KNEE IMPAIRMENT OF

L. HOWELL · 2026 · Case ID: A26026414

DENIED

Summary

The veteran, who served from June 1974 to July 1977, appealed the denial of service connection for a left knee disorder, specifically osteoarthritis, claiming it was secondary to his service-connected lumbosacral strain with a herniated disc. The Board reviewed the evidence to determine if direct, presumptive, or secondary service connection was warranted. The service treatment records did not indicate any in-service complaints, treatment, or diagnosis of a left knee disorder, nor did they show continuity of symptomatology since service. The separation examination also noted no left knee issues and the veteran denied relevant symptoms. The Board found no basis for direct or presumptive service connection. For the secondary claim, the Board considered a January 2021 VA examination. The examiner initially provided a negative opinion, questioning the x-rays and attributing the pain to age, general osteoarthritis, and the veteran's history of right knee issues, while noting a potential link if left knee osteoarthritis was absent. An addendum opinion from the same clinician clarified that the left knee osteoarthritis was less likely than not due to the service-connected back condition, citing osteoarthritis's commonality, age-related factors, genetic predisposition, and the absence of radicular pain. The Board found this addendum opinion adequate and persuasive, concluding that the medical evidence did not support secondary service connection. The veteran's lay statements regarding etiology were given less weight than the medical opinion. The appeal was denied.

Rationale

No in-service complaints, treatment, or diagnosis of left knee disorder in STRs.; Separation exam showed no left knee issues; veteran denied relevant symptoms.; VA addendum opinion found osteoarthritis less likely than not due to service-connected back disability.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210406-151001

Full Decision Text

Citation Nr: A26026414
Decision Date: 03/24/26 Archive Date: 03/24/26

DOCKET NO. 210406-151001
DATE: March 24, 2026

ORDER

Service connection for left knee disorder is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from June 1974 to July 1977; he died in January 2023 and his surviving spouse has been properly substituted as the appellant.

2. A chronic left knee disorder, diagnosed as osteoarthritis, was not shown in service, was not shown to a compensable degree within one year of service, and symptoms of a chronic left knee disorder were not continuous since service; the left knee disorder was not causally or etiologically related to service or to a service-connected disability.

CONCLUSION OF LAW

A left knee disorder was not incurred in service nor was it proximately due to or aggravated by a service-connected disability. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2026).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In January 2021, the agency of original jurisdiction (AOJ) denied the claim. In April 2021, the Veteran appealed to the Board via a Form 10182 and elected the Hearing docket. In March 2022, he withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the January 2021 decision on appeal, as well as any evidence submitted by the Veteran within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). This appeal was then dismissed in November 2023 following the Veteran's death. His surviving spouse has been since properly substituted by the AOJ and stepped into the Veteran's place for all appeals as the appellant. The appeal was reinstated.

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

The Veteran claimed that service connection was warranted for a left knee disorder because it was due to a service-connected low back disability. Turning to the evidence, a January 2021 VA examiner diagnosed left knee osteoarthritis. As such, the first element of service connection was met.

As to an in-service incurrence, the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of a left knee disorder. The July 1977 separation examination report did not reflect any complaints or findings related to the left knee and the accompanying Report Medical History indicated that the Veteran denied trick or locked knee, arthritis, rheumatism or bursitis, and bone
38 C.F.R. § 3.307.

As to presumptive service connection, the Veteran was diagnosed with osteoarthritis, which is a chronic condition and service connection on a presumptive basis under 38 C.F.R. §§ 3.307 and 3.309 will be considered. To that end, a review of the STRs fails to show complaints of, treatment for, or a diagnosis related to the left knee. Thus, the medical evidence does not support presumptive service connection for a chronic disease diagnosed during service.

Next, the disorder did not manifest to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1977 but did not note symptoms related to the left knee until 2017 at the earliest. Moreover, left knee osteoarthritis was not specifically indicated until the January 2021 VA examination. This evidence does not support presumptive service connection on a manifest within one-year from separation" basis.

Further, the medical evidence does not support presumptive service connection based on continuity of symptomatology since service. As noted, the Veteran separated from service in July 1977 but did not report symptoms related to the left knee for 40 years after service, and signs of arthritis were identified no earlier. As such, the medical evidence does not support service connection on a "continuity of symptomatology" basis. Therefore, the medical evidence does not support presumptive service connection on any basis.

Rather, the Veteran's primary contention was that service connection was warranted for a left knee disorder because it was secondary to a service-connected back disability. As noted, he was diagnosis with a left knee disorder and was service connected for a lumbosacral strain with herniated disc. Therefore, the first and second elements of secondary service connection were met.

With regard to a medical nexus between the two, a January 2021 VA examiner opined that the Veteran's left knee osteoarthritis was less likely than not proximately due to or the result of the service-connected disability.

The examiner stated: "I question the results of the x-rays done today (impression: negative L knee) and do believe that vet's pain is likely due to [osteoarthritis] - due to vet's age, location of pain without radiation of pain, gradual onset with no [history of] injury, vet's own report of receiving steroid and 'cushioning' injections for his symptoms (he states by an ortho provider), and long documented history of Right knee [osteoarthritis] (with recommendation for [total knee arthroplasty] R knee)."

The examiner noted that, "his symptoms do not fit clinical picture of other [diagnosis] related to 'left knee condition' claimed condition. It would be most helpful if vet's ortho records related to his L knee symptoms would be made available for review - in the absence of [osteoarthritis], there could possibly be a cause/effect relationship between his service-connected back condition and his knee symptoms."

The AOJ, however, found the VA examination inadequate because the January 20, 2021, examiner provided conflicting information in the report. The AOJ noted that the VA examiner did not provide a current diagnosis for the left knee given limitation of motion with pain and did not provide a suitable secondary opinion and complete rationale for the left knee disability. The Board similarly finds this opinion of limited probative value. Prejean v. West, 13 Vet. App. at 448-49; Nieves-Rodriguez, 22 Vet. App. at 302-04.

In a January 27, 2021, addendum opinion, the VA clinician stated that left knee osteoarthritis was less likely than not to have been caused by the service-connected lumbosacral strain with herniated disc disability. The examiner explained that osteoarthritis was the most common joint disease of adults worldwide, its incidences rose with age, and knee osteoarthritis was the most common type of osteoarthritis
for the left knee disability. The Board similarly finds this opinion of limited probative value. Prejean v. West, 13 Vet. App. at 448-49; Nieves-Rodriguez, 22 Vet. App. at 302-04.

The examiner further noted that genetic factors unquestionably played a role, and people who were overweight were more at risk. Further, the examiner indicated that the Veteran's left knee osteoarthritis was separate from a back disability. They noted that there was no radicular pain and the pain was isolated to the medial aspect of the knee and it did not radiate.

The Board finds that the addendum opinion was adequate for evaluation purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a physical examination. There is no indication that the VA examiner was not fully aware of the Veteran's past medical history or that they misstated any relevant fact.

Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. Therefore, the Board finds the addendum opinion to be of great probative value. As such, the medical evidence does not support service connection on a secondary basis.

The Board has considered the Veteran's lay statements and of the appellant that the left knee disorder was caused by service. While they are competent to report symptoms as this requires only personal knowledge as it comes to them through their senses, they are not competent to offer an opinion as to the etiology of the current disorders due to the medical complexity of the matters involved. This is within the purview of the Board.

To that end, such competent evidence concerning the nature and extent of the Veteran's left knee disorder and the resultant functional impairment has been provided by the medical personnel who examined him during the current appeal and who rendered pertinent opinions in conjunction with the evaluations.

Their findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disorder is evaluated. The VA medical professional explained their reasoning based on an accurate characterization of the evidence. Therefore, the Board attaches greater probative weight to the medical opinion than to lay statements regarding etiology.

In sum, after a careful review of the record, the evidence weighs persuasively against the claim for service connection and there is no doubt to be resolved. As such, the appeal is denied.

Finally, neither the Veteran nor the appellant raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Oettle, T.

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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