KNEE IMPAIRMENT OF

Summary

The veteran, who served from April 1973 to April 1977, appeals the denial of service connection for a left knee disability. The veteran contends that the left knee condition was caused or aggravated by his service-connected left ankle disability. The Board reviewed conflicting medical opinions regarding the nexus between the left ankle and left knee conditions. Earlier VA examinations in February 2011 and September 2015 concluded it was less likely than not that the left knee disability was secondary to the left ankle disability, citing age-appropriate degenerative changes and a lack of supporting medical literature for a direct causal link. However, a later VA examination in June 2021 opined that it was at least as likely as not that the left knee condition is due to or the result of the left ankle condition, referencing the Veteran's history, x-rays, lay reports of altered gait due to ankle pain, and medical research showing a correlation between ankle and knee pain. The Board found the evidence to be in approximate balance, with the later VA opinion and additional medical evidence submitted after the Board hearing supporting a connection. Applying the benefit of the doubt, the Board granted service connection for the left knee disability.

Rationale

Conflicting medical opinions on nexus; Benefit of the doubt applied due to equipoise; Later VA exam found at least as likely as not secondary

Full Decision Text

Citation Nr: A26040413
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210928-188738
DATE: April 29, 2026

ORDER

Entitlement to service connection for a left knee disability is granted.

FINDING OF FACT

The most probative evidence is in relative balance as to whether the Veteran's left knee disorder is proximately due to, a result of, or aggravated by a service-connected left ankle disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a left knee disability, to include as secondary to a left ankle disability, have been met.  38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 1973 to April 1977.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a February 2021 decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In the September 28, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned on May 8, 2025.

Therefore, the Board may only consider the evidence of record at the time of the February 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative 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. 

If the Veteran would like VA to consider any evidence that was submitted 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[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to service connection for a left knee disability is granted.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Generally, service connection requires: (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995).

The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

Finally, the Board has considered the entire record, including the Veteran's VA clinical records and private treatment records. These
).

The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

Finally, the Board has considered the entire record, including the Veteran's VA clinical records and private treatment records. These show complaints and treatment but will not be referenced in detail. The Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Therefore, the Board will discuss the evidence pertinent to the rating criteria and the current disability.

The Veteran contends that his left knee disability was caused or aggravated by his service-connected left ankle disability.

The February 2021 rating decision on appeal contains a favorable finding that the Veteran was diagnosed with a left knee disability. Additionally, the Board observes that the primary disability of a left ankle disability was service connected. The Board is bound by these findings. The remaining question, therefore, is one of nexus.

The Board notes that the record contains conflicting medical opinions. The United States Court of Appeals for Veterans Claims has stated that the probative value of a medical opinion is based on the expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Further, the credibility and weight to be attached to these opinions are within the province of the adjudicator. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). As such, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wensch v. Principi, 15 Vet. App. 362, 367 (2001).

On VA examination in February 2011, the Veteran reported swelling, pain, and stiffness of the left knee, worsened with prolonged standing. He reported this disorder was related to his left ankle disability. The examiner recorded an altered gait. On review of the claims file and examination of the Veteran, including x-rays, the examiner concluded that it was less likely than not that the left knee disability was secondary to the service-connected left ankle disability. The examiner explained that the degenerative changes shown on x-ray for the knee and hip were age-appropriate changes. The degeneration shown was at an expected level given the Veteran's age and constitution.

On VA examination in September 2015, the Veteran reported that his left knee disability was secondary to his service-connected ankle disability. He reported daily recurrent left knee pain, worsened with standing and walking. On review of the claims file and examination of the Veteran, the examiner opined that the left knee disability was less likely than not due to or the result of the left ankle disability. The examiner stated that there was no medical literature supporting a cause and effect relationship between posttraumatic arthritis of the ankle and mild degenerative arthritis of the ipsilateral knee joint or hip joint.

The above opinions did not address whether the Veteran's left knee disability was aggravated or made worse by his left ankle disability.

At a November 2016 hearing, the Veteran reiterated his contentions of secondary service connection, and testified that his treating VA physician from the William B. Kling VA facility told him that his knee and hip disorders were secondary to his left ankle disability.

In an August 2017, the Board denied the claim for service connection for a left knee disability based on the foregoing. However, the Veteran filed a new claim for service connection in November 2017.

In June 2021, the Veteran was afforded a new VA examination relative to his left knee disability. The examiner opined that it was at least as likely as not that the Veteran's left knee condition is due to or the result of the Veteran's left ankle condition. The examiner based his opinion, on a detailed history of the Veteran's conditions. He documented x-rays, and lay reports of the Veteran shifting his weight due to ankle pain. The examiner wrote, "while knee AO has multiple factors of causation such as trauma and obesity an ankle injury is also a probable cause. Problems of the ankle can often contribute to knee pain, as a misaligned ankle can affect gait, this change forces your leg to overcompensate for the misalignment, causing your knee to
 was afforded a new VA examination relative to his left knee disability. The examiner opined that it was at least as likely as not that the Veteran's left knee condition is due to or the result of the Veteran's left ankle condition. The examiner based his opinion, on a detailed history of the Veteran's conditions. He documented x-rays, and lay reports of the Veteran shifting his weight due to ankle pain. The examiner wrote, "while knee AO has multiple factors of causation such as trauma and obesity an ankle injury is also a probable cause. Problems of the ankle can often contribute to knee pain, as a misaligned ankle can affect gait, this change forces your leg to overcompensate for the misalignment, causing your knee to bear extra weight." The examiner also references a medical research showing a correlation between ankle and knee pain.

In the period following the Board hearing, the Veteran also submitted medical evidence that details the relationship between ankle and knee pain.

Based on the available evidence, to include the nexus opinions discussed above, the Board finds that there is at least an approximate balance of positive and negative evidence as to whether the Veteran's left knee disability was caused or aggravated by his service-connected left ankle disability. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for the left knee is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

 

 

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. E. Geary

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.