HIP IMPAIRMENT OF

Summary

The veteran, who served from November 1982 to February 2008, appeals the denial of service connection for a right hip condition (femoral acetabular impingement syndrome, flexion) and bilateral inguinal hernia, as well as the denial of service connection for a left knee disability. The veteran also sought an earlier effective date for an increased 30 percent rating for claw feet, bilateral heel spurs, and gout left great toe. The Board granted an earlier effective date of August 14, 2020, for the increased rating, aligning with the veteran's intent to file. For the right hip condition, the Board denied a compensable rating, finding the veteran's flexion limitation did not meet the criteria for an increased rating, and a separate 10 percent rating for painful extension under a different diagnostic code already compensated for painful motion. For bilateral inguinal hernia, the Board denied a compensable rating, citing that examinations did not detect a recurrent hernia and the veteran's reported symptoms were not objectively supported, thus the evidence weighed against the claim. For the left knee disability, the Board denied service connection, acknowledging in-service complaints and degenerative changes but finding no current disability or functional impairment, with VA examinations noting normal findings and a negative nexus opinion from the examiner. The Board found the evidence persuasively weighed against a current left knee disability, thus denying service connection.

Rationale

Flexion limitation did not meet criteria for compensable rating; Already received 10% rating for painful extension under different DC; Avoidance of pyramiding

Full Decision Text

Citation Nr: A26040160
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 211103-195365
DATE: April 29, 2026

ORDER

1. Entitlement to a compensable disability rating for right hip femoral acetabular impingement syndrome (flexion) is denied.

2. Entitlement to a compensable disability rating for bilateral inguinal hernia is denied.

3. Entitlement to an effective date of August 14, 2020, but no earlier, for the award an increased 30 percent disability rating for claw feet and bilateral heel spurs with gout left great toe is granted, subject to the laws and regulations governing the award of monetary benefits.

4. Entitlement to service connection for a left knee disability is denied.

FINDINGS OF FACT

1. The Veteran's right hip disability manifested in painful motion, however, did not manifest in flexion limited to 45 degrees or less at any point in the appeal period and the Veteran has been in receipt of the maximum 10 percent rating for right hip painful motion under another diagnostic code for the entire period on appeal and cannot be compensated for painful motion twice when both motions are not at a compensable level.

2. The Veteran's bilateral inguinal hernia has not been manifested by a postoperative recurrent inguinal hernia that was readily reducible and well supported by a truss or belt at any point in the appeal period.

3. On August 14, 2020, VA received the Veteran's VA Form 21-0966, Intent to File a Claim for Compensation and VA received the Veteran's completed VA 21-526EZ, Fully Developed Claim (Compensation) that included a claim for increase for service-connected claw feet and bilateral heel spurs with gout left great toe, within a year of receipt 

4. The evidence persuasively weighs against a finding that the Veteran has a current left knee disability during the appeal period or proximate thereto, to include symptoms that caused functional impairment that affects earning capacity.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a compensable disability rating right hip femoral acetabular impingement syndrome (flexion) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5252.

2. The criteria for entitlement to a compensable rating for bilateral inguinal hernia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.114, DC 7338.

3. The criteria for entitlement to an effective date of August 14, 2020, but no earlier, for the award an increased 30 percent disability rating for claw feet and bilateral heel spurs with gout left great toe, have been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.155, 3.400.

4. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1982 to February 2008.

These matters come to the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision (RD) issued by the Department of Veterans Affairs (VA) Regional Office (RO), which in pertinent part, continued 0 percent ratings for service-connected right hip femoral acetabular impingement syndrome (flexion) and bilateral inguinal hernia, to include umbilical hernia; found a clear and unmistakable error in the reduction of service-connected claw feet to include gout left great toe and bilateral heel spurs and resumed a 0 percent rating from March 1, 2008, and increased the evaluation to 30 percent from April 29, 2021; and denied the claim for service connection for a left knee disability. In denying the service-connection claim for the left knee, the AOJ found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of the decision. As the AOJ has already determined that new and
abular impingement syndrome (flexion) and bilateral inguinal hernia, to include umbilical hernia; found a clear and unmistakable error in the reduction of service-connected claw feet to include gout left great toe and bilateral heel spurs and resumed a 0 percent rating from March 1, 2008, and increased the evaluation to 30 percent from April 29, 2021; and denied the claim for service connection for a left knee disability. In denying the service-connection claim for the left knee, the AOJ found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of the decision. As the AOJ has already determined that new and relevant evidence has been submitted as to the claim, the Board need not address new and relevant evidence herein.

In November 2021, the Veteran timely sought review by the Board by submitting a completed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD) and requesting a hearing with a Veterans Law Judge.

In May 2025, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a virtual Board hearing.

In an Appeals Modernization Act (AMA) appeal with a Board hearing, the Board considers the evidence of record at the time of the May 2021 rating decision and any evidence submitted by the Veteran and/or his representative at the hearing up to 90 days following the hearing, which would have been August 6, 2025. 38 C.F.R. § 20.302(a). The 90-day period for submitting evidence following the Board hearing has lapsed, and the Board will proceed with adjudication.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision here. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Increased Ratings

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability.

Diagnostic Codes (DCs) are assigned by the rating officials to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. See 38 C.F.R. § 4.7. When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. See id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of a veteran. 38 C.F.R. § 4.3.

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. It is essential that the examination upon which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervations, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant 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. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40.

Evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss,
, or to deformity, adhesions, defective innervations, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant 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. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40.

Evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss, taking into account any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions regarding the avoidance of pyramiding under 38 C.F.R. § 4.14 do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including flare ups. However, those provisions should only be considered in conjunction with the diagnostic codes predicated on limitation of motion. 38 C.F.R. §§ 4.40, 4.45.

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Painful motion is an important factor of joint disability, which is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. However, the evaluation of painful motion as limited motion only applies when the limitation of motion is noncompensable under the applicable diagnostic code. Mitchell v. Shinseki, 25 Vet. App. 32 (2011).

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on her behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

1. Entitlement to a compensable disability rating for right hip femoral acetabular impingement syndrome (flexion).

The Veteran seeks an increased disability rating for his right hip disability limitation of flexion.

As to the evaluation of the right hip disability with limited flexion, the Veteran's impairment is rated under 38 C.F.R. § 4.71a, DC 5252. Under DC 5252, a 10 percent rating is warranted if flexion is limited to 45 degrees, a 20 percent rating is warranted if flexion is limited to 30 degrees, a 30 percent rating is warranted if flexion is limited to 20 degrees, and a 40 percent rating is warranted if flexion is limited to 10 degrees. 38 C.F.R. § 4.71a, DC 5252.

In a March 2021 Higher Level Review Informal Conference, the Veteran's representative asserted that an evaluation was reduced that was in place for more than 10 years and was unclear as to what was going on. During the May 2025 Board hearing, the Veteran's representative stated that the diagnostic code was switched and a 10 percent was given under DC 5251 for extension and he was not sure exactly why the diagnostic code was changed. He stated that there was really no explanation whatsoever because neither of these ratings would warrant a compensable rating for actual loss of range of motion and was not sure why it was switched, asserting that an error had been made.

In the October 2020 rating decision, the Regional Office (RO) decreased the evaluation of the right hip disability based on limitation of flexion (DC 5252) to a zero (0) percent rating, effective October 21, 2020, and awarded a separate 10 percent ring for the right hip disability under limitation of extension (DC 5251), effective August 14, 2020. Although the Veteran did not meet the criteria for a 10 percent rating under DC 5251, the RO provided a 10 percent rating by analogy based on painful motion.

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Painful motion is an important
.

In the October 2020 rating decision, the Regional Office (RO) decreased the evaluation of the right hip disability based on limitation of flexion (DC 5252) to a zero (0) percent rating, effective October 21, 2020, and awarded a separate 10 percent ring for the right hip disability under limitation of extension (DC 5251), effective August 14, 2020. Although the Veteran did not meet the criteria for a 10 percent rating under DC 5251, the RO provided a 10 percent rating by analogy based on painful motion.

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Painful motion is an important factor of joint disability, which is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. However, the evaluation of painful motion as limited motion only applies when the limitation of motion is noncompensable under the applicable diagnostic code. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Both these provisions clarify that in such situations a veteran is entitled to a singular minimum compensable rating (in this case, 10 percent) based on noncompensable limitation of motion of the joint (in this case, the left hip and thigh). It does not provide for separate 10 percent ratings when there is painful motion across planes.

Since the Veteran was granted a separate 10 percent rating for right hip femoral acetabular impingement syndrome based on painful extension under DC 5251 in the October 2020 rating decision, effective August 14, 2020, the Veteran's rating under DC 5252 for limitation of flexion was reduced to a noncompensable, 0 percent, rating because the Veteran did not meet the criteria for a compensable rating based limitation of flexion and to avoid impermissible pyramiding. As noted above, the evaluation of painful motion as limited motion applies only when the limitation is noncompensable under the applicable diagnostic code and does not provide separate 10 percent ratings when there is painful motion across planes where the planes are not all at a compensable level. The undersigned VLJ explained this to the Veteran and his representative during the May 2025 Board hearing. Thus, the Veteran's "reduction" was not a true reduction based on improvement, rather, it was due to the assignment of the 10 percent rating for limitation of motion on another plane under DC 5251 for limitation of extension.

The Veteran's right hip flexion as measured by the October 2020 VA examiner was from 0 to 115 degrees, with pain. The Veteran was able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion. The Veteran denied flare-ups of the hip. As there are no other records which support a finding of right hip flexion limited to 45 degrees or less during the appeal period, the criteria for an increased 10 percent rating for limitation of hip flexion have not been met. 38 C.F.R. § 4.71a, DC 5252.

For the above reasons, a compensable disability rating for right hip femoral acetabular impingement syndrome (flexion) is not warranted at any point during the period on appeal. The benefit-of-the-doubt-doctrine is therefore not for application and the claim must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). 38 U.S.C. § 5107; 38 C.F.R. § 4.3.

2. Entitlement to a compensable disability rating for bilateral inguinal hernia.

The Veteran seeks an increased disability rating for his bilateral inguinal hernia.

The Veteran's service-connected bilateral inguinal hernia repair is rated under DC 7338. Under DC 7338, a noncompensable rating is assigned for an inguinal hernia that is small, reducible, or without true hernia protrusion, or for an inguinal hernia that is not operated, but remediable. A 10 percent rating is provided for a postoperative recurrent inguinal hernia that is readily reducible and well supported by a truss or belt. A 30 percent rating is provided for an inguinal hernia that is small, postoperative recurrent, or unoperated irremediable, not well supported by a truss, or for an inguinal hernia that is not readily reducible. A 60 percent rating is warranted for an inguinal hernia that
 noncompensable rating is assigned for an inguinal hernia that is small, reducible, or without true hernia protrusion, or for an inguinal hernia that is not operated, but remediable. A 10 percent rating is provided for a postoperative recurrent inguinal hernia that is readily reducible and well supported by a truss or belt. A 30 percent rating is provided for an inguinal hernia that is small, postoperative recurrent, or unoperated irremediable, not well supported by a truss, or for an inguinal hernia that is not readily reducible. A 60 percent rating is warranted for an inguinal hernia that is large, postoperative recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable. 38 C.F.R. § 4.114, DC 7338.

DC 7338 also notes that a 10 percent rating is added for bilateral involvement, provided that the second hernia is compensable. This means that the more severely disabling hernia is to be evaluated, and then a 10 percent rating is added for the second hernia, if the latter is of a compensable degree. 38 C.F.R. § 4.114, DC 7338.

The Veteran was afforded a VA examination in October 2020. The examiner documented subjective symptoms of the Veteran's report that he believed his umbilical hernia had returned and his navel had gotten larger and felt pressure in the abdomen. The examiner documented surgery performed of left and right lap herniorrhaphy, however, on physical examination, the examiner found there was no hernia detected on either the right or left side. The examiner documented there was no indication for a supporting belt or truss. The examiner noted that there were pertinent physical findings on examination of umbilicus with small amount of protrusion on examination, which was described as very faint, well healed surgical scar at umbilicus no tenderness disfigurement, hypo or hyper-pigmentation or abnormal texture. She found that there was no impact on the Veteran's ability to work and referenced a January 2008 examination that showed no hernias, the Veteran being status-post hernia repair from January 2000, and inguinal hernias resolved, possible returning umbilical hernia, however, the Veteran had not been diagnosed.

The Veteran was afforded another VA examination in April 2021. The examiner noted that the claims file was insufficient to find evidence of recurrent hernia or symptoms related to service-connected hernia conditions. The examiner wrote that the Veteran's report of a "tug" sensation when stretching or twisting to either side, soreness with movement, and avoiding activities are known to cause pain as with twisting or stretching arms above the head. Specifically, there was no report of protrusion or pain at surgical sites. Upon physical examination, the examiner found that there was no hernia detected on either the right or left side and no other pertinent physical findings. There was no indication for a supporting belt or truss. She documented that the Veteran's reported pain at the upper right quadrant was incidental and not related to the status post bilateral inguinal or umbilical hernia; found no functional impairment; and made a remark that there are no objective findings of bilateral inguinal nor umbilical hernia on day of examination.

The Veteran's representative asserted during the May 2025 Board hearing that the there was a contradiction on examination and on second examination, the Veteran had pooling pain from the hernia operation. He argued that if a 10 percent is not warranted under the current diagnostic code, a 10 percent evaluation for adhesions due to hernia operations because of the pooling pain is warranted under DC 7301. The Veteran testified to pain with certain motions and protrusion, explaining that his belly button is so flat that it longer was an "innie" like it was immediately after surgery.

The Board concludes that the assigned noncompensable rating is appropriate for the Veteran's bilateral inguinal hernia and that a compensable rating is not warranted. At no point during the period on appeal has the Veteran had a recurrent inguinal hernia. Neither the October 2020 nor the April 2021 VA examiner detected an inguinal hernia upon physical examination. The October 2020 examiner noted the subjective symptoms of the Veteran's report that he believed his umbilical hernia had returned and his navel had gotten larger and felt pressure in the abdomen and found the umbilicus with small amount of protrusion on examination, which was described as very faint, well healed surgical scar at umbilicus, no tenderness, disfigurement, hypo or hyper-pigmentation or abnormal texture, however, ultimately determined that there was no hernia detected on
 rating is not warranted. At no point during the period on appeal has the Veteran had a recurrent inguinal hernia. Neither the October 2020 nor the April 2021 VA examiner detected an inguinal hernia upon physical examination. The October 2020 examiner noted the subjective symptoms of the Veteran's report that he believed his umbilical hernia had returned and his navel had gotten larger and felt pressure in the abdomen and found the umbilicus with small amount of protrusion on examination, which was described as very faint, well healed surgical scar at umbilicus, no tenderness, disfigurement, hypo or hyper-pigmentation or abnormal texture, however, ultimately determined that there was no hernia detected on either side. The April 2021 examiner considered the Veteran's reported symptoms of "tug" sensation and determined that the Veteran's reported pain at the upper right quadrant was incidental and not related to the status post bilateral inguinal or umbilical hernia. Therefore, both examiners had considered the Veteran's reported symptoms, which were similar to those as reported during the May 2025 Board hearing, in finding that the objective examination did not show the presence of hernia on either side.

The Veteran is competent to testify as to his observable symptomology, however, with the competent in-person medical examinations that show two examiners found that the Veteran did not have an inguinal hernia nor required a supporting belt or truss, where both examiners considered these symptoms. The Board concludes that the evidence persuasively weighs against finding that the Veteran experienced a recurrent inguinal hernia at any point during the period on appeal. As the criteria for a 10 percent rating under DC 7338 specifically require a postoperative recurrent inguinal hernia, a compensable rating is not warranted. 38 C.F.R. § 4.114, DC 7338.

To the extent that the Veteran contends he should be rated under another diagnostic code, this disability cannot be rated by analogy. The service-connected disability is specifically listed in the rating schedule, it may not be rated by analogy under a different diagnostic code. See Copeland v. McDonald, 27 Vet. App. 333, 337 (2015).

Thus, for the reasons and bases discussed, the evidence for the claim for a compensable rating for bilateral inguinal hernia versus the evidence against the claim is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and, therefore, most persuasive evidence is against this claim and the claim is denied. See Lynch, 21 F.4th at 781-82.

3. Entitlement to an earlier effective date for an increased 30 percent disability rating for claw feet and bilateral heel spurs with gout left great toe.

The Veteran's representative testified that they were seeking an earlier effective date of August 14, 2020, the date that the Veteran submitted an intent to file for the award of the  30 percent disability rating for claw feet and bilateral heel spurs with gout left great toe.

The Board finds that an earlier effective date of August 14, 2020, is warranted, but no earlier, as explained below.

In the May 2020 rating decision, the Regional Office (RO), found a clear and unmistakable error in the reduction from 10 percent to 0 percent rating as of October 21, 2020, and increased the evaluation to a 30 percent rating, as of April 29, 2021, based on the date of examination.

The statutory guidelines for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C. § 5110. The general rule regarding effective dates is that the effective date of an award based upon an original claim or a claim reopened after final adjudication shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. Id. The implementing regulation adds that except as otherwise provided, the effective date of an award of compensation based on an initial claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400.

Effective March 24, 2015, VA no longer recognized informal claims. See 79 Fed. Reg. 57,660-01 (2015). In their place, VA recognizes "an intent to file a claim," which may be submitted electronically, on a prescribed intent to file form, or through an oral communication to certain VA employees that is later recorded in writing. 38 C.F.R. § 3.155(b)(1)(i)-(iii). If VA receives a complete application form as defined in 38 C.F.R. § 3.160(a) within one year of receipt
 receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400.

Effective March 24, 2015, VA no longer recognized informal claims. See 79 Fed. Reg. 57,660-01 (2015). In their place, VA recognizes "an intent to file a claim," which may be submitted electronically, on a prescribed intent to file form, or through an oral communication to certain VA employees that is later recorded in writing. 38 C.F.R. § 3.155(b)(1)(i)-(iii). If VA receives a complete application form as defined in 38 C.F.R. § 3.160(a) within one year of receipt of an intent to file, VA will consider the complete claim filed as of the date the intent to file was received. 38 C.F.R. § 3.155(b).

The record is clear that the Veteran submitted an intent to file on August 14, 2020. Within one year of the intent to file, on September 30, 2020, the Veteran submitted his formal claim for increase of service connected claw feet and bilateral heel spurs with gout left great toe on VA 21-526EZ, Fully Developed Claim (Compensation).

The Veteran was first afforded a VA examination for foot conditions in October 2020. The Veteran's claim for an increased rating was denied originally in an October 2020 rating decision. However, in a March 2021 rating decision, the RO identified a duty to assist error with the examination during the Higher Level Review and developed for an additional examination, which was provided in April 2021, and the date upon which the current increased 30 percent rating is based. The date of occurrence of a VA examination is not necessarily determinative of the existence of the condition. The effective date is predicated on when the disability can be ascertained. See Swain v. McDonald, 27 Vet. App. 219, 224 (2015).

The Veteran's representative argued that because the October 2020 VA examination was not adequate the clinical findings of the April 2021 VA examination should not be considered new. The Board agrees and accordingly finds that an earlier effective date of August 14, 2020, the date of the intent to file, for the 30 percent rating is warranted, as VA received the Veteran's complete application from within a year of such intent to file, but no earlier, as there is no earlier claim for increase.

4. Entitlement to service connection for a left knee disability.

The Veteran seeks service connection for a left knee disability, which he believes was incurred in or otherwise related to service. During the May 2025 Board hearing, the Veteran's representative stated that in a July 2006 service treatment record, a whole-body scan performed shows degenerative changes of the knees and left mid-foot. See also March 2021 Higher Level Review Informal Conference.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 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).

Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

In the May 2021 rating decision, the AOJ found that a qualifying event, injury, or disease had its onset during service with an April 2005 complaint of left knee pain and left knee degenerative changes shown in July 2008. Further, the evidence shows that the Veteran was exposed to hazards in the Gulf during military service, with his Certificate of Release or Discharge From Active Duty (DD Form 214) which showed that he served in Kuwait, from which his exposure to hazards in the Gulf is conceded.
 §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

In the May 2021 rating decision, the AOJ found that a qualifying event, injury, or disease had its onset during service with an April 2005 complaint of left knee pain and left knee degenerative changes shown in July 2008. Further, the evidence shows that the Veteran was exposed to hazards in the Gulf during military service, with his Certificate of Release or Discharge From Active Duty (DD Form 214) which showed that he served in Kuwait, from which his exposure to hazards in the Gulf is conceded. The Board is bound by these favorable findings. See 38 C.F.R. § 3.104(c).

After a careful review of the evidence of record, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran has a current left knee disability during the appeal period. Therefore, service connection for a left knee disability is not warranted. The reasons follow.

During the January 2025 Board hearing, the Veteran testified that he hurt his knee in service with regular physical training. He indicated that a doctor did not relate his knee problems to his gout but that his left knee continued to bother him since service. The Veteran answered "that's correct" when asked if he had pain in the left knee on repetitive use or on flare-up. The Veteran's representative stated that his knees were not "horrible" compared to the rest of his body.

As noted above, the Veteran's representative referenced the July 2006 whole body bone scan. Additionally, the Veteran had an April 2005 complaint of bilateral knee pain. The July 2006 medical record documents a history of gout, hyperuricemia and bilateral shoulder pain and included findings of degenerative changes of the knees and left midfoot (middle cuneiform) and right sesamoid first metatarsophalangeal joint radiotracer uptake, however, no impressions were provided related to the left knee. In a September 2006 orthopedic consultation, the Veteran was noted to have hyperuncemia/gout and presented with hip pain and x-ray evaluation noted femoral acetabular impingement findings with secondary degenerative joint disease. He reported that he could run approximately one mile without any difficulty at all, although he did occasionally had discomfort in his knee. He indicated that he was not having any difficulties and that normal ambulation did not cause any difficulty in the hips, however, prolonged physical fitness activities caused discomfort in his right knee.

While there were complaints of left knee pain in service, there is no post-service diagnosis or treatment for the left knee indicative of a left knee disability. Specifically, the Veteran testified during the January 2025 Board hearing that he was not seeking treatment or knee complaints at VA but took ibuprofen, waited it out, and limited his activity to not exacerbate it.

The Veteran was afforded a VA examination in October 2020. The Veteran reported that he was in the military for 20-plus years and had excess wear and tear to both knees with increased pain in the right greater than the left for several years. He stated that he had been on a civil service contract in Germany for the preceding five years and has not gotten it diagnosed. He reported pain in the bilateral knees, worse with squatting, kneeling, and climbing hills since the onset with current symptoms of intermittent pain in the right greater than the left that was almost constant, ranging from dull to sharp. The Veteran indicated there was no current treatment and denied any flare-ups of the knee.

The examiner noted that as to the left knee, the claims file was silent for objective medical evidence to support a chronic condition, with no evidence to support a chronic diagnosis or treatment during military service or that was caused by military service. She did not provide a diagnosis but rather documented that both knees were "normal." Upon physical examination, the Veteran's left knee had normal ranges of motion, though with pain noted on examination which did not result in or cause functional loss with no objective evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion and pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time or with flare-ups. There were no additional contributing factors of disability for the left knee.

Upon muscle strength testing, the Veteran had 5 out of 5 strength with flexion and extension, no atrophy, no ankylosis, and no history of recurrent subluxation, lateral instability or recurrent effusion. Joint stability testing was performed with normal anterior instability, posterior instability, medial instability, and lateral instability tests. The examiner found regardless of
 of localized tenderness or pain on palpation. The Veteran was able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion and pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time or with flare-ups. There were no additional contributing factors of disability for the left knee.

Upon muscle strength testing, the Veteran had 5 out of 5 strength with flexion and extension, no atrophy, no ankylosis, and no history of recurrent subluxation, lateral instability or recurrent effusion. Joint stability testing was performed with normal anterior instability, posterior instability, medial instability, and lateral instability tests. The examiner found regardless of the Veteran's current employment status, there was no impact from his left knee on his ability to perform any type of occupational task. The examiner indicated that x-rays were not performed because on the day of the examination, they were not clinically indicated and referenced February 2008 x-rays of the bilateral knees which had an impression of negative bilateral knees.

The examiner provided an opinion that the claimed left knee disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service, injury, event or illness. She stated that there was no chronic diagnosis made for the left knee and explained that the objective examination was normal and symptoms were subjective only, and that a nexus had not been established.

In a February 2021 VA medical record, the Veteran presented for a routine follow-up and complained of waking up with pain in the back of the head and base of the neck, with associated nausea and headaches. In the review of symptoms, under musculoskeletal, the examiner included the Veteran's complaint of bilateral knee pain. However, the assessment and plan did not include findings related to the left knee, only a history of chronic right hip regional pain was noted.

Following VA examination in April 2021, the examiner did not provide a diagnosis and, like the October 2020 examiner, indicated that the left knee was normal. She noted a history of an onset of the claimed left knee disability with an onset of 2008 attributable to physical training and high impact activity during physical training. The Veteran reported that the course was progressively worse since the onset but was unable to provide a history of symptoms or treatments and stated that he was unable to determine if or when he spoke to his primary care or specialist in regard to left knee symptoms. He stated that he had left knee pain with kneeling and flexion and current symptoms of intermittent pain to the left knee with kneeling on the left knee or with bending the left knee across the opposite leg but no reports of instability, erythema or swelling and no other symptoms to report. The Veteran indicated that he had treatment of Celebrex daily for generalized pains not specific for the left knee. The Veteran did not report any flare-ups of the left knee or having any functional loss or functional impairment. He also did not report a history of instability, recurrent subluxation or frequent effusion of the left knee.

Upon physical examination, the Veteran had abnormal range of motion in the left knee to 135 degrees of flexion with active range of motion but full 140 degrees of flexion with passive range of motion, with no evidence of pain or objective evidence of crepitus or localized tenderness or pain on palpation. He was able to perform repetitive-use testing with three repetitions without additional loss of function or range of motion. The examiner found there was no recurrent subluxation, persistent instability, or recurrent patellar instability. The examiner indicated that regardless of the Veteran's current employment status, there was no impact of the left knee on his ability to perform any type of occupational task. She found that x-rays on the day of examination were not clinically inclined and explained that symptoms of the left knee were subjective per the Veteran's report and the claims file was insufficient for reported symptoms, diagnosis, or treatment related to the Veteran's claimed left knee disability. She referenced a January 2008 x-ray of the bilateral knees, which was negative in the report. She stated that on the day of examination, the physical examination was grossly normal, and, therefore, "normal left knee" diagnosis was rendered on day of examination.

The examiner provided an opinion that the claimed left knee disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service, injury, event or illness. She reiterated that the claims file was insufficient for reported symptoms, diagnosis or treatment for a left knee condition and on the day of examination the left knee was grossly normal, the Veteran's symptoms were subjective per his report with a normal left knee diagnosis rendered on the day of examination, and a nexus had not been established. Notably, she referenced the March 2021 rating decision that noted the in service complaints of left knee pain in April 
 grossly normal, and, therefore, "normal left knee" diagnosis was rendered on day of examination.

The examiner provided an opinion that the claimed left knee disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service, injury, event or illness. She reiterated that the claims file was insufficient for reported symptoms, diagnosis or treatment for a left knee condition and on the day of examination the left knee was grossly normal, the Veteran's symptoms were subjective per his report with a normal left knee diagnosis rendered on the day of examination, and a nexus had not been established. Notably, she referenced the March 2021 rating decision that noted the in service complaints of left knee pain in April 2005 and left knee degenerative changes in July 2008, however, she noted the left knee x-ray completed in January 2008 was negative for the left knee.

As such, the evidence persuasively weighs against a finding that the Veteran has a left knee disability, to include symptoms that cause functional impairment of earning capacity. The evidence shows that he complained of left knee pain in February 2021; however, other than that, the evidence does not show that he was exhibiting left knee symptoms. Additionally, the assessment at that time was associated with a history of chronic right hip regional pain. 

The Veteran is competent to relate symptomatology, such as left knee pain; however, even his statements do not establish a left knee disability that causes functional impairment of earning capacity. The Board finds that the most probative evidence as to whether the Veteran has a currently diagnosed left knee disability are the October 2020 and April 2021 VA examiner's opinions, which found that the Veteran did not have a current left knee disability after considering the Veteran's report of in-service knee wear and tear and a review of the claims file, including the April 2005 complaint of bilateral knee pain and July 2006 radiologic examination report that included findings of degenerative changes of the knees, which is based on the interpretation by the medical professional. However, both VA examiners referenced a January 2008 x-ray of the bilateral knees which were negative in the report, in finding that there was no current left knee disability. These examiners have also provided thorough objective testing specific to the knee, as documented above, in making their determination that there was no left knee disability nor functional impairment, specifically finding that the left knee was normal.

The Board is mindful of the holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) explained that where pain alone results in functional impairment that affects earning capacity, even if there is no identified underlying diagnosis, it can constitute a disability. The Veteran has not contended that he has experienced functional impairment affecting his earning capacity related to his claimed left knee disability, and the evidence of record does not show that the Veteran has had such functional impairment. The Veteran was provided objective testing in VA examinations in October 2020 and April 2021, where the examiners both found the Veteran to have a normal left knee based on the results and no functional impairment.

The evidence persuasively weighs against a finding of a left knee disability or symptoms that cause functional impairment of earning capacity during the appeal period or proximate thereto, as mentioned above. The persuasive weight of the evidence is against a finding that the Veteran had a left knee disability at any time during the period on appeal, to include symptoms that cause functional impairment of earning capacity. Although there were in-service complaints related to the left knee, the record does not reflect a current left knee disability, the cornerstone element of service connection has not been met, and service connection is not warranted. As the Board concludes that the evidence persuasively weighs against a current disability, no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection).

As the evidence persuasively weighs against the claim for service connection for a left knee disability, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. Lynch, 21 F.4th 776; 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

A. P. SIMPSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Cheng
 an injury or a disease incurred in service."); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection).

As the evidence persuasively weighs against the claim for service connection for a left knee disability, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. Lynch, 21 F.4th 776; 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

A. P. SIMPSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Cheng, Counsel

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.