KNEE IMPAIRMENT OF

VICTORIA MOSHIASHWILI · 2026 · Case ID: A26037810

MIXED

Summary

The veteran, who served in the United States Navy from April 2001 to July 2006 as a systems organizational apprentice maintenance technician, appeals the denial of increased ratings for his right knee disability and service connection for tinnitus. The Board granted an increased rating for right knee limitation of extension to 10 percent, effective August 30, 2017, based on painful motion. For right knee limitation of flexion, the Board granted a 20 percent rating effective March 7, 2020, based on new VA examination findings. A separate 20 percent rating was granted for right knee instability, effective August 30, 2017, based on moderate impairment and the need for a brace. A 10 percent rating was also granted for a symptomatic right knee meniscal condition, effective August 30, 2017. Service connection for left knee disability as secondary to the service-connected right knee condition was granted, with the Board assigning significant probative weight to a private physical therapist's opinion and the veteran's testimony, finding the left knee condition was likely caused by compensatory limping. Service connection for tinnitus was granted, with the Board affording significant weight to the veteran's credible testimony and finding it consistent with noise exposure during service, despite a negative VA opinion that relied on inaccurate factual premises. The Board applied the benefit of the doubt doctrine to the right knee claims, finding the evidence approximately balanced.

Rationale

Painful motion with functional loss noted; DeLuca factors considered; Analogous to 10% rating for extension limited to 10 degrees

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5261

Docket No.

200618-93543

Full Decision Text

Citation Nr: A26037810
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 200618-93543
DATE: April 22, 2026

ORDER

Effective August 30, 2017, an increased rating of 10 percent for right knee limitation of extension is granted.

From August 30, 2017 to March 6, 2020, a rating in excess of 10 percent for right knee limitation of flexion is denied.

Effective March 7, 2020, an increased rating of 20 percent for right knee limitation of flexion is granted.

Effective August 30, 2017, a separate rating of 20 percent for right knee instability is granted.

Effective August 30, 2017, a separate rating of 10 percent for a right knee meniscus condition is granted.

Service connection for a left knee disability as secondary to service-connected right knee medial meniscus tear with partial meniscectomy is granted.

Service connection for tinnitus is granted.

FINDINGS OF FACT

1. Affording the Veteran the benefit of the doubt, the evidence is approximately balanced (nearly equal) in favor of finding the Veteran's right knee disability is manifested by limitation of extension from painful motion for the entire period on appeal.

2. Affording the Veteran the benefit of the doubt, the evidence is approximately balanced (nearly equal) in favor of finding the Veteran's right knee disability is manifested by limitation of flexion from painful motion from August 30, 2017 to March 6, 2020.

3. From March 7, 2020, the Veteran's right knee disability is manifested by flexion limited to 30 degrees.

4. Affording the Veteran the benefit of the doubt, the evidence is approximately balanced (nearly equal) in favor of finding the Veteran's right knee medial meniscus "bucket handle" tear (with failed repair) caused impairment (to include moderate recurrent right knee instability) requiring the issuance of an assistive device (a brace) for ambulation consistently from January 2018.

5. The probative evidence of record establishes that the Veteran's right knee is diagnosed with a meniscus (semilunar cartilage) condition that results in episodes of popping, swelling and clicking.

6. The most probative and persuasive evidence reflects that the Veteran's left knee disability was caused by his service-connected right knee medial meniscus tear with partial meniscectomy.

7. The most probative and persuasive evidence of record demonstrates that the Veteran's tinnitus began during service.

CONCLUSIONS OF LAW

1. Effective August 30, 2017, the criteria have been met for a 10 percent rating (but no higher) for right knee limitation of extension. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.14, 4.71a, Diagnostic Code (DC) 5261.

2. From August 30, 2017 to March 6, 2020, the criteria have not been met for a rating in excess of 10 percent for right knee limitation of flexion. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.14, 4.71a, Diagnostic Code (DC) 5260.

3. From March 7, 2020, the criteria have been met for an increased rating of 20 percent for right knee limitation of flexion. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.14, 4.71a, Diagnostic Code (DC) 5260.

4. Effective August 30, 2017, the criteria have been met for a separate 20 percent rating (but no higher) for right knee instability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.14, 4.71a, DC 5257 (2021).

5. Effective August 30, 2017, the criteria are met for a separate 10 percent rating for a right knee meniscus condition (symptomatic removal of semilunar cartilage). 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.14, 4.71a, DC 5259.

6. The criteria have been met
knee instability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.14, 4.71a, DC 5257 (2021).

6. The criteria have been met for service connection for a left knee disability as secondary to a service-connected right knee disability.

7. The criteria have been met for service connection for tinnitus. 38 U.S.C. §§ 1110, 1131, 5107(b); 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 April 2001 to July 2006. His military occupational specialty (MOS) was a systems organizational apprentice maintenance technician. See DD Form 214.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 legacy rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). See January 2018 Rating Decision.

The Veteran filed a timely notice of disagreement with the January 2018 rating decision, and the claims were readjudicated in a May 2020 Statement of the Case (SOC). See July 2018 Notice of Disagreement; see also May 2020 Statement of the Case.

The Veteran opted in from the legacy appeals process to the Appeals Modernization Act by submitting a timely Board Appeal (Notice of Disagreement), and electing the Hearing docket.?See June 2020 VA Form 10182; Decision Review Request: Board Appeal (Notice of Disagreement). Therefore, the Board may only consider the evidence of record at the time of the May 2020 SOC as well as any evidence submitted by the Veteran or his representative at the hearing (to include testimony at the hearing) or within 90 days following the hearing. See 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the May 2020 SOC and prior to the date of the scheduled hearing, or (2) more than 90 days following the date of the scheduled hearing, the Board did not consider it in its decision. See 38 C.F.R. §§ 20.300, 20.302, 20.801.

In May 2024, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding is of record. See May 2024 Hearing Transcript.

INCREASED DISABILITY RATINGS- RIGHT KNEE DISABILITY

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects ability to function under the ordinary conditions of daily life, including employment, by comparing the symptoms that the Veteran experiences with the criteria in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10 (2018).

VA has a duty to consider all regulations that are potentially applicable through the assertions and issues raised in the record. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7.

The Board has reviewed all evidence in the claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence as appropriate and the analysis will focus on what the evidence shows, or fails to show, as to the claims.

1. From August 30, 2017, an increased rating for right knee limitation of extension

2. From August 30, 2017 to March 6,
Board has reviewed all evidence in the claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence as appropriate and the analysis will focus on what the evidence shows, or fails to show, as to the claims.

1. From August 30, 2017, an increased rating for right knee limitation of extension

2. From August 30, 2017 to March 6, 2020, a rating in excess of 10 percent for right knee limitation of flexion

3. From March 9, 2020, an increased rating in excess of 10 percent for right knee limitation of flexion

4. From August 30, 2017, a separate rating of 20 percent for right knee instability

5. From August 30, 2017, a separate rating of 10 percent for a right knee meniscus condition

The above listed claims will be addressed together in this opinion because they are closely related and based on the same or similar facts and law.

Legal Criteria

With respect to disabilities of the knees, 38 C.F.R. § 4.71a, DC 5256 through 5263 set forth relevant provisions.

DC 5260 evaluates limitation of flexion. A noncompensable rating is assigned for flexion limited to 60 degrees. A 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 15 degrees.

DC 5261 evaluates limitation of extension. A noncompensable rating is assigned for extension limited to 5 degrees. A 10 percent rating is assigned for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited at 15 degrees. A 30 percent rating is assigned for extension limited at 20 degrees. A 40 percent rating is assigned for extension limited at 30 degrees. A 50 percent rating is assigned for extension limited at 45 degrees.

DC 5257 evaluates knee joint instability. Under the rating criteria in effect during the appeal period prior to February 7, 2021, DC 5257 provided ratings for demonstrated knee joint instability with recurrent subluxation or lateral instability with following ratings: 10 percent for slight impairment, 20 percent for moderate impairment, and 30 percent for severe impairment. 38 C.F.R. § 4.71a, DC 5257 (2020). The words "slight," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence. 38 C.F.R. § 4.6. Additionally, when considering the former version of DC 5257, objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018).

Since February 7, 2021, knee impairments under DC 5257 are rated with consideration of recurrent subluxation or instability, or patellar instability. 38 C.F.R. § 4.71a, DC 5257 (2021).

Under DC 5257, for impairment for the knee manifested as recurrent subluxation or instability, a 10 percent disability rating is warranted for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Id. A 20 percent disability rating is warranted with a knee impairment manifest as one of the following: (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or, (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Id. A 30 percent disability rating is assigned for unrepaired or failed
crutch(es), walker) or bracing for ambulation. Id. A 20 percent disability rating is warranted with a knee impairment manifest as one of the following: (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or, (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Id. A 30 percent disability rating is assigned for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Id.

DC 5259 is used to evaluate symptomatic removal of semilunar cartilage. A 10 percent rating is the highest level available.

Separate compensable ratings may be assigned for limitation of flexion and for limitation of extension, as well as for instability, without violating the rule against pyramiding. See 38 C.F.R. § 4.14.

Normal ranges of motion of the knee are extension to 0 degrees and flexion to 140 degrees. 38 C.F.R. § 4.71, Plate II.

DC 5256 evaluates ankylosis of a knee, DC 5258 evaluates dislocation of semilunar cartilage, DC 5262 evaluates impairment of the tibia and fibula, and DC 5263 evaluates genu recurvatum. The medical record does not document any of these conditions as being present. Therefore, these DCs, including any February 7, 2021, effective revisions, are not applicable and will not be discussed further.

In determining the degree of limitation of motion, the provisions of 38 U.S.C. §§ 4.10, 4.40, and 4.45 must be considered. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The basis of disability evaluation is the ability of the body as a whole or of a bodily system (such as the musculoskeletal system) to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability (due to damage or infection in parts of the system) to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity, or atrophy of disuse. 38 C.F.R. § 4.45.

Factual Background

In October 2005, the Veteran was diagnosed with a complex tear of the medial meniscus with bucket handle component, as well a possible tear of the coronary ligament. See October 2005 CAPRI records.

In October 2008, the Veteran was service connected for a right knee medial meniscus tear with partial meniscectomy with an evaluation of 0 percent under Diagnostic Code 5299-5260, effective July 22, 2008. See October 2008 VA 21-526.

In November 2012, the Veteran filed for an increased rating. In October 2013, the Veteran was granted a 10 percent evaluation for painful motion under DC 5299-5260, effective November 26, 2012. See November 2012 Supplemental Claim; See also October 2013 Rating Decision.

On August 30, 2017, VA received an Intent to File from the Veteran. See September 2017 Intent to File Letter. In October 2017, the Veteran filed a claim for an increased rating for "chronic pain" of his right knee. See October 2017 VA 21-526EZ; see also October 2017 Statement in Support of Claim.

In December 2017, the Veteran underwent a VA examination related to his right knee medial meniscus tear with partial meniscectomy
10 percent evaluation for painful motion under DC 5299-5260, effective November 26, 2012. See November 2012 Supplemental Claim; See also October 2013 Rating Decision.

In December 2017, the Veteran underwent a VA examination related to his right knee medial meniscus tear with partial meniscectomy. The Veteran reported that his right knee gives out on him with any activity, and prevents him from doing chores, playing with his children or standing and walking for long periods of time. He did not experience improvement after his surgery. He also noted mild bilateral genu valgus which compounds his knee pain. On initial range of motion testing, the examiner noted a right knee flexion limited to 65 degrees and extension limited to 5 degrees, which was caused by pain and led to functional loss. The examiner noted objective evidence of localized tenderness or pain on palpation (with a severe right knee proximal tibial head wound). After 3 repetitions, right knee flexion was limited to 65 degrees and extension limited to 5 degrees. The examiner noted that the Veteran's abnormal range of motion caused less movement than normal as well as interference with sitting and standing. The examination was not conducted during a flare-up. Muscle strength training was normal and no ankylosis was present. There was no evidence of recurrent subluxation, lateral instability or recurrent effusion. The examiner noted possible re-injury of the meniscus after surgical repair in 2005 (as stated in a September 2014 progress note) and constant pain after the procedure. However, a December 2017 X-ray of the right knee was normal. The examiner noted occasional use of a brace for the right knee condition. See December 2017 Knee and Lower Leg Conditions Disability Benefits Questionnaire; See also September 2014 CAPRI records.

In January 2018, the Veteran was examined by an orthopedist for his right knee condition. The physician ordered a medial unloader brace for right knee use. See January 2018 CAPRI records.

In January 2018, the AOJ continued the Veteran's 10 percent rating for his right knee disability under DC 5260 for limitation of flexion. The AOJ also awarded service connection for limitation of extension under DC 5261 with a 0 percent evaluation. See January 2018 Rating Decision.

In July 2018, the Veteran filed a Notice of Disagreement with the January 2018 rating decision, asserting that a higher evaluation was warranted for his right knee disability. See July 2018 Notice of Disagreement. In May 2020, the AOJ continued the Veteran's right knee evaluation. See May 2020 Statement of the Case.

In February 2020, VA contacted the Veteran for clarification of his right knee increased rating claim. The Veteran stated that his condition had worsened and was giving him daily trouble. See February 2020 Report of General Information.

In March 2020, the Veteran was afforded a VA examination related to his right knee. He reported right knee flare-ups "2-3 times a month" with "moderate to severe" pain sometimes "up to 3 or 4 days." He believed that his 2005 right knee repair surgery "did not take" and he reported pain ever since. He currently experienced "pain most of the time" with "limited mobility sometimes." He described difficulty with stairs, difficulty running, and moving on slippery surfaces. On initial range of motion examination, the examiner noted a decrease in range of motion of 30 degrees to the right knee during flexion and extension, with pain causing functional loss. There was tenderness of the right knee joint lines with positive patella apprehension. Pain, fatigue, weakness and lack of endurance limited functional ability with repeated use over time (with flexion limited to 110 degrees down to 0 degrees extension) as well as during flare-ups (with flexion limited to 105 degrees down to 0 degrees). The examiner also noted less movement than normal, weakened movement, weakness during strength testing, disturbance of locomotion and interference with prolonged sitting, standing and walking. The examiner noted no ankylosis and no evidence of recurrent subluxation, lateral instability or recurrent effusion. The examiner noted residuals from right knee meniscal repair, including constant knee pain with flare-ups. The examiner noted the use of an unloading brace for support and stability. The examiner noted functional impact
ension. Pain, fatigue, weakness and lack of endurance limited functional ability with repeated use over time (with flexion limited to 110 degrees down to 0 degrees extension) as well as during flare-ups (with flexion limited to 105 degrees down to 0 degrees). The examiner also noted less movement than normal, weakened movement, weakness during strength testing, disturbance of locomotion and interference with prolonged sitting, standing and walking. The examiner noted no ankylosis and no evidence of recurrent subluxation, lateral instability or recurrent effusion. The examiner noted residuals from right knee meniscal repair, including constant knee pain with flare-ups. The examiner noted the use of an unloading brace for support and stability. The examiner noted functional impact from increased pain during flare-ups (when climbing up and down helicopters and performing physical exercise). The examiner noted objective evidence of pain on passive range of motion and non-weight bearing testing of the right knee. See March 2020 Knee and Lower Leg Conditions Disability Benefits Questionnaire.

A March 2020 X-ray report indicated no evidence of acute dislocation or fracture of the right knee. See March 2020 Radiology Report.

In May 2024, the Veteran testified regarding his right knee disability. He stated that he could bend his knee and "get it a little past 90 degrees" but was unable to fully straighten his leg. He reported that he experienced pain throughout the entire range of motion and his knee is most painful from "walking downhill." He reported that he was on a pain management schedule and uses braces "constantly." He reported that he has a meniscal condition and experiences "popping, swelling and clicking." He also reported that he recently started experiencing instability, with his right knee buckling "for the first time the other day." See May 2024 Hearing Transcript.

Analysis

The Board finds that the appeal period for the Veteran's right knee claim is from August 30, 2017 (the date when the Veteran's filed an Intent to File a claim for an increased evaluation of his right knee disability).

Increased Rating for Right Knee- Limitation of Extension

During the December 2017 VA examination, the Veteran's extension was limited to 5 degrees during initial range of motion testing and after three repetitions. In the March 2020 examination, the Veteran's range of motion was flexion limited to 110 degrees, down to 0 degrees extension (and flexion limited to 105 degrees down to 0 degrees extension during flare-ups). Under DC 5261, a noncompensable rating is assigned for extension limited to 5 degrees (or lower). However, in both cases, the examiner noted pain with functional loss during range of motion. With repetitive use, there was pain, fatigue, weakness and lack of endurance limiting functional impact. There was objective evidence of pain during active and passive range of motion testing as well as "moderate to severe" increased pain during flare-ups causing functional impact (specifically, when climbing down from helicopters and performing physical exercise). The Veteran also testified that he was unable to fully straighten his leg and experienced pain throughout the entire range of motion, and that his leg is most painful walking downhill. See May 2024 Hearing Transcript. The Board acknowledges that VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability or incoordination is demonstrated and that those factors are not contemplated in the relevant criteria when evaluating limitation of motion for joint disabilities. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App at 202

Thus, from August 30, 2017, based on consideration of the most probative and persuasive evidence (and consideration of the DeLuca factors), the Board finds that the Veteran's right knee symptoms rise to levels analogous with a 10 percent rating (or extension limited to 10 degrees). Thus, an increased rating of 10 percent disabling for limitation of extension (based on painful motion) is warranted under under 38 C.F.R.§ 4.59.

Increased Rating for Right Knee- Limitation of Flexion

The Veteran is rated at 10 percent for limitation of flexion of the right knee under DC 5260, effective August 30, 2017. The December 2017 VA examination indicated that the Veteran's flexion was limited to 65 degrees, which is noncompensable under DC 5260. The Veteran had been previously granted a 10 percent evaluation based on painful motion, which is the highest allowable rating granted on this basis. Thus, the Board finds that from August 30, 2017 to March 6, 2020, the Veteran's limitation of flexion does not meet the requirements for a rating in excess of 10 percent.

However
Increased Rating for Right Knee- Limitation of Flexion

However, on March 7, 2020, the Veteran was afforded a VA examination which showed that flexion was limited to 30 degrees. Under DC 5260, a 20 percent rating is warranted for flexion limited to 30 degrees. Thus, the Board finds that an increased rating of 20 percent disabling for right knee limitation of flexion is warranted, from March 7, 2020.

Separate Rating-Right Knee Meniscal Condition

The Board finds that the date VA received the Veteran's Intent to File (August 30, 2017) for an increased rating for his right knee disability is the earliest ascertainable point which the separate rating may be established.

In May 2024, the Veteran testified that he had a right knee partial meniscus repair which has resulted in current symptoms such as "popping, swelling and clicking." See May 2024 Hearing Transcript. Accordingly, the Board finds that a separate 10 percent rating for the right knee is warranted under DC 5259 based on residual symptoms of his post-surgical meniscus condition.

Separate Rating- Impairment of the Knee based on Right Knee Instability

The probative evidence indicates that the Veteran has experienced right knee instability throughout the appeal period. During the December 2017 VA examination, the Veteran reported that his right knee "gives out on him with any activity," causing functional impairment. The examiner failed to address the Veteran's lay statement regarding instability, instead noting no evidence of recurrent subluxation, lateral instability or recurrent effusion. The examiner did however note the occasional use of a brace. Additionally, the Veteran's medical records include a January 2018 prescription for a right knee brace. See January 2018 CAPRI records.

During the March 2020 examination, the examiner again did not note recurrent subluxation, lateral instability or recurrent effusion, but did indicate use of an unloading brace for support and stability, as well as the presence of patella apprehension.

In May 2024, the Veteran testified that he had recently started experiencing instability with his right knee buckling "for the first time the other day." The Veteran also testified that he uses braces "constantly."

The Board has considered rating criteria under DC 5257 in effect from prior to and after February 7, 2021 (the effective date of amended criteria).

Under the criteria in effect prior to February 7, 2021, after evaluating the most probative evidence (including the VA examination reports, medical treatment records and testimony), the Board finds that the Veteran demonstrated moderate impairment due to instability with recurrent subluxation or lateral instability. The Veteran has consistently (and "constantly") required the use of a right knee brace for stability and has experienced functional impact which prevents him from doing chores, playing with his children or standing and walking for long periods of time. Under the previous criteria for DC 5257, moderate impairment warrants a 20 percent evaluation.

In evaluating the criteria from February 7, 2021, the Board finds that the Veteran has a right knee medial meniscus "bucket handle" tear (with failed repair) causing persistent instability and that the Veteran has been prescribed a brace since at least January 2018. See January 2018 CAPRI records. Thus, the Veteran also meets the criteria for a 20 percent disability rating under the amended DC 5257.

Accordingly, the Board finds that a separate evaluation of 20 percent for right knee instability is warranted from August 30, 2017.

SERVICE CONNECTION

Legal Criteria

Service connection may be granted for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection for a claimed disability, there must be evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the claimed in-service disease or injury and the current disability. Hickson v.
Accordingly, the Board finds that a separate evaluation of 20 percent for right knee instability is warranted from August 30, 2017.

SERVICE CONNECTION

Legal Criteria

Establishing secondary service connection requires evidence: (1) of a current disability (for which secondary service connection is sought); (2) of a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995).

Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the present of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153 (a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

When there is an approximate balance of positive and negative evidence regarding the merits of the issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule does not apply. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

6. Service connection for a left knee disability as secondary to service-connected right knee medial meniscus tear with partial meniscectomy

Factual Background

In October 2017, the Veteran filed a claim for service connection of a left knee condition as secondary to the service-connected disability of the right knee medial meniscus tear with partial meniscectomy. See October 2017 VA 21-526EZ. He believed that his left knee pain resulted from the stress of compensating for his service-connected right knee disability (which included the inability to put weight on his right knee). See October 2017 Statement in Support of Claim.

In November 2017, the Veteran underwent a physical medicine rehabilitation consultation. The veteran reported worsening right knee pain, which now also included left knee pain. He denied any recent fall or trauma to the left knee. The physician noted "b-knee suspect 2/2 chondromalacia and degen OA of knee. Pt may also have L-knee patellofemoral syndrome as well." The physician noted antalgic gait and that "L knee pain likely compensating for R knee." See November 2017 CAPRI records.

In December 2017, the Veteran was afforded a VA examination. The Veteran reported that he had left knee pain that worsened over time. He believed that his left knee pain was due to walking with a limp because of his right knee disability and placing undue pressure on his left knee. The examiner noted left knee pain on objective examination and diagnosed him with left knee strain. However, the examiner opined that the Veteran's left knee condition was less likely than not resulting from his right knee disability. The examiner reasoned that there was no medical evidence of overcompensation (including abnormal gait from favoring the left knee) and that muscle strength testing was normal. See December 2017 Knee and Lower Leg Conditions Disability Benefits Questionnaire.

In January 2018, the AOJ denied service connection for a left knee condition. See January 2018 Rating Decision. The Veteran filed a timely notice of disagreement with the AOJ's decision. See July 2018 Notice of Disagreement. In May 2020, the AOJ again denied service connection for a left knee disability. See May 2020 Statement of the Case.

In March 2020, the Veteran had an X-ray of his left knee, which was normal with no evidence of dislocation or fracture. See March 2020 Treatment Records.

In March 2020, the Veteran was also afforded a VA examination related to his knees. On objective examination, the examiner noted abnormal range of motion in the left knee which was an impairment contributing to functional loss. The examiner noted
condition. See January 2018 Rating Decision. The Veteran filed a timely notice of disagreement with the AOJ's decision. See July 2018 Notice of Disagreement. In May 2020, the AOJ again denied service connection for a left knee disability. See May 2020 Statement of the Case.

In March 2020, the Veteran had an X-ray of his left knee, which was normal with no evidence of dislocation or fracture. See March 2020 Treatment Records.

In March 2020, the Veteran was also afforded a VA examination related to his knees. On objective examination, the examiner noted abnormal range of motion in the left knee which was an impairment contributing to functional loss. The examiner noted a diagnosis of left knee pes anserinus tendonitis and that the left knee diagnosis was "new and separate" from the right knee diagnosis. The examiner indicated that the Veteran regularly used a brace for support and stability related to his knee diagnoses. See March 2020 Knee and Lower Leg Disability Benefits Questionnaire.

In May 2024, the Veteran testified that his left knee began hurting him about 15 or 16 years ago (after service). He reported that the pain began from limping on his left knee, due to right knee pain. The Veteran stated that he has spoken with "numerous doctors" who have said his left knee pain is related to his right knee disability, but it was not written down. See May 2024 Hearing Transcript.

In June 2024, the Veteran submitted a private medical opinion from a physical therapist. The clinician opined that the Veteran's left knee pain was at least as likely as not caused by his service-connected right knee condition. The clinician reasoned that the Veteran developed a persistent limp from right knee pain following a failed repair surgery in 2005. His right knee pain led to secondary pain in the left knee from compensatory limping. The clinician also explained how an altered gait due to the right knee injury could significantly contribute to the development of osteoarthritis in the left knee due to shifting weight and changing walking patterns. The clinician cited medical literature demonstrating a connection between strenuous physical training and osteoarthritis. See June 2024 Correspondence.

Analysis

The Veteran asserts that service connection is warranted for a left knee condition, as secondary to his service-connected right knee disability. See e.g. May 2024 Hearing Testimony.

As for the first element of service-connection (a current disability), the Veteran was diagnosed with left knee strain in December 2017. See December 2017 Knee and Lower Leg Conditions Disability Benefits Questionnaire. The Veteran was also diagnosed with left knee pes anserinus tendonitis in March 2020. See March 2020 Knee and Lower Leg Conditions Disability Benefits Questionnaire. Thus, the Board finds that the first element required for service connection has been met.

As for the second element required for secondary service connection (a service-connected disability), the Veteran is service connected for right knee medial meniscus tear with partial meniscectomy. Thus, the Board finds that the second element required for secondary service connection has been met.

The matter at issue (the third element required for secondary service connection) is whether the Veteran's current left knee disability was either caused or aggravated by the service-connected right knee disability. Based on a review of the evidence (to include VA and private examination reports, medical treatment records, lay statements, testimony and medical literature submitted by the Veteran), the Board finds that the third element has been met.

The Board assigns significant probative weight to the June 2024 private medical report. The clinician adequately explained how the Veteran's service-connected right knee disability likely caused his left knee condition because altered gait and a persistent limp could lead to the development of a left knee condition, including the development of osteoarthritis. The Board finds that the clinician's opinion was based on accurate factual premise and supported by a thorough explanation (rationale). See Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 304 (2008) ("[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two" and "most of the probative value of a medical opinion comes from its reasoning."); See Reonal v. Brown, 5?Vet. App.?458, 461 (1993) (a medical opinion based on an inaccurate factual premise has no probative value).

The Board also assigns significant probative weight to the November 2017 physical medicine and rehabilitation consultation report. The physician addresses the Veteran's lay statements regarding worsening left knee pain and provides a clear conclusion that the Veteran's left knee condition is likely caused by the right knee disability due to compensation and antalgic gait.
) ("[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two" and "most of the probative value of a medical opinion comes from its reasoning."); See Reonal v. Brown, 5?Vet. App.?458, 461 (1993) (a medical opinion based on an inaccurate factual premise has no probative value).

The Board assigns less probative value to the December 2017 negative VA causal linkage opinion because the examiner reasoned there was no medical evidence of abnormal gait from favoring the left knee. However, the examiner failed to address the Veteran's lay statements that he walked with a limp or notations of "antalgic gait" in the Veteran's treatment records. Thus, the Board finds that the Board relied on an inaccurate factual premise in rendering a negative opinion. See Reonal v. Brown, 5?Vet. App.?458, 461 (1993); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). See also December 2017 Knee and Lower Leg Conditions Disability Benefits Questionnaire; See also e.g. November 2017 CAPRI records.

The Board assigns significant probative value to the competent and credible lay statements and testimony of the Veteran regarding his left knee pain. The Veteran's consistent assertions that left knee pain developed from limping and compensating for his right knee pain are supported by medical treatment records, examination reports and testimony in the evidence of record.

The Board assigns some probative value to the article submitted and cited with the June 2024 private medical opinion. While the article addresses the likelihood of developing osteoarthritis from physical training, it does not address the theory that a left knee injury could be caused by compensation due to a right knee injury.

In summary, the Board has been presented with both positive and negative evidence regarding service connection of the Veteran's left knee condition as secondary to his service-connected right knee disability. After thorough consideration of the evidence of record, the Board finds that the weight of evidence supports awarding service connection on a secondary basis for the Veteran's left knee condition, as secondary to the right knee medial meniscus tear with partial meniscectomy. The appeal is granted.

7. Service connection for tinnitus

Legal Criteria

Tinnitus is an organic disease of the nervous system?and is listed as a "chronic disease" under?38 C.F.R. § 3.309(a). See Fountain v. McDonald,?27?Vet. App.?258?(2015). ?As such, service connection based on continuity of symptoms after discharge under?38 C.F.R. § 3.303(b) is available for tinnitus as an organic disease of the nervous system. ?Walker v. Shinseki,?708 F.3d 1331?(Fed. Cir. 2013).

Finally, tinnitus is the type of disorder associated with symptoms capable of lay observation. See Charles v. Principi,?16?Vet. App.?370?(2002).

Factual Background

In April 2001, the Veteran was afforded a reference audiogram to establish hearing prior to initial duty in hazardous noise areas. It was noted that the Veteran was "routinely noise exposed." See April 2001 Service Treatment Records.

In October 2002, the Veteran's audiogram results showed a positive threshold shift. It was noted that the Veteran was "routinely noise exposed." See October 2002 Service Treatment Records. A June 2005 audiogram report also noted "steady noise exposure," but no significant threshold shift. See June 2005 Service Treatment Records.

In March 2013, the Veteran reported to a clinician that he experienced "tinnitus and decreased hearing right ear since service" and "loud noise onboard ship much of the time." See March 2013 CAPRI records.

In April 2013, the Veteran was afforded an audiology consultation. The clinician noted noise exposure from working along a flight line. The Veteran reported that he experienced tinnitus bilaterally that "comes and goes" and is "sometimes loud enough he feels it affects his hearing." See April 2013 CAPRI records.

In October 2017, the Veteran filed a claim for service connection of tinnitus
," but no significant threshold shift. See June 2005 Service Treatment Records.

In October 2017, the Veteran filed a claim for service connection of tinnitus. See October 2017 VA 21-526EZ. The Veteran asserted that his tinnitus was due to chronic exposure to "extreme loud noise" while performing his duties in active service. See October 2017 Statement in Support of Claim.

In December 2017, the Veteran was afforded a VA examination related to his tinnitus. The Veteran reported recurrent tinnitus, with "ringing" that "started after working on the flight line." The Veteran reported that "sometimes ringing is enough to make me stop what I am doing until it stops." The examiner opined that the Veteran's tinnitus was less likely than not caused by or a result of military noise exposure. The examiner reasoned that there were no significant threshold shifts from a pre-military hearing test performed in April 2001 to an audiogram taken near discharge in June 2005. The examiner also noted that the Veteran's hearing was within normal limits, and a November 2017 audiogram showed no significant threshold shift. See December 2017 Hearing Loss and Tinnitus Disability Benefits Questionnaire.

In January 2018, the AOJ denied the Veteran's claim for service connection of tinnitus. See January 2018 Rating Decision.

In July 2018, the Veteran appealed the January 2018 rating decision with regard to tinnitus. The Veteran asserted that he "experiences ringing in the ears on a regular basis." See July 2018 Notice of Disagreement.

In May 2020, the AOJ again denied service connection for tinnitus. See May 2020 Statement of the Case.

In May 2024, the Veteran testified that his tinnitus "started probably two years after I got into service, so maybe 2003 timeframe" and is still bothering him now. He described his symptoms as "debilitating" and "loud" ringing in his ears, at least two or three times a week. He stated that the symptoms have been "uniform" since they started. See May 2024 Hearing Transcript.

Analysis

After a review of the evidence of record, to include service and post-service treatment records, examination reports and testimony by the Veteran, the Board finds that the Veteran's tinnitus was caused by noise exposure while on active duty.

The Board affords significant probative weight to the Veteran's statements regarding ringing in his ears that began in service and has persisted since. The Veteran is competent to report as to factual matters of which he or she has first-hand knowledge, to include events witnessed during service. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Board finds the Veteran's statements credible because they are consistent with the circumstances of his service, which included noise exposure while working along a flight line. See 38 U.S.C. § 1154 (2012); Caluza v. Brown, 7 Vet. App. 498, 511 (1995).

The Board affords less probative weight to the December 2017 VA examination because the examiner failed to address the Veteran's lay statements regarding recurrent tinnitus (with ringing in his ears from working on the flight line). In addition, the examiner focused on a lack of a significant threshold shift noted in service treatment records, which is an inaccurate factual premise, since a "positive STS" was noted in an October 2002 in-service audiogram report. See October 2002 Service Treatment Records; See also Reonal v. Brown, 5 Vet. App. 458, 461 (1993) Barr v. Nicholson, 21 Vet. App. 303, 311 (2007)

Thus, the Board finds that the most probative and persuasive evidence weighs in favor of tinnitus beginning in service. Accordingly, the Board finds that service connection for tinnitus is warranted.

VICTORIA MOSHIASHWILI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board De Angelis, A.

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
2 Service Treatment Records; See also Reonal v. Brown, 5 Vet. App. 458, 461 (1993) Barr v. Nicholson, 21 Vet. App. 303, 311 (2007)

Thus, the Board finds that the most probative and persuasive evidence weighs in favor of tinnitus beginning in service. Accordingly, the Board finds that service connection for tinnitus is warranted.

VICTORIA MOSHIASHWILI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board De Angelis, A.

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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