KNEE IMPAIRMENT OF

Summary

The Veteran, an Air Force Veteran who served from September 1962 to January 1967, appeals the denial of service connection for left knee strain, right knee strain, and a right ankle condition. The Veteran is service-connected for lumbosacral strain. The Board reviewed the case under the Appeals Modernization Act's Direct Review Docket. The Agency of Original Jurisdiction (AOJ) had previously denied these claims, citing unfavorable etiological opinions from VA examinations conducted in January 2023, July 2025, and December 2025. These VA opinions documented diagnoses of bilateral knee strain and right ankle pain with functional loss but concluded unfavorably regarding service connection. However, the Board found these VA opinions inadequate because they failed to address favorable evidence of record. Specifically, a January 2020 private treatment record documented knee problems secondary to a fall, and a November 2022 VA treatment record noted that the Veteran's back disability caused chronic falls with secondary ankle and hip problems. The Board found these private and VA treatment providers' assessments more probative than the VA examiners' conclusions, as they better accounted for the Veteran's lay reports of increased knee and ankle symptoms after falling and analyzed the conditions in relation to the service-connected lumbosacral strain. Consequently, the Board granted service connection for all three conditions on a secondary basis, resolving the claims in full.

Rationale

Prognosis favors service connection; Secondary to service-connected lumbosacral strain; More probative evidence from private/VA treatment records

Full Decision Text

Citation Nr: A26029928
Decision Date: 04/02/26	Archive Date: 04/02/26

DOCKET NO. 260113-627743
DATE: April 2, 2026

ORDER

Entitlement to service connection for left knee strain is granted.

Entitlement to service connection for right knee strain is granted.

Entitlement to service connection for a right ankle condition (manifested by pain with functional loss that can affect earning capacity) is granted.

FINDINGS OF FACT

1. The probative evidence persuasively favors finding that the Veteran's left knee strain is at least as likely as not due to or the result of his service-connected lumbosacral strain.

2. The probative evidence persuasively favors finding that the Veteran's right knee strain is at least as likely as not due to or the result of his service-connected lumbosacral strain.

3. The probative evidence persuasively favors finding that the Veteran's right ankle condition is at least as likely as not due to or the result of his service-connected lumbosacral strain.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left knee strain have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for right knee strain have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for a right ankle condition (manifested by pain with functional loss that can affect earning capacity) have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from September 1962 to January 1967.  The Board thanks the Veteran for his service to our country. 

On November 14, 2022, VA received a VA Form 21-526EZ initiating the right knee and ankle claims.  In a March 20, 2023, Rating Decision, the Agency of Original Jurisdiction (AOJ) denied the right knee and ankle claims.  On June 6, 2025, VA received a VA Form 20-0995 (Supplemental Claim Application) for the March 2023 Rating Decision; however, in a June 16, 2025, letter, the AOJ informed the Veteran that his Supplemental Claim Application was incomplete.  On June 6, 2025, VA also received a VA Form 21-526EZ initiating the left knee claim.  In a July 31, 2025, Rating Decision, the AOJ denied the left knee claim.  On September 12, 2025, VA received a VA Form 20-0995 (Supplemental Claim Application) for the March 2023 and July 2025 Rating Decisions.  In a January 12, 2026, Rating Decision, the AOJ denied the claims herein.  On January 13, 2026, VA received a VA Form 10182 electing the Board's review of the claims herein under its Direct Review Docket pursuant to the modernized review system under the Appeals Modernization Act (AMA).  38?C.F.R. §?20.301.  The Board has construed the Veteran's request for expeditious processing as a constructive waiver of his remaining time to request a different Board review option under 38 C.F.R. § 20.202(c)(2).  Williams v. McDonough, 37 Vet. App. 305 (2024). 

Applicable Review Periods and Evidentiary Windows

The review period and the evidentiary window are distinct concepts in AMA that are not interchangeable (the review period is limited to the period considered by the AOJ [i.e., ends at the issuance of the AOJ decision on appeal]; the evidentiary window is the time which evidence may be submitted and considered for the issue on appeal).  The Direct Review Docket only permits the Board to review the evidence of record at the time of the AOJ decision(s) on appeal.  38 C.F.R. §§ 20.300(a), 301.  The Board will not consider evidence received after the AOJ decision unless the claimant files a timely request for a Board hearing or an opportunity to submit additional evidence on the VA Form 10182;
 evidentiary window are distinct concepts in AMA that are not interchangeable (the review period is limited to the period considered by the AOJ [i.e., ends at the issuance of the AOJ decision on appeal]; the evidentiary window is the time which evidence may be submitted and considered for the issue on appeal).  The Direct Review Docket only permits the Board to review the evidence of record at the time of the AOJ decision(s) on appeal.  38 C.F.R. §§ 20.300(a), 301.  The Board will not consider evidence received after the AOJ decision unless the claimant files a timely request for a Board hearing or an opportunity to submit additional evidence on the VA Form 10182; in this case, the Veteran has not filed such a request. ?Id; 38 C.F.R. § 20.301; Cook v. McDonough, 36 Vet. App. 175 (2023).

Regarding the appeal herein, the review periods for the right knee and ankle claims span from the date of the claims (November 14, 2022) through the date the AOJ issued the decision on appeal (January 12, 2026); the evidentiary windows for the right knee and ankle claims are limited to evidence associated with the claims file on or before the date the AOJ issued the decision on appeal (January 12, 2026).  Regarding the appeal herein, the review period for the left knee claim spans from the date of the claim (June 6, 2025) through the date the AOJ issued the decision on appeal (January 12, 2026); the evidentiary window for the left knee claim is limited to evidence associated with the claims file on or before the date the AOJ issued the decision on appeal (January 12, 2026).  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.  Cook, supra.

1. Entitlement to service connection for left knee strain

2. Entitlement to service connection for right knee strain 

3. Entitlement to service connection for a right ankle condition 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 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 ("nexus") between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).  Where pain causes functional impairment of earning capacity, a disability for VA purposes exists, even if there is no underlying diagnosis.  Saunders?v. Wilkie,?886 F.3d 1356?(Fed. Cir. 2018).  Secondary service connection may be granted if a disability is due to or the result of a service-connected disease or injury or aggravated by a service-connected disease or injury.  38 C.F.R. § 3.310; Harvey v. Shulkin, 30 Vet. App. 10, 15 (2018); Ward v. Wilkie, 31 Vet. App. 233, 239 (2019); Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023).

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a Veteran's disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki,?24?Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  In this case, the evidence does not indicate that the Veteran has the medical background necessary to opine regarding symptoms or diagnoses that are not lay observable; however, as a lay person, the Veteran is competent to report lay-observable symptoms and functional loss because this requires only personal knowledge, not medical expertise, as it comes to him through his senses.  Layno v. Brown, 6 Vet
-case basis, whether a Veteran's disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki,?24?Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  In this case, the evidence does not indicate that the Veteran has the medical background necessary to opine regarding symptoms or diagnoses that are not lay observable; however, as a lay person, the Veteran is competent to report lay-observable symptoms and functional loss because this requires only personal knowledge, not medical expertise, as it comes to him through his senses.  Layno v. Brown, 6 Vet. App. 465 (1994).  Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional.  Jandreau, supra.

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?

The Veteran is currently service connected for lumbosacral strain.  See January 2026 Codesheet.  The AOJ afforded the Veteran pertinent VA examinations in January 2023, July 2025, and December 2025; the AOJ obtained January 2023, April 2023, July 2025, August 2025, December 2025, and January 2026 etiological opinions with unfavorable etiological conclusions.  Those VA examiners documented a diagnosis of bilateral knee strain and documented the Veteran's reports of right ankle pain with functional loss (including intermittent pain resulting in hypoactive deep tendon reflexes and decreased sensation for light touch).  See January 2023 VA ankle examination; January 2023 VA peripheral nerves examination; December 2025 VA knee examination.  The Board finds the right ankle pain with functional loss to be a disability for VA purposes because it more likely than not would cause functional impairment of earning capacity (as decreased reflexes and sensation would impact motor control, balance, and stability for occupational activities including walking, driving, and other movements involving the lower body).  Saunders, supra.  Further, the Board finds the unfavorable VA opinions to be inadequate because they failed to address favorable evidence of record.  Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).  Specifically: a January 16, 2020, private treatment record documented a history of knee problems secondary to falling; and a November 21, 2022, VA treatment record documented that the back disability caused chronic falls with a history of injury and secondary ankle and hip problems.  The Board finds the January 2020 and November 2022 providers' assessments to be more probative than the VA examiners' conclusions because they better accounted for the Veteran's probative lay reports regarding increased knee and ankle symptomatology after falling and more comprehensively analyzed his claimed conditions in relation to his service-connected back disability and its functional effects.  Barr, supra; Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).  Thus, the Board grants the claims on secondary bases, resolving them in full.

 

 

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. Daus, 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.