OTHER SPECIFIED ANXIETY DISORDER

Summary

The veteran, who served from December 1976 to June 1995, appeals the denial of an increased rating for his acquired psychiatric disorder and the denial of service connection for bilateral knee degenerative arthritis. The Board found the claim for an increased rating for the psychiatric disorder (insomnia disorder with specific phobia situational) to be denied. The Board reviewed the Veteran's service treatment records and multiple VA examinations, as well as a private clinician's evaluation. While the Veteran contended for a higher rating, the Board found that the evidence did not support symptoms reflective of a 70% or 100% rating, noting that the private clinician attributed more severe symptoms to a non-service-connected trauma. The Board also noted that the Veteran's symptoms, as described by VA examiners, resulted in occupational and social impairment consistent with a 30% rating, not the 50% currently assigned. The Board denied the increased rating claim. The claims for service connection for left and right knee degenerative arthritis were remanded. The Board found the VA medical opinions inadequate because they relied on inaccurate premises regarding the service treatment records and failed to address aggravation by the service-connected back condition. A new opinion is required to determine the nature and etiology of the bilateral knee disorder, including whether it is related to service, due to the service-connected back condition, or aggravated by it.

Rationale

Symptoms do not meet criteria for 70% or 100% rating.; Private clinician attributed severe symptoms to non-service-connected trauma.; VA examiners found impairment consistent with 30% rating.

Full Decision Text

Citation Nr: A26039321
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250325-531678
DATE: April 28, 2026

ORDER

A rating in excess of 50 percent for an acquired psychiatric disorder (characterized as insomnia disorder with specific phobia situational), is denied.

REMANDED

Entitlement to service connection for left knee degenerative arthritis is remanded.

Entitlement to service connection for right knee degenerative arthritis is remanded.

FINDING OF FACT

During the entire appellate period, the severity, frequency, and duration of the Veteran's acquired psychiatric disorder symptoms most nearly approximate occupational and social impairment with reduced reliability and productivity and do not more closely approximate occupational and social impairment with deficiencies in most areas.

CONCLUSION OF LAW

The criteria for a rating in excess of 50 percent for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9499-9410.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from December 1976 to June 1995.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a February 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which is also the agency of original jurisdiction (AOJ).

In the March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), the Veteran appealed the February 2025 rating decision, electing the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time the AOJ issued the February 2025 decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from, the Board's receipt of the VA Form 10182. 38 C.F.R. § 20.303.

Increased Rating

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities.?The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations.?38?U.S.C. §?1155.?Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.?38?C.F.R. §?4.1.????? 

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.?38?C.F.R. §?4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant.?38?U.S.C. § 5107(b); 38?C.F.R. §§?3.102, 4.3.

The Veteran's acquired psychiatric disorder has been rated under DC 9499-9410. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after the hyphen. 38 C.F.R. § 4.27. Here, the Veteran's acquired psychiatric disability has been rated analogously to "Other specified anxiety disorder," which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38 C.F.R. 

§ 4.130. 

In relevant part, the General Rating Formula for Mental Disorders provides that a 50 percent rating is assigned if there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability
; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.

The rating of psychiatric disabilities is symptom-driven, meaning that symptomatology should be the fact-finder's primary focus when deciding entitlement to a rating under the rating criteria. 38C.F.R. § 4.130; Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The symptoms listed are not exhaustive but rather serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 346 (2002). 

In the context of determining whether a higher rating is warranted, the analysis requires considering not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas. The rating criteria requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas. 38 C.F.R. § 4.130.

Further, when rating a mental disorder, the Board must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission and must also assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a).??

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b).? 

Here, the Veteran seeks a rating higher than 50 percent for his service connected acquired psychiatric disorder. See Veteran's March 2025 NOD. Specifically, he contends that a 100 percent rating is warranted. Id. 

The Veteran further contends that his fear of flying was combined with his sleep disorder, but that they are separate and thus should be evaluated separately. In this regard, the Board notes that a veteran may not be entitled to be doubly compensated for the same disability. The evaluation of the same disability under various diagnoses is to be avoided, as is the evaluation of the same manifestation under different diagnoses. 38 C.F.R. § 4.14; Amberman v. Shinseki, 570 F.3d 1377 (Fed. Cir. 2009). Here, symptoms attributable to insomnia disorder are explicitly noted in the General Rating Formula for Mental Disorders. To warrant a separate disability rating for insomnia and situational phobia (fear of flying), evidence must show the diagnosis encompassing separate symptomatology. That is not the case here, and to assign separate ratings would violate the rule against pyramiding, evaluating the same disability under various diagnoses. 38 C.F.R. 

§§ 4.14. To the extent the Veteran contends he has another sleep disorder other than insomnia, the Board notes that was part of an October 2025 Board remand and is not part of the instant appeal.  

By way of history, a May 2024 appeal for an initial rating in excess of 50 percent for an acquired psychiatric disorder was denied by the Board in October 2025. However, while the May 2024 Board appeal was still pending, the Veteran filed a  June 2024 claim for a higher rating. Therefore, the rating
 the case here, and to assign separate ratings would violate the rule against pyramiding, evaluating the same disability under various diagnoses. 38 C.F.R. 

§§ 4.14. To the extent the Veteran contends he has another sleep disorder other than insomnia, the Board notes that was part of an October 2025 Board remand and is not part of the instant appeal.  

By way of history, a May 2024 appeal for an initial rating in excess of 50 percent for an acquired psychiatric disorder was denied by the Board in October 2025. However, while the May 2024 Board appeal was still pending, the Veteran filed a  June 2024 claim for a higher rating. Therefore, the rating period on review begins on June 14, 2024, the date of application for an increase in evaluation, with a one-year look back period. 38 C.F.R. § 3.400(o)(2).

Turning to the evidence, the Veteran had a VA examination in December 2023, where he was diagnosed with insomnia disorder associated with lumbar laminectomy, right radiculopathy. The examiner noted the Veteran lived with his wife, experienced restless sleep with waking due to physical discomfort and pain, and stated he never felt rested. He reported no anxiety of note, although he had worries about everyone's safety. He reported pleasurable activities including church, music, singing, jazz, and viewing sports, although he reported phases of not having as much interest, not wanting to leave his house, more sporadic grooming, and not wanting to socialize. The examiner noted the Veteran was engaged and cooperative, he spoke in a typical fashion in logical and goal-oriented responses, his mood was euthymic, and his affect was somewhat blunted but congruent with what he was discussing. He denied suicidal ideation, homicidal ideation, delusions, or hallucinations.

The December 2023 examiner opined that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation due to symptoms of depressed mood, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, disturbances of motivation and mood and neglect of personal appearance and hygiene. He noted symptoms of depressed mood, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and neglect of personal appearance and hygiene. 

The Veteran also submitted a June 2024 Disability Benefits Questionnaire (DBQ) and evaluation from a private clinician. The clinician noted diagnoses of specific phobia, situational (airplanes) and other specified trauma and stressor related disorder, noting that the disorders are separate and that it is possible to differentiate symptoms of the two disorders. In this regard, the clinician noted that the specific phobia resulted in "extreme anxiety when flying in airplane, avoidance," and that the trauma disorder resulted in "hypervigilance, irritability." In the accompanying evaluation, the clinician noted the trauma disorder is "most likely caused by or a result of the murder of his son after his military retirement." Therefore, the other specified trauma and stressor related disorder is distinguishable and separate from the service-connected insomnia disorder with specific phobia situational, per the private clinician who provided the diagnosis of the trauma and stressor related disorder. See Mittleider v. West, 11 Vet. App. 181, 182 (1998).

The June 2024 clinician opined that the Veteran had occupational and social impairment with reduced reliability and productivity due to symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete task, flattened affect, disturbance of motivation and mood, difficulty adapting to stressful circumstances, including work or a work like setting, and obsessional rituals which interfere with routine activities, but also noted that the "phobia causes occasional decrease."

The clinician noted the Veteran was on time, cooperative, and had a flat affect. In the written evaluation, the clinician noted the Veteran reported avoiding flying but feeling extremely anxious when it could not be avoided. He stated that "once the plane lands successfully, he begins to relax." His wife reported sleep problems, with waking and irritability, moodiness, and low tolerance for minor stressors. The Veteran reported other symptoms, but he related them to the traumatic event of his son's murder rather than his insomnia disorder with specific phobia situational. He denied suicidal and homicidal ideations and hallucinations.

Upon November 2024 VA examination, the examiner continued the prior VA examiner's diagnoses of specific phobia, situational (
."

The clinician noted the Veteran was on time, cooperative, and had a flat affect. In the written evaluation, the clinician noted the Veteran reported avoiding flying but feeling extremely anxious when it could not be avoided. He stated that "once the plane lands successfully, he begins to relax." His wife reported sleep problems, with waking and irritability, moodiness, and low tolerance for minor stressors. The Veteran reported other symptoms, but he related them to the traumatic event of his son's murder rather than his insomnia disorder with specific phobia situational. He denied suicidal and homicidal ideations and hallucinations.

Upon November 2024 VA examination, the examiner continued the prior VA examiner's diagnoses of specific phobia, situational (fear of flying) disorder and insomnia disorder associated with lumbar laminectomy, radiculopathy. The examiner noted the Veteran reported being married for 33 years and described his relationship as "very good." He also reported having a good relationship with other family members but stated he does not have many friends. He reported missing out on enjoyed activities such as visiting family or traveling to places that require flying due to his fear, and that he does not join his wife when she flies approximately twice per year to visit family. The Veteran also reported that since his last VA examination, he had retired after 20 years at his job and stated that he had interacted well with his coworkers and supervisors. He reported significant sleep disturbance, taking up to 90 minutes to fall asleep, waking up every 90-120 minutes, and averaging approximately 5 hours of total sleep per night. He stated if he sits down for a few minutes at any time during the day, he will "doze off for a few minutes."

The examiner noted the Veteran maintained adequate personal hygiene, his speech had normal rate and tone, there were no hallucinations or delusions, his mood was within normal limits, and his affect was congruent with his mood. His thought content was devoid of suicidal or homicidal ideations; his thought processes were logical, coherent, and goal oriented; and his cognitive functions were normal. He was fully oriented and his insight and judgment were intact. The examiner opined that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation due to symptoms of depressed mood, anxiety, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, and disturbances of motivation and mood. The examiner specifically noted symptoms of chronic sleep impairment, mild memory loss, and disturbances of motivation and mood.

Here, the Board finds that the overall record does not show that the Veteran's insomnia disorder with specific phobia situational is manifested by symptoms reflective of a higher 70 percent or 100 percent rating at any time during the appellate period. In this regard, the Veteran's symptoms during the appellate period as to these service-connected diagnoses include chronic sleep impairment, perhaps associated with mild memory loss and depressed mood; some decrease in socialization and phases of having less interest in pleasurable activities; and avoidance of flying. 

The Board notes that the December 2023 and November 2024 VA examiners both found the Veteran's symptomatology resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of ability to perform occupational tasks, which is associated with a 30 percent rating rather than the currently assigned 50-percent rating. While the private clinician noted occupational and social impairment with reduced reliability and productivity, which is associated with a 50 percent rating, the clinician noted that the phobia disorder alone causes occasional decrease (or impairment). 

The evidence of record does not indicate that the Veteran has had suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; inability to establish and maintain effective relationships; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting himself or others; an intermittent inability to perform activities of daily living; disorientation to time or place; memory loss for names of close relatives, occupation, or own name; or other unlisted symptoms of a similar nature and severity that would warrant a higher rating during the pendency of the appeal. 

In assessing the severity of the Veteran's insomnia disorder with specific phobia situational, the Board has considered the Veteran's assertions regarding his symptoms, which he is certainly competent to provide. See Layno v. Brown, 6 Vet. App. 465 (1992); 38 C.F.R. § 3.159 (a)(2). However, the criteria needed to support a higher rating requires medical findings regarding the functional impact of these symptoms that are within the province
 perform activities of daily living; disorientation to time or place; memory loss for names of close relatives, occupation, or own name; or other unlisted symptoms of a similar nature and severity that would warrant a higher rating during the pendency of the appeal. 

In assessing the severity of the Veteran's insomnia disorder with specific phobia situational, the Board has considered the Veteran's assertions regarding his symptoms, which he is certainly competent to provide. See Layno v. Brown, 6 Vet. App. 465 (1992); 38 C.F.R. § 3.159 (a)(2). However, the criteria needed to support a higher rating requires medical findings regarding the functional impact of these symptoms that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994).

In this regard, the evidence indicates that the Veteran has been married for many years and reported on November 2024 VA examination that his relationship with his wife was "very good." While the Veteran reported missing out on enjoyable activities such as visiting family or traveling to places that require flying due to his fear of a plane crash, he also reported good relationships with family and former coworkers and supervisors, although he reported he did not have many friends. In addition, the record reflects that the Veteran retired during the pendency of the appeal, but he reported activities including church, music, and watching sports. Moreover, as noted, the two VA examiners found the Veteran's psychiatric symptomatology produced no more than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, with normal routine behavior, self-care, and conversation, which is consistent with the assignment of a lower 30 percent rating, and the private clinician opined the phobia disorder alone causes occasional decrease.

While the Board is cognizant that the private clinician discussed some more severe symptomatology in the evaluation provided, the clinician also stated such symptoms were attributable to the Veteran's non-service-connected trauma disorder due to the post-service murder of the Veteran's son. As well, the private clinician opined that it was possible to differentiate the symptoms of the Veteran's phobia disorder from his trauma disorder, and that the phobia disorder resulted in only occasional decrease. See Mittleider, 11 Vet. App. At 182. The clinician specifically attributed the more severe symptomatology to the unrelated, post-service trauma disorder rather than the service-connected insomnia disorder with specific phobia situational.

The Board has fully considered the Veteran's statements, to include that he believes a 100 percent rating is warranted for his disability; however, the aforementioned medical evidence provides detailed information regarding his retained occupational and social functioning. The Board finds that the Veteran does not possess the needed expertise to detail his level of impairment. As such, the Veteran's lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support the assignment of a higher rating at any point during the appeal period.

Considering the severity, duration, and frequency of all manifestations, whether listed in the schedule or not, the Board finds that the disability does not warrant a rating higher than that assigned.

The Board has considered whether staged ratings under Fenderson v. West, 12 Vet. App. 119 (1999), are appropriate; however, the Board finds that the Veteran's symptomatology has been stable throughout the appeal. Thus, the assignment of staged ratings is not warranted. Furthermore, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the initial rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

Lastly, the Board has considered whether a claim for a total disability rating based on individual unemployability due to service-connected disability (TDIU) has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran reported during his November 2024 VA examination that he had retired since his prior VA examination. The Board finds the Veteran has not alleged, and the record does not suggest, that he is unable to obtain and maintain employment due to his service-connected insomnia disorder with specific phobia situational. As such, a claim for a TDIU is not raised.

Given the above, the most persuasive evidence of record weighs against finding that a rating in excess of 50 percent is warranted. Thus, the claim is denied. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, there is not an approximate balance of positive and negative evidence regarding the merits of the issue; thus, the
). The Veteran reported during his November 2024 VA examination that he had retired since his prior VA examination. The Board finds the Veteran has not alleged, and the record does not suggest, that he is unable to obtain and maintain employment due to his service-connected insomnia disorder with specific phobia situational. As such, a claim for a TDIU is not raised.

Given the above, the most persuasive evidence of record weighs against finding that a rating in excess of 50 percent is warranted. Thus, the claim is denied. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, there is not an approximate balance of positive and negative evidence regarding the merits of the issue; thus, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 

REASONS FOR REMAND

2. Entitlement to service connection for left knee degenerative arthritis.

3. Entitlement to service connection for right knee degenerative arthritis.

Issues 2-3:

The Veteran seeks service connection for his bilateral knee disorder. See Veteran's March 2025 NOD. For the reasons discussed below, the Board finds that a remand is necessary to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a).

The Veteran underwent VA bilateral knees examination in October 2024, and the examiner provided an addendum opinion in December 2024. However, the Board finds the October 2024 VA opinion inadequate as it is based on an inaccurate factual premise that the Veteran's service treatment records are silent for knee pain. In particular, the Veteran's October 1979 service treatment records show a complaint for a knee injury, knee pain and swelling and a diagnoses and treatment for traumatic effusion and moderate medial lateral laxity of both knees. "An opinion based upon an inaccurate factual premise has no probative value." See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). 

In the December 2024 addendum opinion, the examiner continued and reaffirmed a negative nexus opinion for direct service connection. The examiner acknowledged that the Veteran's service treatment record dated in October 1979 show that he was treated for bilateral knee "traumatic effusion with moderate medial lateral laxity," nevertheless, the opinion impermissibly relied on the rationale that the rest of his service treatment records were silent for ongoing complaint or treatment for knee conditions and the absence of evidence of any pertinent treatment on an ongoing basis from active duty to present. See Fountain v. McDonald, 27 Vet. App. 258 (2015). 

Additionally, although the examiner provided a negative nexus for direct service connection, the examiner also opined that his bilateral knee disorder was likely a result of multiple factors, to include his service connected musculoskeletal conditions such as his status post lumbar laminectomy, but that there were no clear evidence from the review of his treatment record to suggest that his service-connected status post lumbar laminectomy, as a singular factor, was the direct cause. However, the examiner has applied the incorrect standard in this instance as it does not have to be the sole cause for there to be service connection. 

Furthermore, the Board finds the October 2024 and December 2024 VA opinions also inadequate for determining the nature and etiology of the Veteran's bilateral knee disorder as the examiner failed to address aggravation by a service-connected disability or disabilities. A medical opinion addressing secondary service connection must address causation and aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). 

Thus, the Board finds that a remand is necessary to obtain an adequate medical opinion to determine the nature and etiology of the Veteran's bilateral knee disorder. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran's bilateral knee disorder. The examiner should review the entire claims file, to include a copy of this remand. Then, the examiner should opine as to the following:

(a)	Is it at least as likely as not that the Veteran's bilateral knee disorder had its onset in, was incurred in, or is related to an event or injury in service, to include his October 1979 injury and diagnosed bilateral knee traumatic effusion and moderate medial lateral laxity conditions?

(b)	Is a bilateral knee disorder at least as likely as not due to the service-connected disability back disability (status post lumbar laminectomy)?

(c)	Is a bilateral knee
endum opinion from an appropriate clinician to determine the nature and etiology of the Veteran's bilateral knee disorder. The examiner should review the entire claims file, to include a copy of this remand. Then, the examiner should opine as to the following:

(a)	Is it at least as likely as not that the Veteran's bilateral knee disorder had its onset in, was incurred in, or is related to an event or injury in service, to include his October 1979 injury and diagnosed bilateral knee traumatic effusion and moderate medial lateral laxity conditions?

(b)	Is a bilateral knee disorder at least as likely as not due to the service-connected disability back disability (status post lumbar laminectomy)?

(c)	Is a bilateral knee disorder at least as likely as not aggravated, i.e., made worse, by the service-connected back disability (status post lumbar laminectomy)?

A complete rationale should be given for all opinions rendered. 

 

 

A. Dean

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Wright, Kadia

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.