Case A26024921

JONATHAN B. KRAMER · 2026 · Case ID: A26024921

MIXED

Summary

The veteran, who served from January 2007 to February 2009, appeals decisions regarding his left ankle scars, left wrist disability, insomnia, left knee condition, and lumbar spine disability. The veteran withdrew claims for left ankle scars, left wrist disability, and insomnia during a February 2025 hearing, leading to their dismissal. For the left knee, the veteran sought an increased rating beyond the 10 percent granted for patellofemoral pain syndrome. The Board reviewed multiple VA examinations and treatment records, noting findings of moderate instability and the need for assistive devices like a cane and wheelchair due to unsteady gait and fall risk. However, the Board found the evidence weighed against a higher rating under Diagnostic Code 5260 (flexion) and 5261 (extension) due to normal range of motion and muscle strength. The Board granted a separate 20 percent rating for left knee instability under Diagnostic Code 5257, citing moderate instability and the need for assistive devices, but found a higher rating unwarranted due to slight instability on examination and conflicting treatment records regarding fall risk. For the lumbar spine, the veteran claimed secondary service connection due to his service-connected feet and knee conditions. The Board found the August 2020 VA examination to be the most probative, concluding the lumbar disability was less likely than not related to service or service-connected conditions, citing a lack of supporting medical evidence and normal findings on service treatment records for the spine, despite an isolated sciatica complaint. The Board granted entitlement to Total Disability based on Individual Unemployability (TDIU) for the period prior to February 5, 2025, noting the combined rating of 70 percent and the Veteran's inability to secure substantially gainful employment due to his service-connected physical and psychiatric conditions, as supported by vocational evaluations.

Special Benefit

TDIU

Diagnostic Code

5257

Docket No.

210202-137955

Full Decision Text

Citation Nr: A26024921
Decision Date: 03/19/26 Archive Date: 03/19/26

DOCKET NO. 210202-137955
DATE: March 19, 2026

ORDER

Entitlement to a compensable rating for left ankle scars has been withdrawn and is dismissed.

Entitlement to service connection for a left wrist disability has been withdrawn and is dismissed.

Entitlement to service connection for insomnia due to prescribed medications has been withdrawn and is dismissed.

Entitlement to rating in excess of 10 percent for left knee patellofemoral pain syndrome is denied.

Entitlement to a separate 20 percent rating for left knee instability is granted.

Entitlement to service connection for mid/lower back, thoracolumbar spine is denied.

For the period on appeal prior to February 5, 2025, entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), is granted.

FINDINGS OF FACT

1. During the February 2025 Board hearing the Veteran indicated that he wished to have the left ankle scars disability claim withdrawn.

2. During the February 2025 Board hearing the Veteran indicated that he wished to have the left wrist disability claim withdrawn.

3. During the February 2025 Board hearing the Veteran indicated that he wished to have the insomnia disability claim withdrawn.

4. The Veteran's left knee disability has manifested flexion of 90 degrees or more and normal extension.

5. The Veteran's left knee has manifested moderate instability.

6. The Veteran's lumbar spine disability is not related to service or a service-connected disability.

7. For the period on appeal prior to February 5, 2025, the Veteran's service-connected disabilities have prevented him from securing or following any substantially gainful occupation.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of entitlement to a compensable rating for left ankle scars disability are met. 38 C.F.R. § 20.205.

2. The criteria for withdrawal of entitlement to service connection for a left wrist disability are met. 38 C.F.R. § 20.205.

3. The criteria for withdrawal of entitlement to service connection for insomnia disability are met. 38 C.F.R. § 20.205.

4. The criteria for a rating in excess of 10 percent for a left knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.20, 4.27, 4.40, 4.45, 4.71a, Diagnostic Codes 5260, 5261.

5. The criteria for a separate 20 percent rating for left knee instability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257.

6. The criteria for service connection for a lumbar spine disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

7. For the period on appeal prior to February 5, 2025, the criteria for an award of TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 2007 to February 2009.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August and November 2020 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran provided testimony at a February 2025 hearing before a Veterans Law Judge. A transcript of the hearing is associated with the claims folder.

The claim is now before the Board on a February 2021 Hearing Review Request by the Veteran under the Appeals Modernization Act (2019) ("AMA"). Under the AMA, when a claimant seeks appellate review through the Board's hearing docket, the Board may consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision on appeal, additional evidence submitted on the date of the Board hearing (including testimony), and additional evidence submitted within 90 days of the hearing. Pub. Law 115-55 (Aug. 23, 2017), 131 Stat. 1114, 38 U.S.C. § 7113(b). The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the VA Form 10182 was received, (2) evidence submitted during the period after the VA Form 10182 was received and the day before the Board hearing, and (3) evidence received 91 or more days after the Board hearing. 38 C.F.R. § 20.303.

Withdrawal

1. Entitlement to a compensable rating for left ankle scars

2. Entitlement to service connection for a left wrist disability

3. Entitlement to service connection for insomnia

An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.? 38 C.F.R. § 20.205.? Withdrawal may be made by the appellant or by his or her authorized representative.? 38 C.F.R. § 20.205.? In the present case, during the February 2025 Board hearing the Veteran withdrew the increased rating for the scars, service connection for the left wrist, and service connection for insomnia claims. The Veteran indicated that he knows that if he refiles the withdrawn claims, he may lose his effective date. Therefore, there remains no increased rating for the scars, service connection for the left wrist, or service connection for insomnia, for appellate consideration.?Accordingly, these claims are dismissed.

4. Entitlement to a rating in excess of 10 percent for a left knee disability

The Veteran contends a rating in excess of 10 percent for the left knee disability is warranted. During the February 2025 Board hearing, it was argued that the Veteran has extreme issues with instability that has resulted in falls. He also has been prescribed a brace and cane due to the knees.

An August 2020 rating decision granted service connection for the Veteran's left knee disability with a 10 percent for rating under Diagnostic Code (DC) 5260.

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Staged ratings are appropriate when the factual findings show distinct time periods where the disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999).

Initially, the Board notes that substantial amendments were made to 38 C.F.R. § 4.71a, effective February 7, 2021. However, these amendments did not amend the rating criteria for Diagnostic Codes for the knees other than under Diagnostic Code 5257 and 5262. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

DC 5260 provides ratings based on limitation of flexion of the leg. Flexion of the leg limited to 60 degrees is rated noncompensable (0 percent); flex
both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

DC 5260 provides ratings based on limitation of flexion of the leg. Flexion of the leg limited to 60 degrees is rated noncompensable (0 percent); flexion of the leg limited to 45 degrees is rated 10 percent; flexion of the leg limited to 30 degrees is rated 20 percent; and flexion of the leg limited to 15 degrees is rated 30 percent. 38 C.F.R. § 4.71a.

Other disability ratings related to the knee include DC 5261. DC 5261 provides ratings based on limitation of extension of the leg. Extension of the leg limited to 5 degrees is rated noncompensable (0 percent); extension of the leg limited to 10 degrees is rated 10 percent; extension of the leg limited to 15 degrees is rated 20 percent; extension of the leg limited to 20 degrees is rated 30 percent; extension of the leg limited to 30 degrees is rated 40 percent; and extension of the leg limited to 45 degrees is rated 50 percent. 38 C.F.R. § 4.71a; see VAOPGCPREC 9-04 (separate ratings may be granted based on limitation of flexion (DC 5260) and limitation of extension (DC 5261) of the same knee joint).

Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II.

Turning to the evidence, in August 2019 VA treatment records the Veteran reported no falls in the last three months.

An August 2020 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with left knee patellofemoral pain syndrome. He reported the current symptoms include knees giving out, stiffness, cracking, pain, knees locking up, swelling, and throbbing pain. He has severe regular left knee flare-ups that are precipitated by bending, walking, standing and lifting. He indicated nothing alleviates the flare-ups. Left knee flexion was limited to 115 degrees with pain and extension was limited to 0 or normal. There was no evidence of crepitus. Upon observation after repetitive use, repeated use over time, and flare-ups flexion was limited to 110 degrees and extension was still normal. Muscle strength for the left knee was normal. There was no muscle atrophy or ankylosis. Upon testing for joint stability, the examination revealed left knee medial and lateral instability. Upon testing for joint stability, the examination revealed left knee medial and lateral instability. Specifically, there was an option to choose +1, +2, and +3 for instability. The examiner indicated there was +1 for the medial and lateral instability which reflected 0 to 5 millimeters versus the +3 which noted 10 to 15 millimeters. There was no history of surgical procedures, meniscal condition, shin splint, stress fracture, or chronic exertional compartment syndrome. He regularly uses a cane as an assistive device to support gain instability due to foot, knee, and back condition. The examiner found there is a functional impact as the Veteran has limitations in standing and ambulation. It was noted that depending on the severity of the flare-up the Veteran's estimated time for walking or standing would be 30 minutes at a time.

A November 2020 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with left knee patellofemoral pain syndrome. He reported the current symptoms include severe sharp throbbing pain, with frequent and constant clicking and popping resulting in knee weakness. He also has spasms and stiffness. He has severe left knee flare-ups lasting one to two hours resulting in spams and stiffness every other day. Left knee flexion was limited to 110 degrees with pain and extension was limited to 0 or normal. There was evidence of crepitus. Upon observation after repetitive use there was no additional loss in range of motion. For repeated use over time and flare-ups flexion was limited to 90 degrees and extension was still normal. Muscle strength for the left knee was normal. There was no
his complaints. He was diagnosed with left knee patellofemoral pain syndrome. He reported the current symptoms include severe sharp throbbing pain, with frequent and constant clicking and popping resulting in knee weakness. He also has spasms and stiffness. He has severe left knee flare-ups lasting one to two hours resulting in spams and stiffness every other day. Left knee flexion was limited to 110 degrees with pain and extension was limited to 0 or normal. There was evidence of crepitus. Upon observation after repetitive use there was no additional loss in range of motion. For repeated use over time and flare-ups flexion was limited to 90 degrees and extension was still normal. Muscle strength for the left knee was normal. There was no muscle atrophy or ankylosis. Upon testing for joint stability, the examination revealed no history of recurrent subluxation or lateral instability. There was no history of surgical repair, meniscal condition, shin splint, stress fracture, or chronic exertional compartment syndrome. He denied using an assistive device. The examiner found there is a functional impact as the Veteran may have difficulties with prolonged walking, standing, and climbing stairs. It was noted that he is a retired UPS mail processor and he lost 0-1 week of time in the last 12 months.

In October 2021, among other ailments, the Veteran reported that the left knee and back affect his ability to walk.

In August 2022 VA treatment records indicated the Veteran has a history of arthritis of the left knee.

In August 2023 the Veteran was mailed a wheelchair and in April 2024 he was issued a cane to ambulate.

In August 2024 an X-ray of the knees was unremarkable. In October 2024 the physical therapist indicated that the Veteran would benefit from use of an 18 inch wheelchair, cane, and tall F22 rollator for gait in order to reduce the risk of falls. It was noted that the Veteran will be issued the device because of unsteady feet and gait abnormalities that are corrected/lessened with the use of the assistive device for mobility.

In January 2025 VA treatment records indicated that Veteran had a low risk of falling with no falls in the last three months. It was noted that he walks independently without assistance or adaptive support and with good safety awareness.

In February 2025 VA treatment records the Veteran reported bilateral ankle and knees giving out resulted in him falling. He thinks his bones are getting brittle.

The remaining medical evidence of record does not address range of motion or condition of the knees.

The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds a rating in excess of 10 percent for both knees under DC 5260 and 5261 is not warranted. However, a separate 20 percent rating for moderate instability is warranted.

Higher ratings are warranted under DC 5260 and 5261, when flexion of the leg is limited to 30 degrees or extension of the leg is limited to 10 degrees or more. The evidence weighs against such manifestations. The evidence has not reflected a flexion of less than 90 degrees and anything other than normal extension as demonstrated in the August and November 2020 VA examination report. As such, the evidence weighs against a finding of a higher rating under DC 5260 and DC 5261.

Regarding instability, the Board notes under Diagnostic Code 5257, prior to the amendment, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability.

According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree.

Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018).

Effective February 7, 2021, Diagnostic Code 5257 provides ratings for other impairment of the knee based on recurrent subluxation or instability, and patellar instability.

For recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A maximum 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation.

For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A maximum 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker.

Here the Board finds a 20 percent rating under DC 5257 is warranted. Notably, in the August 2020 VA examination the Veteran reported knees giving out, stiffness, cracking, pain, knees locking up, swelling, and throbbing pain. During the November 2020 VA examination he continued to complain of constant clicking and popping resulting in knee weakness. Furthermore, in October 2024 the physical therapist indicated that the Veteran would benefit from use of an 18 inch wheelchair, cane, tall F22 rollator for gait in order to reduce the risk of falls. It was noted that the Veteran will be issued the device because of unsteady feet and gait abnormalities that are corrected/lessened with the use of the assistive device for mobility. Additionally, in February 2025 VA treatment records the Veteran reported bilateral ankle and knees giving out resulted in him falling. The Board finds this evidence demonstrates moderate instability under the pre-amended DC 5257.

A higher rating is not warranted as the evidence has not presented severe instability. Here while there are reports of falling or being a fall risk, the August 2019 and January 2025 treatment records indicated the Veteran has a low risk for falls. Notably, the January 2025 treatment records indicated that he walks independently without assistance or adaptive support and with good safety awareness. The VA examinations of record have consistently reflected normal muscle strength for the knees. The Board acknowledges the October 2024 issuance of a cane to ambulate; however, the record reflects ambulating issues due to the feet as the note indicated the cane was issued due to unsteady feet and gait abnormalities. Furthermore, the August 2020 VA examination of record specifically found that upon testing there was +1 for the medial and lateral instability which reflected 0 to 5 millimeters versus the +3 which noted 10 to 15 millimeters, demonstrating that the instability is slight on examination. In light of the evidence as a whole, the Board finds a 20 percent rating, but not higher, for left knee instability is warranted.

The Board finds that a separate or higher rating is not warranted under other DCs related to the knee. DC 5256 refers to ankylosis of the knee, DC 5258 refers to cartilage, semilunar, dislocated, with frequent episodes of "locking," pain, and effusion into the joint, DC 5259 refers to symptomatic removal of the semilunar cartilage, DC 5262 refers to impairment of the tibia and fibula with malunion, and DC 5263
15 millimeters, demonstrating that the instability is slight on examination. In light of the evidence as a whole, the Board finds a 20 percent rating, but not higher, for left knee instability is warranted.

The Board finds that a separate or higher rating is not warranted under other DCs related to the knee. DC 5256 refers to ankylosis of the knee, DC 5258 refers to cartilage, semilunar, dislocated, with frequent episodes of "locking," pain, and effusion into the joint, DC 5259 refers to symptomatic removal of the semilunar cartilage, DC 5262 refers to impairment of the tibia and fibula with malunion, and DC 5263 relates to Genu recurvatum. The evidence has not demonstrated the Veteran suffers from ankylosis, dislocation of the semilunar cartilage, removal of the semilunar cartilage, tibia and fibula with malunion of the knee, or genu recurvatum. Therefore, those DCs are not applicable.

The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. The Veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation. The Court has held that pain alone does not constitute functional loss under VA regulations that evaluate disabilities based upon loss of motion. Mitchell, 25 Vet. App. 32. Even considering such factors as pain and/or functional impairment, such right and left knee disability more closely approximates that of flexion limited to 120 degrees and normal extension. Indeed, the Veteran has reported improvement since the onset. Furthermore, upon repetitive use testing no additional loss in range of motion was found. Therefore, the Veteran's right and left knee disability does not warrant a disability rating in excess of 10 percent under DC 5260 or a separate compensable rating under DC 5261.

Accordingly, the Board finds a rating in excess of 10 percent for the left knee disability is not warranted.

5. Entitlement to service connection for mid/lower back, thoracolumbar spine

The Veteran claims his lumbar spine disability is related to his service. Specifically, in a March 2020 application for benefits the Veteran indicated he had low back pain as a result of the bilateral pes planus with bilateral plantar fasciitis, arguing the feet has caused collapsed arches, altered his posture, and caused his back pain. For the reasons discussed below, the Board finds the evidence weighs against a finding that the Veteran's current disability is related to service. Therefore, service connection is not warranted.

Service connection may be granted 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(a). In general, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

For specific enumerated diseases designated as "chronic" there is a presumption that such chronic disease was incurred in or aggravated by service even though there is no evidence of such chronic disease during the period of service. For the presumption to attach, the disease must have become manifest to a degree of 10 percent or more within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).

Presumptive service connection for chronic diseases may alternatively be established by way of continuity of symptomatology under 38 C.F.R. § 3.303(b). However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a) Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1)
.R. § 3.303(b). However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a) Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Turning to the evidence, service treatment records (STRs) in November 2007 noted that the Veteran was seen for a sciatica evaluation. He was diagnosed with low back pain. Upon examination the thoracolumbar spine showed no abnormalities. In a July 2008 report of medical history, the Veteran denied recurrent back pain or back problems. An August 2008 medical board examination noted normal clinical findings for the spine.

Post service, in March 2019 a neurology report indicated the Veteran has a provisional diagnosis of lower extremity lumbar radiculopathy. An April 2019 assessment revealed lumbar radiculopathy.

In August 2020 Social Security Administration (SSA) records were added to the file. The files document complaints about the low lumbar spine pain, however there are no etiology opinions included.

An August 2020 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with degenerative arthritis of the spine. He reported the lumbar disability began in 2016 secondary to his feet. The examiner opined the claimed condition is less likely as not proximately due to or the result of the service-connected condition. For the rationale the examiner indicated it is less likely than not as there is no documentation from orthopedics or podiatry to support the claim. The MRI is suggestive of degenerative joint disease "which is not consistent normal aging process and not with altered body mechanics due to or the result of [bilateral] pes planus."

In October 2021, among other ailments, the Veteran reported that the left knee and back affect his ability to walk.

In August 2022 VA treatment records indicated the Veteran has a history of a pinched nerve in the back.

A July 2023 MRI of the spine revealed impressions of straightening of the normal lumbar lordosis, slight interval progression of degenerative disc disease of L4-L5, and slight asymmetric narrowing of the left lateral recess.

In May 2024 VA treatment records indicated Veterans' active problems included lumbar radiculopathy.

During the February 2025 Board hearing, it was argued that the Veteran has an in-service complaint and regarding secondary service connection the VA examiner failed to address the fact that the Veteran's gait has changed due to the service-connected feet and knee disabilities.

The Veteran submitted an April 2025 Vocational Evaluation from C.V., a rehabilitation specialist. The report noted that the Veteran's bilateral feet conditions has developed edema in both legs requiring the Veteran to elevate his legs nine times a day for 10 to 30 minutes at a time. It was concluded that due to this impaired locomotion the Veteran has hip and back pain all day every day.

The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disability is not related to service.

In this regard, the Board finds the August 2020 VA examination discussed above is the most probative evidence of record. The examiner found the lumbar spine is not related to a service-connected condition and provided an adequate rationale. There are no contrary medical opinions of record.

The Board acknowledges the Veteran's attorney arguments during the Board hearing. Specifically, the attorney argued that the Veteran has an in-service complaint, suggesting that there should be an opinion on direct service connection. The Veteran's March 2020 application has
otion the Veteran has hip and back pain all day every day.

The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disability is not related to service.

The Board acknowledges the Veteran's attorney arguments during the Board hearing. Specifically, the attorney argued that the Veteran has an in-service complaint, suggesting that there should be an opinion on direct service connection. The Veteran's March 2020 application has specifically asserted that the lumbar spine is related to the service-connected bilateral pes planus with bilateral plantar fasciitis.

Additionally, the Board acknowledges that the evidence established that an event or injury occurred in service. As described above, the STRs document an isolated occurrence of what appears to be trauma to the lower lumbar spine, noted as sciatica. However, there are no other STRs related to the lumbar spine, and the July 2008 report of medical history reflects explicit denials of recurrent back pain or back problems. Additionally, an August 2008 medical board examination noted normal clinical findings for the spine. As such, any in-service injury to the left shoulder or cervical spine appears to have been acute and transitory and resolved prior to discharge. As noted above, other than an isolated complaint of sciatica in service, the record does not reflect any other complaints related to the lumbar spine and the record does not provide competent evidence linking that isolated sciatica complaint to the current disability. The Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). Given the absence of competent evidence to link his impairment to active service, the Board finds that the Veteran has not substantiated his claim for service connection for a lumbar disability. Hickson v. West, 12 Vet. App. 247 (1999). Therefore, an opinion on direct service connection is not warranted.

The only evidence relating the Veteran's lumbar spine disability to an in-service injury or service-connected disability are the Veteran's lay statements. However, these statements alone do not establish a medical nexus. Indeed, while the Veteran is competent to provide evidence regarding matters that can be perceived by the senses, he is not shown to be competent to render medical opinions on questions of etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology). As such, as a lay person, he is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the diagnosis, etiology, or causation of a specific disability. The question of diagnosis and causation, in this case, involves complex medical issues that the Veteran is not competent to address.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a right knee condition is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

6. Entitlement to a TDIU

The Veteran contends TDIU is warranted. He has a combined rating of 100 percent effective February 2025 as the Veteran is service-connected at a 100 percent for the psychiatric disability effective February 5, 2025. Additionally, the Veteran has been awarded SMC effective February 5, 2025. In view of these circumstances - the concurrent assignment of a 100 percent rating for a single disability and SMC - the question of whether TDIU may be awarded is for the period on appeal prior to February 5, 2025. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). As such, the Board recharacterizes the claim to entitlement to a TDIU for the appeal period prior to February 5, 2025.

Total disability means that there is present any impairment of mind or body sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.
- the question of whether TDIU may be awarded is for the period on appeal prior to February 5, 2025. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). As such, the Board recharacterizes the claim to entitlement to a TDIU for the appeal period prior to February 5, 2025.

Total disability means that there is present any impairment of mind or body sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.15. Substantially gainful employment is defined as work which is more than marginal, and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). See also Faust v. West, 13 Vet. App. 342 (2000). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the United States Court of Appeals for Veterans Claims (Court) explained that substantially gainful employment contains economic and noneconomic components. The economic component means "an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person," while the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. Id.

The Court defined "employment in a protected environment" within 38 C.F.R. § 4.16(a) to unambiguously mean "a lower-income position that, due to the veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024).

In making this determination, consideration may be given to factors such as the veteran's level of education, special training, and previous work experience, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993).

A veteran is totally disabled if his service-connected disability or combination of service-connected disabilities is rated at 100 percent pursuant to the Schedule for Rating Disabilities. 38 C.F.R. § 3.340(a)(2). Even if a veteran is less than 100 percent disabled, he still is deemed totally disabled under the Schedule for Rating Disabilities if he satisfies two requirements. 38 C.F.R. § 4.16(a). First, the veteran must meet a minimum percent evaluation. If he has one service-connected disability, it must be evaluated at 60 percent or more. If he has two or more service-connected disabilities, at least one disability must be evaluated at 40 percent or more and the combined evaluation of all the disabilities must be 70 percent or more. The following will be considered as one disability with respect to the minimum percent evaluation: (1) disabilities of one or both upper extremities or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system (e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric), (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Second, the veteran must be found to be unable to secure and follow a substantially gainful occupation as a result of his service-connected disability or disabilities. Id.

In determining whether a TDIU is warranted, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the weight of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

Turning to the evidence, a March 2020 VA 21-8940 form (claim for TDIU) indicated bilateral pes planus with bilateral plantar fasciitis, patellofemoral arthritis, and chronic synovitis prevented him from working. He reported the last time he worked full time was March 2013 and he became too disabled to work in April 2013. His employment history included work as a Federal Senior Custody Officer. The educational history included four years of high school with no special training. In the remarks section the Veteran provided a list of his medications and indicated they make it difficult to work and drive, noting the cause blurred vision, dizziness, headaches, and tiredness. The Veteran submitted an April 2021 VA 21-8940 form which was consistent with the March 2020 application, however the employment history indicated the Veteran worked part time in packaging from September 2014 to December 2014.

During an August 2020 VA examination for the knee the examiner found there is a functional impact as the Veteran has limitations in standing and ambulation. It was noted that depending on the severity of the flare-up the Veteran's estimated time for walking or standing would be 30 minutes at a time. The November 2020 VA examination for the knee provided similar functional impact findings. An examination for the foot conditions reflected functional impact findings. Specifically, the examiner found that depending on the severity of the flare-up, the Veteran's estimated time for standing and walking would be approximately 30 minutes at a time. An examination for the ankle provided similar findings.

The Veteran submitted an April 2025 Vocational Evaluation from C.V., a rehabilitation specialist. The report indicated the Veterans bilateral pes planus with plantar fascitis, adjustment disorder, right ankle pain, left knee, left ankle, peritoneal nerve pain, right knee, and left ankle all result in a vocational impact. It was noted that the Veteran's psychiatric disability results in him staying home as much as possible as he does not like to interact with others. He is angry most of the time and in 2023 he stabbed himself. The educational and training history includes a high school diploma and 18 months of certification in auto body and welding. The report indicated the Veteran does not have transferable skills to light or sedentary employment. Employment history included three and a half years as a federal correction officer. After review of the treatment records it was concluded that the Veteran could not perform a substantially gainful occupation at any exertional level due to his service-connected physical limitations.

The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds for the appeal period prior to February 5, 2025, a TDIU is warranted for the combined effects of all the service connected disabilities, and to the extent the assigned separate 20 percent rating for left knee disability herein does not result in a combined 100 percent rating.

The Board notes schedular TDIU has been met since July 27, 2015, as the combined rating was 70 percent and the Veteran had a single disability, pes planus, with a 50 percent rating. 38 C.F.R. § 4.16(a).

The question of the ability to engage in a substantially gainful occupation must be looked at in a practical manner, and mere theoretical ability to engage in substantial gainful employment is not a sufficient basis to deny benefits. The test is whether a particular job is realistically within the physical and mental capabilities of the claimant. Moore v. Derwinski, 1 Vet. App. 356, 359 (1991), citing Timmerman v. Weinberger, 510 F.2d 439, 442 (8th Cir. 1975).

The Veteran has not worked full time since 2013. The record reflects that the Veteran has a high school diploma and 18 months of certification in auto body and welding. Post-military, his past employment requires prolonged standing, walking, or sitting, as he worked as a corrections officer and in packaging. The only training he has consists of auto body and welding which would require prolonged standing, walking, or sitting. The VA examinations and treatment records for his disabilities consistently provide the same limitation. Specifically, the Veteran's estimated time for standing and walking would be approximately 30 minutes at a time. Furthermore, the April 2025 Vocational Evaluation indicates that the Veteran does not have transferable skills to light or sedentary employment.

Accessing the ability to engage in
full time since 2013. The record reflects that the Veteran has a high school diploma and 18 months of certification in auto body and welding. Post-military, his past employment requires prolonged standing, walking, or sitting, as he worked as a corrections officer and in packaging. The only training he has consists of auto body and welding which would require prolonged standing, walking, or sitting. The VA examinations and treatment records for his disabilities consistently provide the same limitation. Specifically, the Veteran's estimated time for standing and walking would be approximately 30 minutes at a time. Furthermore, the April 2025 Vocational Evaluation indicates that the Veteran does not have transferable skills to light or sedentary employment.

Accessing the ability to engage in a substantially gainful occupation in a practical manner, the Board finds for the appeal period prior to February 5, 2025, the Veteran is unable to work. Given his lack of training and line of work, mainly in positions requiring prolonged standing, walking, or sitting, it would be unreasonable for him to apply to work at any job consistent with his training and employment history. Moreover, there is medical evidence demonstrating that the service-connected knee, feet, and ankle affect his ability to work. Furthermore, the April 2025 report noted that Veteran's psychiatric disability results in him staying home as much as possible as he does not like to interact with others and he is angry most of the time. For all these reasons, it is impracticable for him to find a substantially gainful occupation.

Accordingly, the Board finds that the evidence supports finding the Veteran is unemployable due to the effects of his service-connected disabilities. Thus, for the period on appeal prior to February 5, 2025, entitlement to schedular TDIU under 38 C.F.R. § 4.16(a), is granted.

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Jackman, Bridget

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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