FOOT IMPAIRMENT OF

A. S. CARACCIOLO · 2026 · Case ID: A26030288

MIXED

Summary

The veteran, who served in the United States Army from February 1977 to August 2002, appeals the denial of service connection for bilateral foot disabilities (right and left foot, including fallen arches and strain) and bilateral knee disabilities (right and left knee). The veteran also sought service connection for these conditions as secondary to his service-connected lumbar spine degenerative disc disease. The Board granted readjudication for the right and left foot claims due to new and relevant evidence, specifically the veteran's testimony from a November 2024 hearing regarding the onset and treatment of foot symptoms in and after service, and continuity of symptoms. However, the Board denied direct and secondary service connection for the foot claims, finding insufficient evidence of persistent or recurrent foot disability and no duty to provide a VA examination. For the right knee, the Board granted service connection, finding the veteran's testimony and treatment records, including a 2018 meniscus repair and 2019 VA treatment records noting chronic pain and injections, established continuity of symptoms and warranted granting the benefit of the doubt. The Board found the VA examiner's negative nexus opinion for the right knee lacked probative value due to failure to address continuity of symptoms and the general medical relationship between lumbar spine and knee degeneration. The left knee claim was remanded for additional development, including obtaining service treatment and personnel records from Kuwait and Afghanistan, and a new VA medical opinion addressing the nature and etiology of the left knee disability, its relation to service, and its secondary connection to the right knee or lumbar spine conditions.

Rationale

New and relevant evidence (veteran testimony) secured for readjudication.; Insufficient evidence of persistent or recurrent foot disability.; No duty to provide VA examination due to lack of persistent symptoms.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201020-115381

Full Decision Text

Citation Nr: A26030288
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 201020-115381
DATE: April 2, 2026

ORDER

Readjudication of entitlement to service connection for a right foot disability is granted.

Readjudication of entitlement to service connection for a left foot disability is granted.

Entitlement to service connection for a right foot disability, to include fallen arches and strain, to include as secondary to a lumbar spine disability, is denied.

Entitlement to service connection for a left foot disability, to include fallen arches and strain, to include as secondary to a lumbar spine disability, is denied.

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

REMANDED

Entitlement to service connection for a left knee disability, to include as secondary to a service-connected disability, is remanded.

FINDINGS OF FACT

1. In a March 2018 rating decision, the Department of Veterans Affairs (VA) Veterans Benefits Administration, which is the Agency of Original Jurisdiction (AOJ) denied entitlement to service connection for each of a right and left foot disability, to include as secondary to a lumbar spine disability, finding that the Veteran had no current right or left foot disability and that there was no evidence any right or left foot symptoms were related to the Veteran's lumbar spine disability.

2. New evidence relevant to the existence of each of a right and left foot disability and a relationship to service was presented or secured following the March 2018 rating decision and the Veteran's August 2020 supplemental claim application.

3. The Veteran has not had a right foot disability, to include fallen arches and strain, at any time during or approximate to the pendency of the claim.

4. The Veteran has not had a left foot disability, to include fallen arches and strain, at any time during or approximate to the pendency of the claim.

5. The Veteran's right knee disability began during active service.

CONCLUSIONS OF LAW

1. The criteria for readjudication of the claim for entitlement to service connection for a right foot disability, to include fallen arches and strain, are met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

2. The criteria for readjudication of the claim for entitlement to service connection for a left foot disability, to include fallen arches and strain, are met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

3. The criteria for service connection for a right foot disability, to include fallen arches and strain, due to service or service-connected disability, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for a left foot disability, to include fallen arches and strain, due to service or service-connected disability, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for right knee disability are 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 Army from February 1977 to August 2002.

These matters come before the Board of Veterans' Appeals (Board) from an October 2020 rating decision by the Department of Veterans Affairs (VA) Veterans Benefits Administration, which is the Agency of Original Jurisdiction (AOJ).

In the October 2020 Notice of Disagreement, the Veteran elected the Hearing docket. A Board hearing was held on November 2024. A transcript of the November 2024 hearing has been associated with the file.

Because the Veteran selected hearing docket review in his October 2020 Notice of Disagreement, the Board may only consider the evidence of record at the time of the October 2020 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.
on November 2024. A transcript of the November 2024 hearing has been associated with the file.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider as to the right knee, or left or right foot claims, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Because the Board is remanding the left knee claim, 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).

New and Relevant Evidence

The Veteran originally filed a claim for a right knee disability in November 2002. In February 2003, the AOJ denied entitlement to service connection for the right knee. The Veteran did not appeal. In January 2018, the Veteran filed a VA Form 21-526EZ, Fully Developed Claim, seeking service connection for bilateral knee disabilities, including joint arthritis, limited flexion, swelling, and chronic pain, and service connection for bilateral foot disabilities including fallen arches and limited flexion. As to both the bilateral knees and feet, the Veteran also sought service connection as secondary to lumbar spine degenerative disc disease.

In a March 2018 rating decision, the AOJ denied service connection for each of left and right foot joint arthritis, left and right foot fallen arches, and left and right knee symptoms including arthritis, limited flexion, swelling, and chronic pain. As to the right knee, the AOJ found that new and material evidence had been received since the February 2003 rating decision, warranting reopening of the claim in the legacy appeals system, but denied the claim on the merits with the other claims.

Because the claims raised in the August 2020 VA Form 20-0995, Supplemental Claim Application, for left and right foot arthritis, left and right foot fallen arches, and left and right knee disabilities were each previously adjudicated for service connection on the merits, VA will readjudicate each only if new and relevant evidence was secured or presented since the time of the prior adjudication in March 2018. See 38 C.F.R. §§ 3.156(d), 3.2501. New evidence is evidence not previously part of the actual record before agency adjudicators. Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed.

Readjudication of each of the left and right foot disability claims is addressed more specifically below.

As to each of a left and right knee disability, the October 2020 rating decision found that new and relevant evidence had been secured or presented to readjudicate the claims, to include as secondary to the service-connected lumbar spine disability. This is a favorable finding by the AOJ and, in general, such favorable findings are binding on the Board. See 38 C.F.R. § 3.104(c). The Board therefore addresses each of these claims only on the merits and does so separately below. See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c).

1. Readjudication of entitlement to service connection for a right foot disability.

2. Readjudication of entitlement to service connection for a left foot disability.

1. Readjudication of entitlement to service connection for a right foot disability.

2. Readjudication of entitlement to service connection for a left foot disability.

As an initial matter, in the November 2024 hearing, the Veteran made no arguments for service connection for left or right foot arthritis and stated that his physicians had not said that he had arthritis in his feet. However, the Veteran did assert that he had "strain," limited flexion, and fallen arches bilaterally which began in service and that he needed supportive insoles for his shoes. November 2024 hearing. Because the Veteran claimed bilateral foot strain and functional limitations, as well as fallen arches, relative to a foot disability generally, the Veteran's claim for service connection encompasses a claim for each of a left and right foot disability, to include fallen arches and strain. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009).

In the March 2018 rating decision, as noted, the AOJ determined that the Veteran had no current left or right foot arthritis disability, that there was no evidence of a left or right foot diagnosis within the required period of time after separation to allow for presumptive service connection, and that there was no evidence that the claimed left or right foot disabilities were related to the Veteran's service connected lumbar spine disability of degenerative disc disease.

Following the March 2018 rating decision, the Veteran filed a medical journal article addressing the relationship between back and knee pain, but not foot dysfunction. Additional VA treatment records were associated with the claims file in August 2020 and September 2020 which covered a period of treatment from August 2018 to September 2020, and a VA knee and lower leg examination was associated with the claims file in September 2020. These medical records did not address a foot disability. Thus, although this evidence was not before the AOJ prior to the March 2018 rating decision and so was new, it was not relevant to the Veteran's bilateral foot disability claims.

In the November 2024 hearing, however, the Veteran testified regarding the onset, treatment in service, and progression of left and right foot disabilities. Additional private treatment records were also secured in February 2025 following the November 2024 hearing. While the February 2025 private treatment records do not address a foot disability, the Veteran's testimony at the November 2024 hearing is evidence that was not before the AOJ prior to the March 2018 rating decision and addresses the onset and treatment of right and left foot symptoms in and after service. The November 2024 hearing testimony was new evidence that tended to prove or disprove a matter at issue in the March 2018 rating decision, namely, the existence of a foot disability in and after service, as well as a continuity of symptoms in the feet.

Because new and relevant evidence regarding each of a right and left foot disability, to include strain and fallen arches, thus has been secured, readjudication is granted. See 38 C.F.R. § 3.156(d), § 3.2501.

3. Entitlement to service connection for a right foot disability.

4. Entitlement to service connection for a left foot disability.

New and relevant evidence having been secured, the Veteran challenges the denial of entitlement to service connection for each of a left and right foot disability, to include strain and fallen arches, including as secondary to a lumbar spine disability.

Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. As a general matter, evidence for service connection for a disability must show: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases will be presumed related to service if they were shown as chronic in service, or if they manifested to a compensable degree within a presumptive period following separation from service, or if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113,
i, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases will be presumed related to service if they were shown as chronic in service, or if they manifested to a compensable degree within a presumptive period following separation from service, or if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis for a disability, as referenced by the Veteran in his August 2020 supplemental claim application. 38 C.F.R. § 3.310. 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. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

VA did not provide the Veteran with an examination for a left or right foot disability. On the record before the AOJ, however, VA had no duty to provide such an examination. For the duty to exist, the record must contain "competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability." 38 U.S.C. § 5103A(d)(2)(A). Private and VA treatment records covering the period following the Veteran's separation from service include no references to left or right foot pain or dysfunction or any treatment for the left or right foot, to include the provision of insoles as indicated by the Veteran in his testimony at the November 2024 hearing.

A January 2003 VA examination performed shortly after separation reveals no complaints regarding foot pain or dysfunction. The Veteran's separation report of medical examination and report of medical history likewise reflect no "foot trouble" or foot symptoms and report normal feet on clinical examination, although mild tenderness and a reduced range of motion in the spine are noted.

Moreover, while the Veteran sought service connection for a left and right foot disability, his testimony in the November 2024 hearing references only "strain" and notes that he has used insoles which "seem to have helped." Additionally, the Veteran acknowledged that he had not been told by a physician that he had arthritis in either foot, did not state that he had a different left or right foot diagnosis, and did not state that he experienced pain in his feet.

This evidence is insufficient to show persistent or recurrent symptoms of a left or right foot disability, including pain. See Saunders v. Wilkie, 886 F.3d 1356, 1368 (2018). Therefore, there was no duty to provide a medical examination for the left or right foot claim. See 38 U.S.C. § 5103A(d)(2)(A). Additionally, the evidence, as reviewed above, does not support that the Veteran had a left or right foot disability at any time approximate to the pendency of his claim of entitlement to service connection for a left or right foot disability. Without a disability at some time during the pendency of the claim, entitlement to service connection directly, presumptively, or as secondary to a service-connected lumbar spine disability cannot be shown. See 38 U.S.C. §§ 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310; Spicer, 61 F.4th at 1365; Shedden, 381 F.3d at 1166-
does not support that the Veteran had a left or right foot disability at any time approximate to the pendency of his claim of entitlement to service connection for a left or right foot disability. Without a disability at some time during the pendency of the claim, entitlement to service connection directly, presumptively, or as secondary to a service-connected lumbar spine disability cannot be shown. See 38 U.S.C. §§ 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310; Spicer, 61 F.4th at 1365; Shedden, 381 F.3d at 1166-67. Entitlement to service connection for each of a left and right foot disability is therefore denied.

5. Entitlement to service connection for a right knee disability.

The Veteran additionally challenges the denial of entitlement to service connection for a right knee disability, to include as secondary to a lumbar spine disability. October 2020 Notice of Disagreement. As noted, the October 2020 rating decision found that new and relevant evidence had been presented or secured regarding the right knee disability but nonetheless found that the evidence did not support a change to the denial of entitlement to service connection, to include as secondary to the Veteran's lumbar spine disability.

VA provided the Veteran with a spinal examination in September 2020, following the filing of the August 2020 supplemental claim application. The September 2020 VA examiner identified a 1982 diagnosis of right knee strain. The VA examiner noted that the Veteran reported that he injured his right knee in the early 1980s in service. The Veteran further stated to the examiner that the knee pain had worsened over the years and resulted in a meniscus repair of the right knee in October 2018. Despite the surgery, the Veteran stated that the right knee symptoms had not improved much and that he continued to experience a constant aching pain in the right knee with occasional swelling. Range of motion testing revealed a decreased range of motion in the right knee, with pain noted on examination and causing functional loss.

The September 2020 VA examiner opined that the Veteran's right knee disability was unrelated to his right knee symptoms in service. The VA examiner noted that, although there were right knee complaints in service, x-rays of the right knee were always unremarkable. In offering the negative nexus opinion, the VA examiner failed to address the Veteran's report of continued symptoms of right knee pain and limitations in and since service, even after surgery.

The September 2020 VA examiner also opined that the Veteran's bilateral knee pain symptoms were unrelated to his service-connected lumbar spine disability. The examiner cited only generally Oxford's Textbook on Orthopedics and Trauma and provided no rationale for the opinion. Additionally, the examiner failed to respond to the 2015 medical journal research article filed in August 2020 which specifically noted that researchers had observed that degenerative changes in the lumbar vertebrae levels led in most cases to degenerative changes in the knee joints even if the pain was not felt immediately in the knee joint. The September 2020 VA examiner's report, which fails to address the Veteran's contentions of continued right knee symptoms and treatment in and since service, provides only the right knee range of motion and other data related to functional performance, and offers a conclusion that the Veteran's right knee disability was neither caused nor aggravated by the Veteran's lumbar spine disability, without explanatory rationale, is entitled to no probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Service treatment records reflect that the Veteran complained of a right knee injury in August 1982. The August 1982 care provider identified a diagnosis of right knee strain and ordered an x-ray, with apparently unremarkable results according to service treatment records at the time. In a follow up to the August 1982 appointment, a September 1982 record notes that the Veteran was experiencing functional limitations due to the knee injury and ordered activity restrictions of no running for 2 weeks. Thereafter, in September 2001 examination, service treatment records show that the Veteran reported he had experienced knee pain for the prior two weeks. Although the September 2001 imaging report stated that the impression was unremarkable, the report noted a history of trauma in 1982 which had "resolved with problems."

A May 2019 VA treatment record, created as the Veteran established care at the VA, included chronic right knee pain in a list of medical problems. The Veteran reported to the care provider at that time that he was getting injections for the right knee disability from a private provider
a September 1982 record notes that the Veteran was experiencing functional limitations due to the knee injury and ordered activity restrictions of no running for 2 weeks. Thereafter, in September 2001 examination, service treatment records show that the Veteran reported he had experienced knee pain for the prior two weeks. Although the September 2001 imaging report stated that the impression was unremarkable, the report noted a history of trauma in 1982 which had "resolved with problems."

A May 2019 VA treatment record, created as the Veteran established care at the VA, included chronic right knee pain in a list of medical problems. The Veteran reported to the care provider at that time that he was getting injections for the right knee disability from a private provider and also noted that, while still in service, he completed physical therapy in Kuwait. Private treatment records show not only injections in June 2024 for the right knee pain but also an arthroscopy procedure with a partial medial and lateral meniscectomy for a meniscus tear in October 2018.

In favor of direct service connection, then, are the Veteran's reports in the September 2020 VA examination and November 2025 testimony regarding the continuity of his symptoms and the treatment of the symptoms in service with analgesics, which is supported by service treatment records addressing the right knee complaints in service. As well, the service treatment records reflect that almost 20 years after the initial injury to the right knee, care providers identified weeks-long right knee pain symptoms at that time as related to the 1982 trauma and reported the 1982 trauma as resolved but with problems. Finally, the May 2019 VA treatment records indicate as well that the Veteran underwent physical therapy for the right knee at some other point in service.

In the review of evidence, the benefit of the doubt is given to the Veteran in resolving the merits of any issue material to the determination of the matter where there is an approximate balance of evidence. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc). Giving the Veteran the benefit of the doubt regarding the in-service onset of his right knee disability and continued symptoms in and after service, entitlement to service connection for a right knee disability is warranted in this matter. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d at 1166-67.

REASONS FOR REMAND

1. Entitlement to service connection for left knee disability.

The Veteran also challenges the denial of entitlement to service connection for a left knee disability, to include as secondary to a lumbar spine disability. October 2020 Notice of Disagreement. As with the right knee claim, the October 2020 rating decision found that new and relevant evidence had been presented or secured regarding the left knee disability but nonetheless found that the evidence did not support entitlement to service connection, to include as secondary to the Veteran's lumbar spine disability.

In the September 2020 VA examination, the examiner reported a left knee strain diagnosis as of the month of the examination in September 2020. The Veteran reported in the September 2020 VA examination that his left knee pain had begun years after the right knee symptoms and without direct injury or trauma to the left knee. The Veteran stated that he continued to experience intermittent sharp pain in the left knee. Range of motion testing in the September 2020 VA examination indicated a decreased range of motion in the left knee with pain noted on examination and causing functional loss.

The September 2020 VA examiner opined that the left knee disability was not medically related to the right knee disability. The examiner stated that there was no clear evidence that an injury to one joint would have any significant impact on the opposing joint, except in situations of major muscle or nerve damage causing partial or complete paralysis or of the shortening of a limb with a resulting obvious Trendelenburg gait, which was not the situation in the instant matter.

As with the right knee, the September 2020 VA examiner additionally opined without explanation that the left knee disability was not related to the service-connected lumbar spine degenerative disc disease. As with the right knee medical opinion, the September 2020 VA examiner did not address the 2015 medical journal article filed in August 2020 which specifically identified a general medical relationship between lumbar spine degenerative disc disease and knee joint pain and degeneration.

The September 2020 VA examiner's report, which, as with the medical opinion for the right knee, contains only range of motion and functional performance data and fails to provide a rationale for the conclusion that the Veteran's left knee disability was neither caused nor aggravated by the Veteran's lumbar spine disability. The September 2020 VA medical opinion is therefore entitled to no probative value as to secondary service connection to the Veteran's lumbar spine disability. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Additionally, there is a deficiency in the record that existed prior to the October 2020 decision on appeal. VA treatment records in August 2018 and May 2019 reflect that the Veteran underwent physical therapy for his right knee disability in Kuwait. The claims file does not appear to include service treatment records reflecting such treatment, or even service, in Kuwait although the evidence has a reasonable possibility of sustaining a left knee disability claim. VA's failure to obtain and review a complete copy of the Veteran's service treatment records prior to the rating decision constitutes a pre-decisional duty to assist error requiring remand for correction. 38 C.F.R. § 20.802(a).

In the November 2025 hearing, the Veteran also referenced service in Afghanistan, for which period service treatment records or personnel records also do not appear to be in the claims file. Therefore, service treatment and military personnel records relevant to the Veteran's treatment and service in Kuwait or other locations in the Southwest Asia theater of operations generally during the Persian Gulf War should be sought on remand.

The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file.

The matters are REMANDED for the following action:

1. Obtain the Veteran's service treatment records for periods of service in Kuwait, Afghanistan, or other Persian Gulf War deployment in active duty service and obtain the Veteran's military personnel records.

2. Once the above has been completed, obtain an addendum medical opinion from an appropriate medical professional addressing the nature and etiology of the Veteran's left knee disability.

The entire claims file should be provided to the examiner for review and the report should reflect that such review occurred. The need for an examination is left to the discretion of the examiner. All diagnostic testing deemed to be necessary by the examiner should be accomplished.

After reviewing the entire claims file, the examiner is asked to provide an opinion as to the following:

(a.) Whether the Veteran's left knee disability had onset during service or is otherwise causally or etiologically due to service, to include any period of deployment to the Southwest Asia theater of operations during the Persian Gulf War.

(b.) If the examiner answers the above in the negative, opine as to whether the Veteran's left knee disability was caused by his service-connected right knee disability or lumbar spine degenerative disc disease.

(c.) Whether the Veteran's left knee disability would be less severe and result in less functional impairment but for the Veteran's service-connected right knee disability or lumbar spine degenerative disc disease.

*If the examiner opines that the left knee disability would result in less functional impairment but for the right knee disability or lumbar spine degenerative disc disease, the examiner must attempt to establish a baseline level of severity of the diagnosed left knee disability prior to aggravation by the primary service-connected disability.

A. S. CARACCIOLO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Guill, Associate 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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