OSTEOARTHRITIS

Summary

The veteran, who served in the Air Force from August 1991 to March 1996, appeals the denial of service connection for left knee degenerative joint disease. The veteran contended that the left knee condition was secondary to service-connected right knee strain with degenerative arthritis, thoracic and lumbar spine muscle strain with degenerative changes, and right ankle/foot sprain, including altered gait. The Board reviewed the evidence, noting that service treatment records were negative for any left knee complaints, treatment, or diagnosis during service. The veteran did not describe a specific in-service injury to the left knee, nor was it diagnosed within one year of separation or show continuity of symptomatology. Regarding the secondary claim, two VA examiners (February 2024 and January 2025) opined that the left knee disability was less likely than not caused or aggravated by the service-connected right knee, spine, and ankle conditions, finding the conditions medically unrelated. The Board found these opinions persuasive, interpreting them to mean the left knee condition was not caused by or made worse by the other disabilities. The Board also addressed the veteran's challenge to the adequacy of these opinions, finding they sufficiently addressed causation and aggravation. The Board afforded no weight to a private opinion from Kanyan Xiao, citing grammatical errors, ambiguous language, and lack of specific evidence. The Board also found the veteran's lay assertions regarding causation and gait abnormality to be outside the realm of common knowledge for a layperson and lacking probative value. Consequently, service connection for left knee degenerative joint disease was denied.

Rationale

Service treatment records negative for left knee complaints/diagnosis; No specific in-service injury described for left knee; VA examiners opined left knee disability less likely than not related to service-connected conditions

Full Decision Text

Citation Nr: A26036867
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 260127-632900
DATE: April 21, 2026

ORDER

Service connection for left knee degenerative joint disease is denied.

FINDING OF FACT

The Veteran's left knee disability did not have its onset during service, it was not manifested as arthritis to a compensable degree within the first post-service year, and it is not otherwise shown to be related to disease or injury in service or to be caused or aggravated by service-connected right knee strain with degenerative arthritis, muscle strain of the thoracic and lumbar spine with degenerative changes, and/or sprain of right ankle and foot.

CONCLUSION OF LAW

The criteria for service connection for left knee degenerative joint disease are not met.  38 U.S.C. §§ 1110, 5107;?38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the Air Force from August 1991 to March 1996.

The appeal originates from a January 2025 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO/AOJ).  In January 2026, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement) and elected direct review by a Veterans Law Judge.  Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal.  38 C.F.R. § 20.303.

The January 2026 VA Form 10182 also listed the issue of a clothing allowance based on bilateral knee braces, but that issue was not adjudicated in the listed rating decision.  As such, the issue is not addressed here.

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 claim on appeal.  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 in this decision, 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, 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 may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. § 1110; 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).

Certain chronic diseases (including degenerative arthritis) 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; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309.

Service connection may be established on a secondary basis for a disability which is due to or the result of service-connected disease or injury.  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.  Compensation may be established for any incremental increase in disability and additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence.  Ward v. Wilkie, 31 Vet.
3.307, 3.309.

Service connection may be established on a secondary basis for a disability which is due to or the result of service-connected disease or injury.  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.  Compensation may be established for any incremental increase in disability and additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence.  Ward v. Wilkie, 31 Vet. App. 233, 239 (2019).

The Veteran contends that his diagnosed left knee degenerative joint disease is secondary to service-connected right knee strain with degenerative arthritis; muscle strain of the thoracic and lumbar spine with degenerative changes; and sprain of right ankle and foot, including altered gait.  See September 2023 Claim; November 2023 VA Examination.  

With respect to direct service connection, service treatment records are negative for complaints, treatment, or diagnosis of a left knee disability.  For example, a January 1996 report of medical history shows that the Veteran reported many medical conditions (e.g., right foot pain, headaches) but offered no complaint for the left knee.  He contends that he developed a left knee disability over time but does not describe a discrete in-service injury or disease of the left knee.  See November 2023 Correspondence.  There is also no evidence that degenerative arthritis was diagnosed within one year of separation or that he had left knee pain beginning in service with continuity of symptomatology attributable to the disease.  See January 2025 CAPRI.  

With respect to secondary service connection, the February 2024 and January 2025VA examiners opined that the left knee disability was less likely as not caused or aggravated by the service-connected right knee, thoracic/lumbar spine, and/or right ankle/foot disabilities.  The February 2024 examiner determined that orthopedic literature did not support an injury to one joint having any significant impact on another or opposite uninjured joint or limb unless there was major muscle damage, nerve damage, or shortening of the injured limb resulting in a clinically obvious gait abnormality.  Based on review of the record, the Veteran's history, and the examination results, the February 2024 examiner found that this level of severity was not shown.  This was confirmed by the January 2025 VA examiner, who found that the left knee and right ankle were separate and medically unrelated conditions, including based on review of medical literature.

The Veteran challenges the adequacy of these opinions, contending that they do not address both causation and aggravation.  See July 2024 Correspondence.  Although the examiners may not have used the precise language of 38 C.F.R. § 3.310, it is clear from the rationales that the examiners addressed both causation and aggravation relationships by opining that there is no relationship between the disability of the right ankle and the disability of the left knee, and that the left knee and right ankle are "medically unrelated."  Likewise, the language used by the February 2024 examiner that an injury to one joint has no significant effect on another joint unless there is major muscle damage, nerve damage or limb shortening, and such is not shown here.  

Accordingly, the Board interprets these opinions to mean that the left knee degenerative joint disease was not caused by or made worse by disabilities of the other extremity because they are medically unrelated.  The opinion sufficiently informed the Board of the clinician's judgment on the relevant medical questions and the "essential rationale" for the opinions.  Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement).  Where a medical opinion is lacking in detail, "the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination."  Acevedo, 25 Vet. App. at 294.  Moreover, medical reports must be read as a whole and in the context of the evidence of record.  Id.  In this case, the February 2024 and January 2025 opinions are highly probative and persuasive.

The Veteran
 conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement).  Where a medical opinion is lacking in detail, "the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination."  Acevedo, 25 Vet. App. at 294.  Moreover, medical reports must be read as a whole and in the context of the evidence of record.  Id.  In this case, the February 2024 and January 2025 opinions are highly probative and persuasive.

The Veteran cites medical literature to support his claim but did not provide the text for the Board's review.  He cites nonprecedential decisions from the cases of other claimants, which have no probative value here because they are based on a different appellant with facts that pertain to that particular appellant.  He incorrectly states that the February 2024 examiner did not review the record.  He also relies on a July 2010 VA opinion for the right knee, despite the opinion being for a different body part, the opinion being aged (and therefore not benefiting from advancements in medical understanding), and the opinion lacking citation to medical literature. 

In July 2024, the Veteran submitted a private opinion from a family medicine physician, Kanyan Xiao of Woodstock, Georgia.  Xiao's opinion contains grammatical errors and ambiguous language.  For example, Xiao stated, "Where there is a question of medical connection probability [between the left knee and right knee and low back disabilities], a medical connection proximity is sound."  Xiao quoted fragments of medical literature, leaving the original context unclear.  In addition, Xiao's opinion is largely a recitation of evidence from the record without identifying specific evidence demonstrating the proposed relationships.  In one instance, Xiao asserted that the Veteran has a "long-standing limp...documented and caused by service connected injury of right leg and low back," yet the evidence recited from treatment records does not identify the limp.  Therefore, Xiao's opinion is unpersuasive and is afforded no weight.   

Consideration is also given to the personal assertions of the Veteran that his left knee disability is related to his service-connected disabilities, including through a gait abnormality or overcompensation.  However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007).  The disability at issue is not a condition that is readily amenable to probative lay comment regarding causation.  The Veteran is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation.  See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012).  The lay evidence does not constitute competent medical evidence and lacks probative value.

Accordingly, service connection for left knee degenerative joint disease must be denied.

 

L. B. CRYAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Alhinnawi

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.