KNEE IMPAIRMENT OF

T. RAYMOND · 2026 · Case ID: A26032092

MIXED

Summary

The veteran, who served in the U.S. Navy from September 1983 to July 1986 and again from October 2003 to December 2003, appeals a December 2019 rating decision. The veteran sought service connection for bilateral knee disabilities, bilateral ankle disabilities, bilateral hammer toes, bilateral shoulder disabilities, a low back disability, erectile dysfunction (ED), bilateral hearing loss, and tinnitus. The Board granted service connection for left knee degenerative joint disease and right knee osteoarthritis, finding that the evidence established a link between the current knee conditions and an in-service wrestling injury in August 1985, supported by early degenerative changes noted in 1986 and the veteran's credible testimony about knee symptoms during service. The Board denied service connection for ankle and hammer toe claims, finding the evidence weighed against a service connection, and noted the veteran's bare assertions without sufficient supporting evidence or diagnoses. The Board remanded claims for right and left shoulder disabilities, low back disability, ED, bilateral hearing loss, and tinnitus due to pre-decisional duty to assist errors. Specifically, the RO failed to obtain necessary VA examinations or opinions for the shoulder, low back, ED, and audiological claims, despite competent evidence of current disabilities potentially related to service or in-service events like noise exposure. The remand instructions require updated VA examinations and opinions to address the etiology and service connection of these remanded conditions.

Rationale

Current diagnosis of left knee disability; In-service injury documented (wrestling injury August 1985); Link established via medical records and credible lay testimony

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200219-59980

Full Decision Text

Citation Nr: A26032092
Decision Date: 04/08/26 Archive Date: 04/08/26

DOCKET NO. 200219-59980
DATE: April 8, 2026

ORDER

Entitlement to service connection for left knee degenerative joint disease is granted.

Entitlement to service connection for right knee osteoarthritis is granted.

Entitlement to service connection for a left ankle disability is denied.

Entitlement to service connection for a right ankle disability is denied.

Entitlement to service connection for hammer toes, left foot is denied.

Entitlement to service connection for hammer toes, right foot is denied.

REMANDED

Entitlement to service connection for a right shoulder disability is remanded.

Entitlement to service connection for a left shoulder disability is remanded.

Entitlement to service connection for a low back disability is remanded.

Entitlement to service connection for erectile dysfunction (ED) is remanded.

Entitlement to service connection for bilateral hearing loss is remanded.

Entitlement to service connection for tinnitus is remanded.

FINDINGS OF FACT

1. The evidence is at least in approximate balance as to whether the Veteran has a current left knee disability related to his active-duty military service.

2. The evidence is at least in approximate balance as to whether the Veteran has a current right knee disability related to his active-duty military service.

3. The evidence persuasively weighs against finding that, during the period on appeal, the Veteran has had a left ankle disability at any time during or approximate to the pendency of his claim that is related to active duty.

4. The evidence persuasively weighs against finding that, during the period on appeal, the Veteran has had a right ankle disability at any time during or approximate to the pendency of his claim that is related to active duty.

5. The evidence persuasively weighs against finding that, during the period on appeal, the Veteran has had left foot hammer toes at any time during or approximate to the pendency of his claim that is related to active duty.

6. The evidence persuasively weighs against finding that, during the period on appeal, the Veteran has had right foot hammer toes at any time during or approximate to the pendency of his claim that is related to active duty.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left knee disability are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a right knee disability are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a left ankle disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for left foot hammer toes are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for right foot hammer toes are not 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 in the United States Navy from September 1983 to July 1986 and from October 2003 to December 2003.

This case arrived before the Board of Veterans' Appeals (Board) on appeal from a December 2019 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ).

In a November 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran appealed the decision and elected the Board's Hearing docket under the Appeals Modernizations Act (AMA).

The Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge in April 2024.

In an AMA hearing docket, the Board may consider only the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by a Veteran or his/her representative
(Board) on appeal from a December 2019 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ).

The Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge in April 2024.

In an AMA hearing docket, the Board may consider only the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by a Veteran or his/her representative with, or within 90 days from the date of the Board hearing. See 38 C.F.R. § 20.302. The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the date of the Veteran's Board hearing or (2) evidence submitted more than 90 days after the Veteran's Board hearing. 38 C.F.R. § 20.302.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the within claims. 38 C.F.R. § 20.300.

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 those 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.

Additionally, under the AMA, the Board is not permitted to remand a case to the AOJ for additional development unless the development should have been conducted prior to the rating decision on appeal. See 38 C.F.R. § 20.802(a) (if there has been a pre-decisional duty to assist error, the claim must be returned for correction of the error and readjudication). Notably, unlike in the Legacy system, VA's duty to assist ends when VA issues the notice of decision on a claim or returned claim and does not recommence unless a supplemental claim is submitted, or a claim is returned to the AOJ for correction of an error. 38 U.S.C. § 5103A(e); 38 C.F.R. § 3.159(c). The statute specifically provides that the Secretary's duty to assist shall not apply to review on appeal by the Board. 38 U.S.C. § 5103A(e)(2). Thus, VA has no duty to assist a claimant in obtaining evidence to substantiate a claim during the period after issuance of the notice of a decision.

Veterans Benefits Law

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 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 between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F. 3d 1163, 1166 -67 (Fed. Cir. 2004).

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Likewise, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence, which it finds to be more persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not afforded to each piece of evidence contained in the record; not every item of evidence has the same probative value.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in
on that of which he or she has personal knowledge). Likewise, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence, which it finds to be more persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not afforded to each piece of evidence contained in the record; not every item of evidence has the same probative value.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving the issue shall be given to the claimant. 38 U.S.C. § 5107(b).

1. Service connection for left knee degenerative joint disease is granted.

2. Service connection for right knee osteoarthritis is granted.

The Board concludes that the Veteran has diagnoses of right and left knee disabilities that are related to his military service.

First, the Veteran has a current diagnosis. The Veteran submitted a private doctor letter in July 2024 during an applicable evidentiary window. The physician noted that the Veteran has a left knee complex flap tear of the body and posterior horn of the medial meniscus with small radial component and mild peripheral extrusion of meniscal tissue as well as moderate medial compartment degenerative joint disease, and right knee horizontal cleavage tearing involving the posterior horn and body of the medial meniscus with associated parameniscal cysts as well as osteoarthritis most significant within the medial compartment.

The Board finds the Veteran sustained injuries during service and that the evidence of record establishes a link between the Veteran's current right and left knee conditions and his injury during service.

Specifically, a VA Medical Center record from 1986 documents a history of sustaining a wrestling injury in the Navy in August 1985. Upon X-Ray, early degenerative changes to the left knee were recorded in September 1986.

Significantly, the Veteran's service treatment records shows that during active duty in February 1986, the Veteran was treated for sharp stabbing pain to both knees. Additionally, the Veteran testified at the April 2024 Board hearing as to experiencing knee symptoms from before leaving service in both knees including pain, popping, clicking, and the knees buckling or "going out."

Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue.").

As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996).

In this case, the Board finds the Veteran to be credible.

The board-certified family medicine doctor also noted in her July 2024 letter that injuries from a previous motor vehicle accident further developed during the Veteran's second period of active duty, which he testified to as well.

The Board reiterates that evidence in approximate balance in the Veteran's favor or nearly equal regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Moreover, service connection for the Veteran's left knee was previously granted by the AOJ in a September 1986 rating decision.
the Veteran's second period of active duty, which he testified to as well.

Moreover, service connection for the Veteran's left knee was previously granted by the AOJ in a September 1986 rating decision. However, the knee was not awarded a compensable rating, and it appears that procedurally the grant of service connection was removed from the Veteran's file. It is not evident from the record that VA followed the due process requirement of 38 C.F.R. § 3.105(d) for severing service connection in denying the Veteran a previously granted benefit.

For the foregoing reasons, the Board finds the evidence of record supports the Veteran's claims. The claims for service connection of right and left knee disabilities are therefore granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).

3. Service connection for a left ankle disability is denied.

4. Service connection for a right ankle disability is denied.

5. Service connection for hammer toes, left foot is denied.

6. Service connection for hammer toes, right foot is denied.

The Board has reviewed the record and finds that the evidence persuasively weighs against an award of service connection for disabilities of the left or right ankles, and bilateral hammertoes for the following reasons.

Service connection generally will be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § § 1110; 38 C.F.R. § 3.303(a).

Following a November 2018 Intent to File, the Veteran filed for service connection in August 2019. The AOJ denied the claims in December 2019. The evidence of record prior to the December 2019 decision and within 90 days following the April 2024 Board hearing do not related disabilities of the Veteran's ankles or toes to his active-duty military service.

While the Veteran testified at his Board hearing that he may have rolled his ankles during service, elevated his feet since the time of service, and believes he has hammertoes from wearing military boots, there are no diagnoses to his ankles and feet of disabilities from his time in the military. Moreover, there are no statements or medical evidence available from prior to the December 2019 rating decision to find that the RO was required to obtain a VA examination or medical opinion pertaining to these claims.

Although VA has a duty to assist the Veteran in substantiating a claim, that duty is not a one-way street, and it is important that the Veteran make efforts to assist VA in gathering evidence relevant to the claim. Woods v. Gober, 14 Vet. App. 214 (2000); Hurd v. West, 13 Vet. App. 449 (2000). The Board finds that the Veteran's bare assertion, without more, that the Veteran has an alleged disability due to service, does not require more of VA's duty to assist. Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010).

After a careful review of the evidence of record, the Board finds the weight of the evidence is against the claims of entitlement to service connection for disabilities of the left ankle and right ankle, and for left hammertoes and right hammertoes.

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), the Board must remand a claim to correct an error by the AOJ to satisfy its duty to assist the claimant under 38 U.S.C. § 5103A, if the error occurred prior to the AOJ decision on appeal. 38 U.S.C. § 5103A(f)(2)(A); 38 C.F.R. § 20.802(a). The Board may also remand a claim to correct any other AOJ error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. § 20.802(a).

On a final note, the Board presently refrains from exercising any judgement
and a claim to correct an error by the AOJ to satisfy its duty to assist the claimant under 38 U.S.C. § 5103A, if the error occurred prior to the AOJ decision on appeal. 38 U.S.C. § 5103A(f)(2)(A); 38 C.F.R. § 20.802(a). The Board may also remand a claim to correct any other AOJ error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. § 20.802(a).

On a final note, the Board presently refrains from exercising any judgement as to the merits of the remanded claims, and defers adjudication to the AOJ. In other words, remand of an issue is not indicative of a favorable finding or determination.

1. Service connection for a right shoulder disability is remanded.

2. Service connection for a left shoulder disability is remanded.

The December 2019 rating decision provided a favorable finding that the Veteran has a current disability in that private treatment records show bilateral shoulder pain with suspected labrum tear, tendinosis, and osteoarthritis.

The Veteran's military occupational specialty required physical activities including maneuvering heavy equipment onboard his ship on active duty. However, the RO did not obtain an examination.

VA must provide an examination or opinion with regard to claims for disability compensation when there is competent evidence of a disability (or persistent or recurrent symptoms of a disability) that may be associated with an in-service event, injury, or disease, but there is insufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).

The Board finds a pre-decisional duty to assist error therefore occurred, and thus a remand is necessary to obtain a VA examination with professional medical opinion pertaining to his claim for benefits. See 38 C.F.R. § 20.802(a).

3. Service connection for a low back disability is remanded.

4. Service connection for erectile dysfunction (ED) is remanded.

The December 2019 rating decision provided a favorable finding that the Veteran has a current disability of his low back of lumbosacral spine strain with degenerative arthritis.

The Veteran's military occupational specialty required physical activities including maneuvering heavy equipment onboard his ship on active duty. However, the RO did not obtain an examination.

Moreover, service treatment records associated with the claims file in January 2019 show the Veteran was involved in a September 2003 motor vehicle accident in the days prior to his second active-duty period of service which began in October 2003. The Board notes that generally every Veteran shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). The presumption of soundness "attaches only where there has been an induction examination in which the later-complained-of disability was not detected." See Crowe v. Brown, 7 Vet. App. 238, 245 (1994).

With respect to a disability noted on entry, aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b). A preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during such service, unless
attaches only where there has been an induction examination in which the later-complained-of disability was not detected." See Crowe v. Brown, 7 Vet. App. 238, 245 (1994).

With respect to a disability noted on entry, aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b). A preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during such service, unless there is clear and unmistakable evidence that the increase in disability is due to the natural progress of the condition. However, aggravation is not conceded where the disability underwent no increase in severity during service based on all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b).

Thus, a medical opinion is needed which considers aggravation of any injury of disability occurring prior to active-duty military service.

Additionally, the Board notes that the record has raised the question as to whether the Veteran has ED as a result of a low back disability.

As discussed previously, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). For a successful claim of secondary service connection, there must be competent evidence of a current disability; evidence of a service-connected disability; and competent evidence of a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

As service connection for low back is remanded, the claim for ED is intertwined and must be remanded as well. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).

5. Service connection for bilateral hearing loss is remanded.

6. Service connection for tinnitus is remanded.

The RO obtained a VA examination for hearing loss and tinnitus in October 2019 showing hearing loss for VA purposes. However, the examiner only considered the Veteran's first period of active duty in the 1980s, while noting that his hearing loss developed some time between January 2003 and August 2005. The Board finds that a new opinion that considers the Veteran's active duty from October 2003 to December 2003.

As the above was a pre-decisional duty to assist error, a remand is necessary to obtain an adequate medical opinion as to whether any current audiological disability is related to service. 38 C.F.R. § 20.802(a).

The case is REMANDED for the following:

1. The AOJ should obtain a VA examination and opinion from an appropriate medical clinician to determine the etiology of the Veteran's shoulder disabilities.

The claims file must be reviewed, and the clinician should answer the following:

(a.) Provide diagnoses for all identifiable shoulder disabilities.

(b.) Is it at least as likely as not (at least approximately 50 percent or greater probability) that a shoulder disability had onset in service or is related to service?

A complete rational should accompany any opinion provided.

2. The AOJ should obtain an opinion from an appropriate VA clinician to determine the etiology of the Veteran's low back and ED. If an examination is deemed necessary, then one should be scheduled.

The claims file must be reviewed, and the clinician should answer the following:

(a.) Is it at least as likely as not (at least approximately 50 percent or greater probability) that a low back disability had onset in service or is related to service?

(b.) Is it at least as likely as not (approximately 50 percent or greater probability) that the Veteran has ED related to service or was (a) caused or (b) aggravated by the Veteran's low back disability?

If aggravation is found, the clinician should identify the baseline level of severity prior to the onset of aggravation.

A complete rational should accompany any opinion provided.

3. The AOJ should obtain an addendum opinion from an audiologist as to whether the Veteran has current hearing loss and/or tinnitus related to service. If an examination is deemed necessary, then one should be scheduled
50 percent or greater probability) that a low back disability had onset in service or is related to service?

If aggravation is found, the clinician should identify the baseline level of severity prior to the onset of aggravation.

A complete rational should accompany any opinion provided.

The claims file must be reviewed, and the audiologist should answer the following:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any hearing loss experienced by the Veteran (1) began during active service to include periods from September 1983 to July 1986 and October 2003 to December 2003; (2) manifested within one year after discharge from service; OR (3) is related to an in-service injury or disease, including noise exposure?

(b.) The clinician must also opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has any tinnitus which (1) began during active service; (2) manifested within one year after discharge from service; OR (3) is related to an in-service injury or disease, including noise exposure.

A complete rational should accompany any opinion provided.

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kuczynski, B.

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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