Case A26032828

Summary

The Veteran, who served in the U.S. Navy from December 1988 to December 1992, appeals the denial of service connection for diabetes mellitus, type II, and the denial of service connection for right knee osteoarthritis. The Veteran withdrew the claim for diabetes mellitus, type II, during a Board hearing, and this claim was dismissed. The Board then proceeded to adjudicate the claim for right knee osteoarthritis on the merits. The Veteran contended that his right knee osteoarthritis developed secondarily to service-connected lumbar spine, left knee, and bilateral plantar fasciitis disabilities due to altered biomechanics. Evidence presented included the Veteran's testimony, a July 2021 VA C&P Examination Report diagnosing right knee osteoarthritis, and a January 2025 private medical nexus opinion from J.K., APRN. The VA C&P exam noted no in-service complaints of joint issues, but the private opinion from J.K. provided a detailed rationale linking the current right knee osteoarthritis to compensatory gait changes resulting from the service-connected lumbar spine, left knee, and bilateral plantar fasciitis conditions. J.K. cited medical literature supporting this connection and concluded there was at least a 51% probability that the right knee condition stems from these multifactorial service-connected issues. The Board found this evidence persuasive and granted service connection for the right knee osteoarthritis on a secondary basis. The Veteran's service was characterized as general, under honorable conditions.

Full Decision Text

Citation Nr: A26032828
Decision Date: 04/09/26	Archive Date: 04/09/26

DOCKET NO. 210209-140635
DATE:       April 9, 2026

ORDER

The claim for entitlement to service connection for diabetes mellitus, type II, is dismissed.

Entitlement to service connection for right knee osteoarthritis is granted.

FINDINGS OF FACT

1. During the Veteran's November 2024 hearing, the Veteran requested that his appeal for entitlement to service connection for diabetes mellitus, type II, be withdrawn. His request was explicit, unambiguous, and done with a full understanding of the consequences of such action.

2. The evidence demonstrates that the Veteran's right knee osteoarthritis is secondarily related to service-connected lumbar spine, left knee, and bilateral plantar fasciitis disabilities as a result of altered biomechanics.

CONCLUSIONS OF LAW

1. The criteria for dismissal of the claim for diabetes mellitus, type II, have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205; DeLisio v. Shinseki, 25 Vet. App. 45, 47 (2011).

2. The criteria for entitlement to service connection for right knee osteoarthritis, as secondary to service-connected lumbar spine, left knee, and bilateral plantar fasciitis disabilities, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Navy from December 1988 until his general discharge, under honorable conditions, in December 1992.

The Veteran first filed a claim for service connection for his right knee condition in July of 2015, under the legacy claims processing system. In September 2015, the Agency of Original Jurisdiction (AOJ) denied the Veteran's claim. ...

In January 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, requesting to readjudicate the claim for service connection for, inter alia, a right knee condition.

In February 2020, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had not been received. Therefore, the Board must determine whether new and relevant evidence has been received based only on the evidence of record at the time of the AOJ supplemental claim decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302.

In this regard, the Board observes that the Veteran submitted new and relevant evidence during his November 2024 Board hearing, describing altered biomechanics; this evidence relates to the nexus element of his claim. As such, the Board finds that new and relevant evidence has been received and proceeds to adjudicate the claim on the merits.

In adjudicating the claim, the Board may only consider the evidence of record at the time of the February 2020 AOJ supplemental claim decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302. If evidence was submitted either (1) during the period after the AOJ issued the supplemental claim 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.

Withdrawal

1. The claim for entitlement to service connection for diabetes mellitus, type II, is dismissed.

Under 38 U.S.C. § 7105, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. An appeal may be withdrawn by the Veteran or representative on the record at a hearing, or in writing at any time before the Board promulgates a decision. 38 C.F.R. § 20.204.

During the November 2024 Board hearing, prior to the promulgation of a Board decision, the Veteran withdrew the claim for entitlement to service connection for diabetes mellitus, type II. The presiding VLJ confirmed the withdrawal with the Veteran and his attorney before taking testimony on the remaining issue. The Veteran expressed his understanding that his claim for entitlement to service connection for diabetes mellitus, type II would be dismissed as opposed to receiving an actual decision on the merits of the claim.

The Board
 law in the determination being appealed. An appeal may be withdrawn by the Veteran or representative on the record at a hearing, or in writing at any time before the Board promulgates a decision. 38 C.F.R. § 20.204.

During the November 2024 Board hearing, prior to the promulgation of a Board decision, the Veteran withdrew the claim for entitlement to service connection for diabetes mellitus, type II. The presiding VLJ confirmed the withdrawal with the Veteran and his attorney before taking testimony on the remaining issue. The Veteran expressed his understanding that his claim for entitlement to service connection for diabetes mellitus, type II would be dismissed as opposed to receiving an actual decision on the merits of the claim.

The Board finds that the Veteran's withdrawal of the claim for entitlement to service connection for diabetes mellitus, type II, on appeal is "explicit, unambiguous, and done with full understanding of the consequences of such action on the part of the claimant." DeLisio v. Shinseki, 25 Vet. App. 45, 47 (2011); see also Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018). This is especially so given that the Veteran was represented by an individual who had the duty to counsel the Veteran as to how to best pursue his claims. Therefore, there remain no allegations of errors of fact or law for appellate consideration with regard to this issue. Accordingly, the Board does not have jurisdiction to review the claim and the issue of entitlement to service connection for diabetes mellitus, type II is dismissed.

Service Connection

2. Entitlement to service connection for right knee osteoarthritis is granted.

The Veteran contends that he developed right knee osteoarthritis on a secondary basis as result of altered biomechanics attributable to service-connected lumbar spine, left knee, and bilateral plantar fasciitis disabilities.

Service connection may be granted for 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).

Alternatively, service connection may also be granted for disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Secondary service connection may be established by a showing that a nonservice-connected disability is caused or aggravated (chronically worsened) by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

During his November 2024 Board hearing, the Veteran testified that he did not experience right knee issues prior to service or during service, but that he has been experiencing problems with his right knee for over twenty years at this point, dating back to shortly after service. He also testified that, as a result of gait disturbances attributable to his service-connected lumbar spine, left knee, and bilateral plantar fasciitis disabilities, he began to develop right knee symptomatology.

The Veteran has been diagnosed with right knee joint osteoarthritis. See July 2021 VA C&P Examination Report.

In connection with his claim for service connection, the Veteran submitted a positive medical nexus opinion from his private physician, J.K., APRN, in January 2025. J.K. opined noted the Veteran's diagnosis of osteoarthritis, as identified during the Veteran's July 2021 VA examination. J.K. then opined that the Veteran's right knee osteoarthritis is likely secondary to an altered gait resulting from his service-connected lumbar spine condition, plantar fasciitis, and left knee condition. J.K. noted that the Veteran's records indicate that upon enlistment in July 1988, he had no reports of painful or swollen joints. J.K. noted that subsequent examinations revealed various musculoskeletal issues, such as very mild degenerative changes in both knees noted in November 2018 and mild medial compartment changes in the right knee, as identified during a March 2020 x-ray. 

J.K. also noted that the Veteran's left knee (previously subjected to surgery for rod removal and multiple evaluations due to pain) was imaged via MRI in June 2020. The June 2020 MRI report identified a large bucket handle tear of the lateral meniscus, in addition to moderate cartilage
 left knee condition. J.K. noted that the Veteran's records indicate that upon enlistment in July 1988, he had no reports of painful or swollen joints. J.K. noted that subsequent examinations revealed various musculoskeletal issues, such as very mild degenerative changes in both knees noted in November 2018 and mild medial compartment changes in the right knee, as identified during a March 2020 x-ray. 

J.K. also noted that the Veteran's left knee (previously subjected to surgery for rod removal and multiple evaluations due to pain) was imaged via MRI in June 2020. The June 2020 MRI report identified a large bucket handle tear of the lateral meniscus, in addition to moderate cartilage loss in the medial compartment. J.K. explained that these left knee complications highlight significant impairment leading to compensatory adjustments in the Veteran's gait mechanics.

J.K. then noted that the presence of bilateral plantar fasciitis, diagnosed in January 2021 alongside a right side degenerative arthritis, compound the situation as the high arches contribute to altered walking patterns, ultimately affecting the joints in the lower extremities.

J.K. also reasoned that the lumbar spine is implicated, with a service-connected diagnosis of degenerative arthritis contributing to radiculopathy, which can lead to further alterations in weight bearing and gait. J.K. explained that, biomechanically, when one joint undergoes stress or is in pain, the body compensates by redistributing weight and adjusting posture, often leading to abnormal movement patterns that place undue stress on adjacent joints, in this case, the right knee.

J.K. concluded that such changes in gait due to conditions in other anatomical regions have been documented in the literature, supporting the likelihood that the Veteran's right knee osteoarthritis is more likely than not caused by this compensatory mechanism from multifactorial conditions of the lumbar spine, plantar fasciitis, and left knee condition. J.K. summarized as follows: "Therefore, it is my professional medical opinion that there is at least a 51% probability that the current right knee condition directly stems from the interplay of these service-connected conditions, severely affecting the Veteran's daily activities and overall quality of life." J.K. provided a number of citations to medical literature discussing gait patterns and kinematics, which provide additional support for the conclusions reached.

In reviewing the evidence of record, the Board finds that the persuasive evidence demonstrates that the Veteran's right knee osteoarthritis is secondarily related to service-connected lumbar spine, left knee, and bilateral plantar fasciitis disabilities as a result of altered biomechanics. As such, the claim for right knee osteoarthritis on a secondary basis is granted.

 

 

H.M. WALKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Hennessy

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.