynch v. McDonough,?21 F.4th 776 (Fed. Cir. 2021).?

A. ISHIZAWAR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Brown, D. L.

The Board
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A. ISHIZAWAR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Brown, D. L.

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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