KNEE IMPAIRMENT OF

J. SAIKH · 2026 · Case ID: A26033778

MIXED

Summary

The veteran, who served in the United States Army from December 1990 to May 1991, with additional periods in the Army National Guard and Army Reserve, appeals the denial of service connection for a left ankle disability, a left knee disability, and hemorrhoids. The veteran also appealed the denial of service connection for a right knee disability. The Board found that service connection for the right knee disability was previously granted with a 10 percent rating, effective May 30, 2024. The Board affirmed this grant, noting that the AOJ's favorable finding was binding. For the left ankle, left knee, and hemorrhoids claims, the Board remanded them to the AOJ due to pre-decisional duty to assist errors. The Board noted that service treatment records for hemorrhoids were unavailable, heightening the duty to assist. For the left ankle, the VA examiner's opinion was found inadequate for failing to address the veteran's statements of continued pain. For the left knee, the Board found the VA examiner's opinion inadequate for relying on the absence of in-service diagnosis and failing to address the veteran's reports of continued pain and surgery, especially given the unavailability of service discharge examination records. The Board ordered new VA examinations and opinions for these remanded conditions.

Rationale

AOJ's favorable finding is binding; Criteria for service connection met

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201118-123777

Full Decision Text

Citation Nr: A26033778
Decision Date: 04/13/26 Archive Date: 04/13/26

DOCKET NO. 201118-123777
DATE: April 13, 2026

ORDER

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

REMANDED

Entitlement to service connection for a left ankle disability (left ankle sprain/cracked bone) is remanded.

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

Entitlement to service connection for hemorrhoids is remanded.

FINDING OF FACT

The Veteran's right knee disability was incurred during active service.

CONCLUSION OF LAW

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

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from December 1990 to May 1991. He also had periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) in the Army National Guard from September 1984 to January 2001 and had service in the Army Reserve from September 1984 to June 1996, to include a period of active duty for training (ACDUTRA) from December 1984 to April 1985. His decorations include the Army Service Ribbon and National Defense Service Medal.

These matters come to the Board of Veterans' Appeals (Board) on appeal from an August 2020 rating decision issued by the Department of Veterans Affairs (VA). The Veteran timely appealed to the Board by filing a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)) in August 2020 and selected the hearing docket. 38 C.F.R. §§ 20.201, 20.202(b)(2). The Board notes that the VA Form 10182 also lists neck and shoulder claims. However, during the May 2024 hearing the Veteran confirmed that the only claims on appeal included entitlement to service connection for hemorrhoids, a right knee disability, a left knee disability, and a left ankle disability.

In May 2024, the Veteran and his spouse testified at a Board hearing before the undersigned. A transcript of that hearing has been associated with the record. Therefore, the Board may only consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) 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(a). The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the hearing was held, or (2) evidence submitted more than 90 days after the hearing was held. 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 that claim. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify that 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.

As to the claims of entitlement for service connection for a left knee disability, a left ankle disability, and hemorrhoids, the Board is remanding those claims to the AOJ for correction of pre-decisional duty to assist errors. The AOJ will consider any additional evidence that has been submitted when those claims are readjudicated. 38 C.F.R. § 3.103(c)(2)(ii).

Law and Analysis

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence
to assist errors. The AOJ will consider any additional evidence that has been submitted when those claims are readjudicated. 38 C.F.R. § 3.103(c)(2)(ii).

Law and Analysis

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).

Service connection can be established for disability due to disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA. 38 U.S.C. §§ 101(2), (22), (24), 1110; 38 C.F.R. §§ 3.1(d), 3.6(a), (c), 3.303; Harris v. West, 13 Vet. App. 509, 511 (2000); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). ACDUTRA is defined, in part, as full-time duty in the Armed Forces performed by Reserves for training purposes, or full-time duty performed by members of the National Guard of any State under 38 U.S.C. §§ 316, 502, 503, 504, or 505, or the prior corresponding provisions of law. 38 U.S.C. § 101(2); 38 C.F.R. § 3.6(c).

Service connection can also be established for disability due to injury, but not disease, incurred in or aggravated in the line of duty during a period of inactive duty training (INACDUTRA), or from an acute myocardial infarction, cardiac arrest, or cerebrovascular accident which occurred during INACDUTRA. 38 U.S.C. § 101(2), (23), (24); 38 C.F.R. §§ 3.1(d), 3.6(a), (d). The term "inactive duty training" is defined, in pertinent part, as duty (other than full-time duty) performed by a member of the National Guard of any State under 38 U.S.C. §§ 316, 502, 503, 504, or 505, or the prior corresponding provisions of law. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d)(4).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

Right Knee

Prior to the promulgation of a decision in this appeal, a February 2025 rating decision granted entitlement to service connection for a right knee disability and assigned a 10 percent rating, effective May 30, 2024.

Despite the later grant of service connection, the Board is obligated to decide the earlier, pending claim because there is the possibility of an earlier effective date for the grant of service connection. See Green v. McDonough, 37 Vet. App. 127, 136048 (2024); Warren v. McDonald, 28 Vet. App. 214 (2016).

The AOJ's favorable finding that the Veteran's right knee disability is related to service is binding on the Board. Accordingly, the Board finds that the criteria for entitlement to service connection for a right knee disability are met and the claim is granted. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.104, 3.303.

REASONS FOR REMAND

Hemorrh
, pending claim because there is the possibility of an earlier effective date for the grant of service connection. See Green v. McDonough, 37 Vet. App. 127, 136048 (2024); Warren v. McDonald, 28 Vet. App. 214 (2016).

REASONS FOR REMAND

Hemorrhoids

The Veteran asserts that he developed hemorrhoids as a result of his active duty service. See August 2019 VA Form 21-526EZ. September 2019 private treatment records reflect that the Veteran has a medical history of hemorrhoids and underwent a hemorrhoidectomy.

The Board notes that a complete copy of the Veteran's service treatment records (STRs) are unavailable. See March 2020 Service Treatment Record Certification. When service records are unavailable through no fault of a veteran, VA has a heightened duty to assist, to explain its findings and conclusions, and to carefully consider the benefit-of-the-doubt rule. Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991).

Given the Veteran's assertions, his medical history, and the heightened duty to assist, the Veteran should have been provided with a VA examination and a medical opinion should have been obtained. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, a remand is necessary to obtain a VA examination and a medical opinion that addresses the nature and etiology of the Veteran's hemorrhoids.

Left Ankle

Service personnel records include a February 1987 Statement of Medical Examination, DA Form 2173, which shows that the Veteran sustained a sprained left ankle that was incurred in the line of duty. The form states that the Veteran was on "inactive duty training." It states that while trying to dismount the Bradley, he fell which resulted in him putting off all of his weight on his left ankle.

In July 2020 the Veteran underwent a VA ankle conditions examination at which time he was diagnosed with acute ankle sprain, resolved in 1987 and left ankle strain on examination. The Veteran stated that in 1990, he was dismounting off of a vehicle, slipped, and twisted his ankle. He stated that he sought medical attention during which it was wrapped and a sprain was diagnosed. He stated that it healed with no further treatment. However, he also stated that he had continued left ankle pain over the years.

The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the Veteran's left ankle sprain in 1987 was acute only. There is no evidence of chronicity of care.

The Board finds this opinion is inadequate since it did not address the Veteran's statements that his ankle pain had continued over the years. In Miller v. Wilkie, 32 Vet. App. 249, 260 (2020), the United States Court of Appeals for Veterans Claims held that an examiner "must address the veteran's lay statements to provide the Board with an adequate medical opinion." Accordingly, a remand is necessary to obtain a new opinion.

Left Knee

An August 1986 Statement of Medical Examination and Duty Status shows that the Veteran injured his knee while dismounting a Bradley during a period of ACDUTRA.

In July 2020 the Veteran underwent a VA examination. The examiner diagnosed bilateral knee strain on examination. The Veteran stated that in 1990 he was dismounting from a vehicle and twisted his knee which caused right knee pain. As previously addressed, the Veteran has been granted service connection for his right knee disability. The Veteran also reported that his pain has continued since service, and that he sought medical treatment and was informed that he had a torn meniscus. He also reported having surgery on his left knee, followed by physical therapy.

The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The
ACDUTRA.

The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the lower extremities discharge examination was normal and there was no evidence of chronicity of care for any bilateral knee condition.

However, as previously noted, the Veteran's service discharge examination was not available. Thus, it is unclear how the examiner was able to determine that the Veteran's knees were normal upon examination. In addition, the examiner relied upon the absence of an in-service diagnosis, but did not address the Veteran's reports that his knee pain had continued since service. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner did not comment on a veteran's reports of in-service injury and instead relied on the absence of evidence in a veteran's service treatment records to provide a negative opinion); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (an opinion that does not consider all relevant evidence, including lay statements, is inadequate). Accordingly, a remand is necessary to obtain a new opinion.

The matters are REMANDED for the following action:

1. The Veteran should be afforded a VA examination to determine the nature and etiology of his hemorrhoids.

The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements.

The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation.

The examiner should opine as to whether it is at least as likely as not that the Veteran's hemorrhoids are causally or etiologically related to his military service, to include any symptomatology therein.

In rendering this opinion, the examiner should address the Veteran's assertions that he developed hemorrhoids from sitting, not getting enough fiber in service, and eating cold ready to eat meals in service. See May 2024 Hearing Transcript.

A clear rationale for all opinions should be provided.

2. The AOJ should obtain a VA medical opinion to determine the nature and etiology of the Veteran's left ankle disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed.

The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions.

The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

The examiner should opine as to whether it is at least as likely as not that the Veteran has a left ankle disability that is causally or etiologically related to his military service, to include any symptomatology or environmental exposures therein.

In rendering this opinion, the examiner should address the February 1987 Statement of Medical Examination documenting a left ankle sprain and the Veteran's statements made during the July 2020 VA examination that his left ankle pain has continued over the years.

A clear rationale for all opinions should be provided.

3. The AOJ should obtain a VA medical opinion to determine the nature and etiology of the Veteran's left knee disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed.

The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions.

The examiner should opine as to whether it is at least as likely as not that the Veteran has a left knee disability that is causally or etiologically related to his military service, to include any symptomatology or environmental exposures therein.

(Continued on the next page
, and evaluations deemed necessary by the examiner should be performed.

The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions.

(Continued on the next page)

In rendering this opinion, the examiner should address the Veteran's statements made during the July 2020 VA examination that his knee pain has continued since service.

A clear rationale for all opinions should be provided.

J. SAIKH

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Adams, 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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