KNEE IMPAIRMENT OF

Summary

The Veteran served from November 2005 to September 2011. The Veteran appeals the November 2024 denial of service connection for bilateral knee conditions, claiming they are secondary to a service-connected left ankle disability. The Veteran asserts that an altered gait due to ankle pain places extra pressure on both knees, causing pain, swelling, and strain, which worsens with ankle flare-ups and impacts her ability to work. The Veteran reported significant difficulty climbing stairs and missing work due to knee pain. The Board found the Veteran competent to report her knee symptoms and that her testimony, combined with the VA examiner's findings of medical plausibility, supported secondary service connection. The VA examiner provided a negative nexus opinion, stating a lack of formal diagnoses, but was found inadequate for failing to consider if pain alone, causing functional impairment, could constitute a disability. The Board found the Veteran's knee pain, worsened by the service-connected ankle condition, resulted in functional impairment of earning capacity, thus granting service connection for both knees. The decision did not involve specific diagnostic codes or percentages for the granted conditions.

Rationale

Secondary to service-connected left ankle disability; Pain causes functional impairment of earning capacity; Competent lay testimony regarding symptoms and work impact

Full Decision Text

Citation Nr: A26036457
Decision Date: 04/20/26	Archive Date: 04/20/26

DOCKET NO. 250916-586781
DATE: April 20, 2026

ORDER

Service connection for a right knee disability is granted.

Service connection for a left knee disability is granted.

FINDING OF FACT

The Veteran has bilateral knee pain which is worsened by her service connected left ankle disability, resulting in functional impairment of earning capacity. 

CONCLUSION OF LAW

The criteria for service connection of bilateral knee disabilities are 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 from November 2005 and September 2011.

The rating decision on appeal was issued in November 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

The Veteran filed a new July 2024 claim seeking service connection for bilateral knee sprain/strain/ankylosis. The agency of original jurisdiction (AOJ) issued a November 2024 rating decision denying the claim. 

In the September 16, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service.  38?U.S.C. §?1110; 38?C.F.R. §?3.303. 

Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b).

1. Right knee condition

2. Left knee condition

The Veteran contends that she has a bilateral knee condition due to her service connected left ankle lateral collateral ligament sprain (left ankle disability). Specifically, the Veteran contends that "[t]o avoid putting too much weight on the ankle, [she] [has] had to change the way [she] walk[s]. This altered gait places extra pressure on both knees. Over time, the added stress has caused ongoing pain, swelling, and strain in both knees. [She] did not have these problems before [her] ankle injury, and [she] notice[s] the knee pain worsens whenever [her] ankle flares up. This has made daily life and work more difficult. [Her] job requires [her] to climb three flights of stairs multiple times a day, which puts even more strain on [her] knees. By the end of the day, [she] often experience significant discomfort in both [her] knees and ankle." See September 2025 Correspondence.

Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. See Layno v. Brown; 38 C.F.R. § 3.159(a)(2). Competent lay evidence means any evidence not requiring that the proponent
 whenever [her] ankle flares up. This has made daily life and work more difficult. [Her] job requires [her] to climb three flights of stairs multiple times a day, which puts even more strain on [her] knees. By the end of the day, [she] often experience significant discomfort in both [her] knees and ankle." See September 2025 Correspondence.

Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. See Layno v. Brown; 38 C.F.R. § 3.159(a)(2). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Id. Competent lay evidence can be sufficient on its own to establish any element of a claim. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

The Veteran is not currently diagnosed with any knee condition. See August 2024 VA Examination Report; July 2024 X-Ray Imaging Report. However, for VA purposes a disability is any condition that results in functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 

An August 2024 VA examiner rendered a negative nexus opinion based on a lack of formal diagnoses, after determining that knee strain or sprain and right and left ankle lateral collateral ligament sprain could be medically related. The opinion was inadequate, however, in that it failed to consider whether pain alone, without any underlying pathology or disease process, can constitute a current disability if there is objective evidence that the pain causes functional impairment resulting in a decrease of earning capacity.  See Saunders, supra. 

The Veteran reported to the August 2024 VA examiner that climbing stairs is very difficult for her, that she has stairs at her job, that the bathroom is downstairs while she works upstairs, which makes going to the bathroom a few times a day hard. The examiner found that procured evidence from the Veteran suggested that both during flare ups, as well as after repeated use over time, the Veteran experienced functional loss, due to pain, fatigability, and weakness. See August 2024 VA Examination Report. The examiner also noted that there was history of frequent effusion of both knees. Finally, the Veteran specifically reported that she worked as an air traffic controller who "had to miss work because of the problems with [her] knees." 

The Board finds that the Veteran was competent to report symptoms of pain in her knees due to changing the way she walks, which during flareups reached a level of 9 out 10 on the pain scale, and which caused her to have to miss work. See Layno, supra. The Veteran's testimony, in concert with the VA examiner's findings that it is medically plausible for the diagnosed left ankle condition in this case to cause knee pain, supports a finding that service connection is warranted for the knee conditions on a secondary basis. In sum, the Board finds that the Veteran has knee pain which is worsened due to her service connected ankle disability, and results in functional impairment of earning capacity. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

 

S. C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackson, Atossa K.

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.