KNEE IMPAIRMENT OF

MICHELLE L. KANE · 2026 · Case ID: A26040090

GRANTED

Summary

The veteran, who served in the U.S. Air Force from April 1983 to June 2003, appeals the denial of service connection for bilateral knee conditions. The veteran's service treatment records were silent regarding knee complaints during service, but post-service medical records from 2005 onwards documented bilateral knee pain, chondromalacia patella, and osteoarthritis. The veteran consistently reported strenuous duties during service, including prolonged squatting, jumping from trucks, carrying heavy gear, and extensive running, which he believed caused his knee problems. Lay statements from his wife and fellow servicemembers corroborated his complaints of knee pain during and after service. The Board found the veteran's lay testimony and statements credible, noting consistency with his reported strenuous military duties. While a February 2018 VA examiner provided a negative nexus opinion, finding the work not arduous and attributing the condition to wear and tear and obesity, the Board found this opinion unpersuasive. The Board also found a subsequent April 2021 VA examiner's opinion inadequate for failing to address the lay evidence and relying solely on the absence of in-service injury documentation. Conversely, a February 2018 private orthopedic specialist's opinion, which considered the Veteran's reported history and strenuous military duties, was found persuasive, linking the arthritis to service. Resolving all reasonable doubt in the veteran's favor, the Board granted service connection for bilateral knee conditions.

Rationale

Credible lay evidence of chronic knee pain during and since service; Persuasive private medical opinion linking condition to strenuous military duties; Benefit of the doubt afforded to the veteran

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210524-161391

Full Decision Text

Citation Nr: A26040090
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210524-161391
DATE: April 29, 2026

ORDER

Service connection for a right knee condition is granted.

Service connection for a left knee condition is granted.

FINDING OF FACT

Affording the Veteran the benefit of the doubt, the probative evidence shows that the Veteran has bilateral knee conditions that were incurred in service or due to service.

CONCLUSIONS OF LAW

1. The criteria for service connection for a right knee condition have been met. 38 U.S.C. § 38 U.S.C. 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304; Diagnostic Code 5260.

2. The criteria for service connection for a left knee condition have been met. 38 U.S.C. § 38 U.S.C. 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304; Diagnostic Code 5260.

REASONS AND BASES FOR FINDING AND CONCLUSIONS

The Veteran served on active duty in the U.S. Air Force from April 1983 to June 2003 when he retired.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

In this appeal the Veteran seeks service connection for bilateral knee conditions. The procedural history shows that the AOJ denied service connection for bilateral knee arthritis in a February 2011 rating decision. The Veteran filed a March 2011 Notice of Disagreement initiating a VA legacy appeal. As part of the appeal process, a Statement of the Case was issued in December 2012 and the Veteran filed a January 2013 Form 9 Appeal to the Board of Veterans' Appeals. The AOJ issued an April 2013 Supplemental Statement of the Case (SSOC). In August 2013 the Board remanded the case for a videoconference hearing before the Board which took place in September 2013. The case was remanded by the Board in February 2015 and October 2016 for further development. The AOJ issued a December 2016 SSOC. In November 2017 the Board again remanded the case for additional development. The Veteran elected to participate in VA's new modernized review process, the Rapid Appeals Modernization Program (RAMP), in June 2018 and requested a higher-level review. In an October 2018 rating decision, the AOJ again denied service connection for the knees. In January 2019 the Veteran filed a RAMP Selection form; however, in March 2020 VA informed the Veteran that his application to participate in the RAMP program could not be processed as the program had concluded. The Veteran filed a VA Form 20-0995 Supplemental Claim Application in April 2021.

In the May 2021 decision, on appeal here, the AOJ found that new and relevant evidence had been received, readjudicated the claims, and confirmed and continued the denials for service connection for the knees. The AOJ's finding of new and relevant evidence is a favorable finding, binding on the Board as it is not clearly erroneous. 38 C.F.R. § 3.104(c).

The Veteran filed a May 2021 VA Form 10182 Notice of Disagreement and elected the Hearing docket. A Board hearing was held before the undersigned Veterans Law Judge in November 2024. The transcript of the hearing is of record.

The Board may only consider the evidence of record at the time of the May 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. The record shows that the Veteran submitted additional evidence during the 90-day evidentiary window following the Board hearing.

Service Connection

Service connection may be granted for a current disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.
J issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. The record shows that the Veteran submitted additional evidence during the 90-day evidentiary window following the Board hearing.

Service Connection

Service connection may be granted for a current disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, 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 (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The Veteran contends that he has bilateral knee conditions that were incurred in service or due to service.

The AOJ noted as a favorable finding that the Veteran has been diagnosed with bilateral knee strain and degenerative arthritis and left knee chondromalacia patella. The AOJ noted that knee arthritis is a chronic disease which may be presumptively linked to military service. These favorable findings are binding on the Board as they are not clearly erroneous. 38 C.F.R. § 3.104(c).

Service treatment records (STRs) are silent for any complaints, treatment or diagnosis for knee conditions. STRs show that in a November 2002 Physical Profile Serial Report, for purposes of an annual health assessment, the Veteran was evaluated and noted to have fully met medical standards with no limitations under the PULHES profile system. STRs show that the Veteran had a retirement physical in December 2002 where no medical history of knee conditions was noted; however, examination of the knees was not documented.

Medical records show that the Veteran was seen at a medical facility in May 2005 for a complaint of left knee pain. It was noted that he had a symptomatic Bakers cyst. X-ray results for the left knee were normal. A June 2005 left knee MRI showed chondromalacia patella.

In a September 2010 Statement in Support of Claim the Veteran stated that at the time of his retirement physical his knees were not checked and knee problems went undiagnosed.

The Veteran was seen by a medical provider in September 2010 for a complaint of bilateral knee pain and was diagnosed with knee osteoarthritis. Bilateral knee x-rays showed trans-compartmental degenerative osteoarthritis.

A January 2012 medical record notes a history of bilateral knee pain for over 1 year, after turning rapidly while umpiring. In June 2012 he reported that his knee pain started in 2004. The diagnosis was knee osteoarthritis. In May 2013 he reported having chronic bilateral knee pain for several years. Subsequent medical records show that the Veteran had treatment for the knees due to bilateral knee osteoarthritis.

A September 2013 buddy statement was submitted from Mr. J.C.B. who stated that he has known the Veteran since 2005 and that since then he has observed the Veteran with knee problems.

A September 2013 buddy statement was submitted from Mr. J.K.B. who stated that he has known the Veteran since 1998. He stated that the Veteran complained of knee pain in 2005 and that he observed him having problems with his knees. He was aware that the Veteran's duties during service
was knee osteoarthritis. In May 2013 he reported having chronic bilateral knee pain for several years. Subsequent medical records show that the Veteran had treatment for the knees due to bilateral knee osteoarthritis.

A September 2013 buddy statement was submitted from Mr. J.C.B. who stated that he has known the Veteran since 2005 and that since then he has observed the Veteran with knee problems.

A September 2013 buddy statement was submitted from the Veteran's spouse who stated that while in service she observed that her husband appeared stiff and sore after physical training and that he took Motrin. She stated that the Veteran was seen by a doctor in 2005 when it was learned that he had arthritis.

A September 2013 Board hearing took place where the Veteran testified that during service his duties included working as a satellite communications technician which required working in small communication vans where squatting was necessary. His training also included running five days a week on concrete roads. He stated that he was required to constantly jump from high trucks, which he did for over 15 years. He also stated that he had to carry heavy gear. He stated that he took Motrin constantly due to aches and pain including knee soreness. He testified that in 2005 he was umpiring a softball game when he stepped the wrong way and had knee pain, and that he was diagnosed with arthritis.

The Veteran was afforded a VA examination for knee conditions in December 2015. The examiner noted a 2010 diagnosis of left knee osteoarthritis. The Veteran reported no knee injury in service but reported activities in service such as running on concrete three days a week for a distance of three miles, carrying heavy loads, and marching. He reported that his knee pain started after retirement in March 2005 with left knee complaints and then had right knee complaints in 2008. The examiner addressed the issue of service connection, but the Board in a prior decision found that the examiner's medical opinion was inadequate and therefore it is not probative.

The Veteran was afforded a VA examination for knee conditions in November 2016 where the examiner provided a nexus opinion regarding service connection. However, the Board previously found that the medical opinion was inadequate for purposes of adjudication and therefore is not probative.

A February 2018 nexus letter from a private practitioner, Dr. A.W., was submitted. The provider, an orthopedic surgeon, stated that the Veteran was seen for evaluation for chronic knee pain with underlying osteoarthritic changes. The Veteran reported that his knee pain began while serving in the military from 1983 to 2003 for which he needed to take over-the-counter anti-inflammatories. The Veteran reported that his knee pain was exacerbated by the work that he performed in service, including sitting for prolonged periods on low stools, kneeling, squatting and lifting heavy loads. It was noted that he was first diagnosed with arthritic changes by radiographic findings in 2004 after he retired from the military, and that since then he has had consistent treatment for his knees. The physician opined that with the Veteran's long service in the military and his diagnosis of arthritic changes very shortly after retirement, the arthritis started during active military duty and is more likely than not service connected and a result of the type of work that he performed while in the service.

The Veteran was afforded a VA examination for knee conditions in February 2018. The examiner noted diagnoses for bilateral knee joint osteoarthritis, chondromalacia patella, and pseudogout. The examiner provided a negative nexus opinion stating that it was less likely than not that the Veteran's bilateral knee osteoarthritis had its onset in or was otherwise related to service. The examiner relied upon medical studies which show that noncompetitive running does not cause arthritis of the knees. She concluded that while the Veteran described knee straining activities during service, heavy, arduous or manual work did not appear to have been done by his MOS. She noted that the occupational risk of knee osteoarthritis is well-established in specific occupations such as floor layers, miners, dockers, and elite athletes. She noted that service treatment records did not indicate knee pain. She concluded that repetitive knee strain associated with the Veteran's MOS and his duties were less likely than not associated with the onset of knee arthritis. She also indicated that the Veteran's obesity was a factor as she noted that by 2004 he had gained 25 lbs. since service.

The Veteran had another VA examination for knee conditions in
cause arthritis of the knees. She concluded that while the Veteran described knee straining activities during service, heavy, arduous or manual work did not appear to have been done by his MOS. She noted that the occupational risk of knee osteoarthritis is well-established in specific occupations such as floor layers, miners, dockers, and elite athletes. She noted that service treatment records did not indicate knee pain. She concluded that repetitive knee strain associated with the Veteran's MOS and his duties were less likely than not associated with the onset of knee arthritis. She also indicated that the Veteran's obesity was a factor as she noted that by 2004 he had gained 25 lbs. since service.

The Veteran had another VA examination for knee conditions in April 2021. The examiner noted diagnosis of bilateral knee strain, degenerative arthritis, and left chondromalacia patella. The Veteran reported that during service his duties included working in tactical satellite equipment vans where he could not stand up. He reported that he had to jump from trucks which were elevated, that he engaged in running, heavy lifting, wearing heavy backpacks, and rappelling and landing on his feet. He also reported doing extensive walking and playing softball. He reported that he had progressive knee pain since service. The examiner opined that the Veteran's bilateral knee osteoarthritis which was diagnosed in 2010 was less likely than not incurred in or caused by an in service injury, event or illness. The examiner noted that there was not an associated injury while in service and therefore it was less likely than not that the Veteran's bilateral knee condition occurred while in service.

At the November 2024 Board hearing the Veteran testified that he was a tactical satellite communications technician which required that he work long shifts in communication vans where he could not stand up and had to squat for long periods of time. He stated that he carried heavy equipment under field conditions for at least 16 years of his 20-year career and had to take Motrin constantly for knee pain. He stated that he had to wear heavy load-bearing equipment, that he had to jump from elevated trucks, and was engaged in running and marching during service. He stated that after service he was diagnosed with arthritis and was told by his physician that arthritis develops due to wear and tear over the years. The Veteran stated that he retired in 2003 and that he had knee problems in 2004 and it wasn't until 2005 that he was seen by an orthopedic specialist. The Veteran's wife testified that she has known the Veteran for 40 years and that he has had knee complaints over the entire time.

A lay person is competent to report observable symptomatology of an injury or illness, but he or she is not competent to render expert opinions or diagnoses of complex medical conditions. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). Nevertheless, the Board can find the lay statements competent and sufficient to establish a condition that existed prior to a formal diagnosis if the lay statements describe the symptoms that are supported by a medical professional who later diagnoses a disability. See Davidson v. Shinseki, 581 F.3d at 1316 (Fed. Cir. 2007); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

Affording the Veteran the benefit of the doubt, the Board finds that service connection for bilateral knee conditions is warranted.

The Veteran has been consistent in the reported history of his knee conditions at Board hearings and at VA examinations. The lay evidence provided by the Veteran, including his Board testimony, statements and the lay statements of others, including his wife and co-workers, is credible evidence that the Veteran had chronic bilateral knee pain during and since service. The Veteran has given credible testimony that his duties during service involved strenuous work involving prolonged periods of field work where he was required to work in cramped communication vans, had to exit elevated military trucks by jumping, and while wearing heavy gear, and had to carry heavy equipment and do extensive running in training during much of his 20-year military career. Arguably, this caused wear and tear on his knees as he has testified.

The February 2018 VA examiner concluded that the Veteran's activities during service did not involve heavy, arduous or manual work and provided a negative nexus opinion. However, the Board disagrees with the examiner's conclusion as the record shows that the Veteran's duties involved heavy strenuous work as he has described. The Board finds that the report of this examiner is not persuasive.

The Board also finds that the April 2021 VA examiner's medical opinion is inadequate. Although the examiner noted the Veteran's reported history in her report, she did not address the lay evidence in her opinion. The examiner based her negative nexus opinion on the lack of a reported injury during service. See Fountain v. McDonald, 27 Vet. App. 258, 272 (2015) (stating that the Board must first establish a proper foundation for drawing inferences against a claimant from an absence of documentation); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (stating that "[w]hen assessing a claim, the Board may not consider the absence of evidence as substantive negative evidence."). See Buchanan v. Nicholson, 451 F.3d 1331, 1336, n. 1 (Fed. Cir. 2006) (stating that an examiner's opinion failed to consider whether lay statements presented sufficient evidence of the etiology of the Veteran's disability such that his claim could be proven without contemporaneous medical evidence).

The February 2018 medical opinion from the Veteran's private treating orthopedic specialist is persuasive. This provider considered the Veteran's reported history and the nature of his military duties which involved extensive sitting for prolonged periods on low stools, kneeling, squatting and lifting heavy loads, and is probative evidence that the Veteran's bilateral knee condition began during service due to his military duties.

Based on the above and resolving all reasonable doubt in favor of the Veteran, the claims for service connection for bilateral conditions are granted.

MICHELLE L. KANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Lawrence Hubert

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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