KNEE IMPAIRMENT OF

PAUL R. CASEY · 2026 · Case ID: A26023260

MIXED

Summary

The Veteran served from January 1971 to January 1974, and again from August 1974 to July 1992. The Veteran appeals the denial of service connection for hypertension and a right lower arm condition, while seeking service connection for bilateral knee, right hip, low back, and tinnitus conditions. The Board granted service connection for bilateral knee, right hip, low back, and tinnitus. For the bilateral knee disability, the Board found the Veteran's lay statements and a private provider's opinion more persuasive than the VA examiner's opinion, which failed to adequately address the Veteran's claims and the provenance of his current disability. Service connection for the right hip and low back conditions was granted on a secondary basis, linked to the bilateral knee disability due to altered gait, with the Board favoring the private provider's opinion over the VA examiner's. Tinnitus was granted based on the Veteran's credible statements and a private provider's opinion linking it to in-service acoustic trauma, with no contrary evidence. The claims for hypertension and a right lower arm condition were remanded. For hypertension, the Board found the VA examiner's opinion insufficient, failing to address synergistic effects of toxic exposures or aggravation, and the private opinion lacked discernible rationale. For the right lower arm condition, the Board noted conflicting evidence regarding its origin and whether it was aggravated during service, requiring further clarification.

Rationale

Service treatment records show knee pain in service; Veteran avers in-service injury with continuity of symptomatology; Private provider opinion supports claim, links to current disability; VA examiner opinion found unconvincing for failing to address lay statements and provenance

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241106-490844

Full Decision Text

Citation Nr: A26023260
Decision Date: 03/16/26 Archive Date: 03/16/26

DOCKET NO. 241106-490844
DATE: March 16, 2026

ORDER

Entitlement to service connection for a bilateral knee disability is granted.

Entitlement to service connection for a right hip disability is granted.

Entitlement to service connection for a low back disability is granted.

Entitlement to service connection for tinnitus is granted.

REMANDED

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for a right lower arm condition is remanded.

FINDINGS OF FACT

1. The evidence of record indicates the Veteran's bilateral knee disability had onset in service, with continuity of symptomatology therefrom.

2. The Veteran's right hip disability has been caused or aggravated by altered gait attributable to his bilateral knee disability.

3. The Veteran's low back disability has been caused or aggravated by altered gait attributable to his bilateral knee disability.

4. The Veteran's tinnitus is a result of in-service acoustic trauma.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a bilateral knee disability have been met. 38?U.S.C. §§?1101, 1112, 1113, 1131, 1137;?38?C.F.R. §§?3.307, 3.309.

2. The criteria for entitlement to service connection for a right hip disability have been met. 38?U.S.C. §§?1101, 1112, 1113, 1131, 1137;?38?C.F.R. §§?3.307, 3.309, 3.310.

3. The criteria for entitlement to service connection for a low back disability have been met. 38?U.S.C. §§?1101, 1112, 1113, 1131, 1137;?38?C.F.R. §§?3.307, 3.309, 3.310.

4. The criteria for entitlement to service connection for tinnitus have been met. 38?U.S.C. §§?1101, 1112, 1113, 1131, 1137;?38?C.F.R. §§?3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1971 to January 1974, and from August 1974 to July 1992.

In the November 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the October 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or representative] with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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[s], 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 for service connection for hypertension, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to service connection for a bilateral knee disability

Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service.?38?U.S.C. §§?1110, 1131;?38?C.F.R. §?3.303?(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki,?557 F.3d 1362, 1366?(Fed. Cir. 2009) (quoting Shedden v. Principi,?381 F. 3d 1163, 1167?(Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson,?19?Vet. App.?247, 431?(2006). Service connection may be granted for any disease initially 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).

In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including other organic diseases of the nervous system, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service.?38?U.S.C. §§?1101, 1112, 1113, 1131, 1137;?38?C.F.R. §§?3.307, 3.309.

For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim.?38?C.F.R. §§?3.303?(b), 3.309; Walker v. Shinseki,?708 F.3d 1331?(Fed. Cir. 2013).

Service treatment records reflect a complaint of knee pain in 1973. The Veteran avers that he in fact injured both knees in service, and has experienced continuity of symptomatology from separation.

In support of that claim, the record reflects a disability questionnaire, submitted in May 2024 by a private provider, explaining that the Veteran experienced several knee injuries in service, which have led to disability during the current appeal period. The record reflects a history of arthroscopic surgery on both knees, as well as a right total knee replacement, with ongoing bilateral knee pain.

The Board acknowledges the contrary VA medical opinion of record, which maintains that the record does not reflect an actual diagnosis of knee disability in service, but finds the opinion unconvincing, insofar as it fails adequately to consider and address the Veteran's lay statements, or to identify any alternative or more likely provenance for current knee disability than that offered by the Veteran.

As such, the Board finds the most persuasive evidence of record favors the claim for service connection for a bilateral knee disability, and the appeal will be granted.

2. Entitlement to service connection for a right hip disability

Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

The private provider who submitted the May 2024 disability questionnaire explained that the Veteran is beset by current right hip disability which has resulted from altered gait attributable to the Veteran's bilateral knee condition.

The VA examiner with whom the Veteran met in July 2024 conceded a current diagnosis of trochanteric pain syndrome of the right hip, and acknowledged evidence of an in-service coccyx fracture as well as the Veteran's complaints of in-service pain with continuity of symptomatology, but maintained that the condition was
a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

The VA examiner with whom the Veteran met in July 2024 conceded a current diagnosis of trochanteric pain syndrome of the right hip, and acknowledged evidence of an in-service coccyx fracture as well as the Veteran's complaints of in-service pain with continuity of symptomatology, but maintained that the condition was less likely than not service related, primarily based on the absence of documented complaints of hip pain for years following separation.

The Board affords greater probative weight to the private assessment. First, the mere absence of treatment sought or received for a claimed condition does not, in itself, establish the absence of symptoms, and the Board will not rely on that evidence alone to deny a claim. Second, the VA examiner did not address the claimed mechanism of secondary service connection detailed in the private opinion, and the Board is disinclined to remand the matter for clarity and potentially negative development.

Accordingly, finding the most persuasive evidence of record in support of the claim, the Board finds warranted entitlement to service connection for a right hip disability on a secondary basis, and the appeal will be granted.

3. Entitlement to service connection for a low back disability

The Veteran has a current diagnosis of lumbosacral strain, confirmed by a VA examiner with whom he met in July 2024.

As with the Veteran's hip condition, the private provider who submitted a May 2024 opinion explained that the Veteran's bilateral knee disability resulted in an altered gait, which in turn has caused or contributed to the Veteran's current lumbar spine condition.

While the July 2024 VA examiner disagreed as to the ultimate determination of service connection, his opinion did not address adequately the theory of entitlement raised by the private provider, and does not appear adequately to have considered the Veteran's credible lay statements regarding onset and continuity of symptomatology.

As such, the Board finds more probative the private opinion, and on that basis finds warranted entitlement to service connection for a low back disability on a secondary basis. The appeal will be granted.

4. Entitlement to service connection for tinnitus

The Veteran has credibly averred that he has tinnitus because of in-service noise exposure. Because the Veteran in this case has offered competent, credible statements that he experiences tinnitus, the Board finds he has met the current disability threshold. See Charles v. Principi, 16 Vet. App. 370, 374 (2002)("ringing in the ears is capable of lay observation"). The dispositive issue is therefore whether tinnitus is related to service.

The May 2024 private disability questionnaire explained that the Veteran was exposed to acoustic trauma from loud machinery, including jackhammers, during active duty service, and the Veteran has indicate that his tinnitus had onset in service and has continued since separation. The record contains no evidence of post-service hazardous noise exposure that better explains the Veteran's current tinnitus.

Accordingly, the Board finds the most persuasive evidence of record supports the claim for service connection for tinnitus, and the appeal will be granted.

REASONS FOR REMAND

1. Entitlement to service connection for hypertension is remanded

2. Entitlement to service connection for a right lower arm injury

Under the AMA, the Board must remand a claim to correct an error by the AOJ to satisfy its duty to assist the Veteran under 38 U.S.C. §5103A, if the error occurred prior to the AOJ decision on appeal. 38 U.S.C. §5103A?(f)(2)(A); 38 C.F.R. §20.802?(a). The Board may also remand a claim to correct any other AOJ error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. §20.802?(a).

The Veteran has a current diagnosis of hypertension, furnished at least as early as 2000. He claims that the condition is related to service, to include as a consequence of toxic exposures therein. A VA examiner with whom the Veteran met in May 2017 indicated the condition was unrelated to service, despite service records showing what the examiner characterized as "acute and isolated and resolved" elevations in blood pressure during active duty, based principally on the lack of diagnosis or treatment for years after separation. As explained above, that rationale is insufficient, in itself, to form the basis for a denial of
correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. §20.802?(a).

A July 2024 VA examiner considered whether the Veteran's hypertension was related to documented in-service exposure to volcanic ash and poor air quality while serving in the Philippines, but indicated only that current medical research could not establish definitively that hypertension could be caused by such exposures. The opinion failed to consider explicitly the Veteran's other risk factors for hypertension, or in fact to address his condition with any specificity. The opinion also did not address the question of aggravation or whether documented exposures could constitute a contributory factor in the later development of hypertension.

The Board is cognizant of the private assessment indicating that hypertension is "directly and causally related to [the Veteran's] military service," but as the opinion is not supported by any rationale that the Board can discern, it cannot be afforded probative value.

As such, the matter must be remanded for a new VA examination and expert medical opinion that cures the above-identified defects.

Regarding the claimed right lower arm injury, the record is not clear with respect to when initial injury of the arm took place. The record reflects diagnostic imaging showing a healed fracture of the right lower arm several months after entry into active duty service, a VA examiner with whom the Veteran met concluding that the injury must have pre-existed service. In contrast, the aforementioned private provider relates that the Veteran claimed to have injured the arm during training at Sheppard Air Base.

On remand, clarity must be obtained as to whether a right arm condition predated entry into active duty service, and if so, whether that condition was aggravated in any degree during such service.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination with a qualified clinician to explore the nature and etiology of his hypertension. The entire claims file must be reviewed prior to the examination.

The examiner should state whether it is at least as not that the hypertension had onset in service or is etiologically related to service, to include as a consequence of the combined synergistic effects of the Veteran's toxic exposures.

All opinions expressed must be supported by thorough rationale.

2. Schedule the Veteran for a VA examination with a qualified clinician to explore the nature and etiology of his right lower arm condition. The entire claims file must be reviewed prior to the examination.

The examiner should state whether, on a clear and unmistakable basis, a right lower arm condition predated entry into active duty service, and if so, whether that condition was clearly and unmistakably not aggravated in any degree by such service.

If a right lower arm condition did not predate entry into active duty service, OR if such a condition was aggravated during active duty service, the examiner should state whether it is at least as likely as not that a current right arm condition is etiologically related to service, to include an aggravated pre-existing condition.

Paul R. Casey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Z. Sahraie, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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