KNEE IMPAIRMENT OF

Summary

The Veteran served on active duty from May 1996 to December 2003. The Veteran appeals the denial of service connection for a right knee disability, a left knee disability, bilateral hands arthritis, and residuals of a left thumb injury. The Board reviewed the evidence of record at the time of the May 2021 AOJ decision, as well as evidence submitted at a February 2025 hearing. The Veteran had previously filed claims for these conditions in 2009 and 2015, both of which were denied. The Board is bound by favorable findings that the Veteran sought treatment for his knees in 2002 and 2003, and is currently diagnosed with bilateral knee strain, patellofemoral pain syndrome, bilateral gamekeeper's thumb, trigger finger, and post-traumatic arthritis. A May 2021 VA examination was deemed inadequate for impermissibly ignoring the Veteran's lay assertions regarding onset and etiology. A March 2021 private clinician provided a positive nexus opinion, which the Board found more probative due to the length of care provided. Resolving all doubt in the Veteran's favor, the Board found the evidence in approximate balance for the knee conditions. For the hand and thumb conditions, the Board similarly found the private opinion more probative than the VA examination. Service connection for all four conditions was granted.

Rationale

Onset during service; Treatment in service; Positive private nexus opinion; Inadequate VA exam

Full Decision Text

Citation Nr: A26029245
Decision Date: 03/31/26	Archive Date: 03/31/26

DOCKET NO. 210625-168515
DATE: March 31, 2026

ORDER

Service connection for a right knee disability is granted.

Service connection for a left knee disability is granted.

Service connection for bilateral hands arthritis is granted.

Service connection for residuals of a left thumb injury is granted.

FINDINGS OF FACT

1.  The Veteran has a right knee disability which had its onset during service.

2.  The Veteran has left knee disability which had its onset during service.

3.  The Veteran has bilateral hands arthritis which had its onset during service. 

4.  The Veterans has left thumb injury residual due to an injury sustained during service.

CONCLUSIONS OF LAW

1.  The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2.  The criteria for service connection for a left knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3.  The criteria for service connection for bilateral hands arthritis are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4.  The criteria for service connection for residuals of a left thumb injury are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1996 to December 2003.

The rating decision on appeal was issued in May 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

By way of history, the Veteran filed a new July 2009 claim seeking service connection for a left thumb and bilateral knees condition. The agency of original jurisdiction (AOJ) issued an October 2009 rating decision denying the claim. 

The Veteran then filed a new October 2015 claim seeking service connection for the same conditions, plus bilateral hands arthritis. The AOJ issued a February 2016 rating decision finding no new and material evidence was submitted and denying the claim. 

In March 2021 the Veteran submitted a supplemental claim seeking service connection for a left thumb condition, bilateral knees condition, and bilateral hands arthritis. The AOJ issued a May 2021 rating decision finding that new and relevant evidence was received but still denying the claim. 

In the June 25, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on February 10, 2025.

Therefore, the Board may only consider the evidence of record at the time of the May 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38?U.S.C. §?1110; 38?C.F.R. §?3.303.

1. Right knee disability

2. Left knee disability

The Veteran contends that he has a bilateral knee disability which had its onset during service and has continued ever since separation. Specifically, the Veteran contends that "the onset of left knee pain was in 2001 that he attributes [it] to his military occupational specialty as a mechanic, standing on hard surfaces, crawling and jumping off, vehicles. In addition, he notes running and rucking has aggravated his knees." See April 2021 VA Examination Report. 

The Board is bound by the AOJ's favorable findings that the Veteran's service treatment records on April 26, 2002 note that he sought treatment for his left knee, and on October 17, 2003, and note that he sought treatment for his right knee. 
The Veteran contends that he has a bilateral knee disability which had its onset during service and has continued ever since separation. Specifically, the Veteran contends that "the onset of left knee pain was in 2001 that he attributes [it] to his military occupational specialty as a mechanic, standing on hard surfaces, crawling and jumping off, vehicles. In addition, he notes running and rucking has aggravated his knees." See April 2021 VA Examination Report. 

The Board is bound by the AOJ's favorable findings that the Veteran's service treatment records on April 26, 2002 note that he sought treatment for his left knee, and on October 17, 2003, and note that he sought treatment for his right knee. 38 CFR § 3.104(c). See May 2021 Rating Decision. The Board is also bound by the AOJ's favorable findings that the Veteran is currently diagnosed with bilateral knee strain with patellofemoral pain syndrome. Id. 

Although a May 2021 VA examiner rendered a negative nexus opinion after conducting a records review only, the opinion is inadequate in that it impermissibly ignores the Veteran's lay assertions as to the onset and etiology of his knee disabilities. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336, n. 1 (Fed. Cir. 2006).  As such, the Board has assigned low probative value to this opinion. 

A March 2021 private clinician rendered a positive nexus opinion. This opinion explained that the Veteran under the clinic's care since the year 2013 and explained that the Veteran had no other known risk factors that may have precipitated his current condition. Id.  The Board finds this opinion more probative because the length of time the Veteran had received personal care from the clinicians in the practice would provide a better understanding of his disabilities than that formed after a records review alone.

Accordingly, and resolving all doubt in the Veteran's favor, the Board finds that the evidence is at least in approximate balance as to whether the Veteran has a bilateral knee disability which had its onset during service. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

3. Bilateral hands disabilities

4. Left thumb injury residuals

The Veteran contends that he has bilateral hands disabilities that had their onset during service. He also contends that he experiences residuals of a left thumb injury which he sustained during service. See February 2025 Hearing Transcript. 

The Board is bound by the AOJ's favorable findings that that the Veteran is currently diagnosed with (1) bilateral gamekeeper's thumb, (2) bilateral trigger finger, and (3) bilateral post-traumatic arthritis. 38 CFR § 3.104(c); See May 2021 Rating Decision.

Although a May 2021 VA examiner rendered a negative nexus opinion after conducting a records review only, the opinion is inadequate in that it impermissibly ignores the Veteran's lay assertions as to the onset and etiology of the bilateral hands and left thumb disabilities. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336, n. 1 (Fed. Cir. 2006).

The aforementioned March 2021 private clinician rendered a positive nexus opinion which the Board finds more probative than the records review opinion of the May 2021 VA examiner for the same reasons noted above. 

Accordingly, and resolving all doubt in the Veteran's favor, the Board finds that the evidence is at least in approximate balance as to whether the Veteran has a bilateral hands and left thumb disabilities which had their onset during service. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

 

S. C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackson, Atossa K.

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.