KNEE IMPAIRMENT OF

Summary

The Veteran, who served from August 2011 to January 2012, appeals the denial of service connection for right knee disability, left knee arthritis, and bilateral knee instability. The Board found that the Veteran's current disabilities met the criteria for service connection. Regarding the right knee disability and left knee arthritis, the Board noted the favorable findings from the April 2025 VA examination, which diagnosed these conditions. For bilateral knee instability, the Board considered the Veteran's competent and credible lay statements, corroborated by private and VA medical records, indicating persistent symptoms and the need for knee braces for stability. Although service treatment records did not explicitly document complaints of bilateral knee pain or instability during service in 2012, they did show a temporary profile for chronic bilateral knee pain in November 2015. The Board found the Veteran's lay evidence regarding the onset and continuity of symptoms to be competent and credible, particularly given the severe degenerative changes noted in private medical records from 2023 and 2024. The Board also found the VA examiner's negative nexus opinions inadequate because they failed to consider the Veteran's lay statements and the progression of his condition, and did not adequately address the instability aspect. The Board resolved the resulting reasonable doubt in favor of the Veteran, granting service connection for all claimed knee conditions.

Rationale

Favorable finding from April 2025 VA examination regarding current disability.; Competent and credible lay evidence of symptom onset during service and continuity of symptoms.; Inadequate VA opinion due to failure to consider lay evidence and progression of severe arthritis.; Reasonable doubt resolved in favor of the Veteran due to equipoise in evidence.

Full Decision Text

Citation Nr: A26040542
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250722-567843
DATE: April 30, 2026

ORDER

Entitlement to service connection for right knee meniscal tear, anterior cruciate ligament tear and degenerative arthritis (right knee disability) is granted.

Entitlement to service connection for left knee degenerative arthritis (left knee arthritis) is granted.

Entitlement to service connection for right knee instability is granted.

Entitlement to service connection for left knee instability is granted.

FINDINGS OF FACT

1. The evidence is at least evenly balanced as to whether the Veteran's right knee disability began during service.

2. The evidence is at least evenly balanced as to whether the Veteran's left knee arthritis began during service.

3. The evidence is at least evenly balanced as to whether the Veteran's bilateral knee instability began during service.

CONCLUSIONS OF LAW

1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right knee disability have been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for left knee arthritis have been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

3. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right knee instability have been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

4. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for left knee instability have been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 2011 to January 2012, with other service in the Reserves.  

This case comes before the Board of Veterans' Appeals (Board) from an April 2025 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).  In that decision, the RO adjudicated a November 2024 Form VA 21-526EZ claim for bilateral knee instability and "knee" and denied entitlement to service connection for right knee disability and left knee arthritis.

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket, identified the April 2025 rating decision, and the specific issues of service connection and disability evaluations for right knee disability and left knee arthritis, noting that both were claimed as knee instability.  The Board will decide entitlement to service connection for right knee disability and left knee arthritis, but is precluded in this decision from addressing the appropriate disability ratings, as they must be determined by the agency of original jurisdiction (AOJ) in implementing this decision.  Monk v. Wilkie, 32 Vet. App. 87, 98 (2019) (effective date and rating issues lie "downstream from the initial grant of benefits, and the initial NOD that appealed the denial of benefits cannot initiate appellate review of the downstream element").

Based on the Veteran's election of the Direct Review docket, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 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 claims, 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 right knee disability, left knee arthritis and bilateral knee instability is granted. 

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service.  38 U.S.C. § 1110; 38
 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 claims, 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 right knee disability, left knee arthritis and bilateral knee instability is granted. 

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a relationship between the current disability and the in-service disease or injury.  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).  Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

As favorably found by the AOJ, the April 2025 VA examination report contains a diagnosis of left knee arthritis and right knee meniscal tear, anterior cruciate ligament tear and arthritis.  The Board is bound by this favorable finding, 38 C.F.R. § 3.104(c), and the current disability requirement has thus been met with respect to right knee disability and left knee arthritis.

Separately, in his November 2024 Form VA 21-526EZ, the Veteran identified bilateral knee instability.  The Veteran further reported bilateral knee instability as shown in private treatment records from 2023 and 2024 (discussed below), as well as during his April 2025 VA examination, explaining that he must wear knee braces for stability when completing any physical task outside of the home.  Although the evidence of record does not include a formal diagnosis of a particular bilateral knee instability disability based on physical examination testing, impairment alone is sufficient in some circumstances to show the existence of current bilateral knee instability, see Saunders v. Wilkie, 886 F.3d 1356 (2018) (pain alone can serve as a disability for VA compensation purposes if it rises to the level of functional impairment that affects earning capacity), and the Board must address any relevant lay evidence and compare it to the medical evidence to determine which is more probative, keeping in mind that objective medical evidence is not automatically more probative than lay evidence, see English v. Wilkie, 30 Vet. App. 347, 349 (2018).  To this point, the Veteran is competent to report bilateral knee instability, such as his knee giving out, and the Board has no reason to challenge the credibility of his contention that has been consistently relayed to his orthopedist and the VA examining physician.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (a layperson is competent to report observations).  Based on the foregoing, including the Veteran's statement that he cannot leave his home without knee braces for stability, the current disability requirement has been met for bilateral knee instability disabilities.

Regarding an in-service injury, during his April 2025 knee and lower leg VA examination, the Veteran reported that his bilateral knee pain began during 2012, when he noticed pain when squatting.  Service records show that the Veteran completed his initial active duty training in January 2012.  In his November 2024 Form VA 21-526EZ, he further explained that he began to experience bilateral knee pain and instability during his military training, which included running and rucking.  The Veteran could not recall if he went to medical when he first noticed his knee pain and service treatment records do not show complaints or treatment regarding bilateral knee pain in 2012.  However, his service treatment records from November and December 2015 show that the Veteran was placed on a temporary physical profile due to chronic bilateral knee pain.  As the Veteran is competent and credible to report the observable symptoms of the claimed disorder that developed in service during his initial active duty training, such as knee pain and instability when bending, Layno v. Brown, 6 Vet. App. 465, 470 (1994) (lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared), and his reported symptoms are consistent with the "places, types, and circumstances
 pain and service treatment records do not show complaints or treatment regarding bilateral knee pain in 2012.  However, his service treatment records from November and December 2015 show that the Veteran was placed on a temporary physical profile due to chronic bilateral knee pain.  As the Veteran is competent and credible to report the observable symptoms of the claimed disorder that developed in service during his initial active duty training, such as knee pain and instability when bending, Layno v. Brown, 6 Vet. App. 465, 470 (1994) (lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared), and his reported symptoms are consistent with the "places, types, and circumstances of service as shown by service records," 38 C.F.R. § 3.303(a), the in-service injury element has been met.

The remaining issue is thus whether there is a relationship between the current right knee disability, left knee arthritis and bilateral knee instability and the in-service injury.  

Private treatment records from March 2023 show that the Veteran reported an increase in right knee pain following a recent injury; the Veteran also explained that he has had knee pain for many years.  As recorded by the VA physician completing the April 2025 VA examination report, a March 2023 MRI of the right knee showed tears of both the medial and lateral meniscus, severe osteoarthritis in the lateral compartment, and moderate osteoarthrosis in the medial and patellofemoral compartment.  The orthopedist was concerned about the extensive, severe and advanced arthritis of the right knee, recording that the Veteran has "a relative difficult issue with his younger age and degenerative changes in the knee."  An April 2023 private treatment record shows that the Veteran also had "advanced arthritis in both knees particularly for his younger age," with the orthopedist administering bilateral knee injections.  In July 2023, the Veteran reported right knee instability and that he has been wearing a knee brace for stability.  The Veteran continued to wear the knee brace, as shown in March 2024 private treatment records, and continued to experience bilateral knee pain and intermittent swelling.  A March 2024 x-ray showed advanced degenerative changes noted in the right knee and moderately advanced in the left, with no fracture, subluxation or dislocation seen.  The Veteran continued to receive knee injections and was referred for a surgical consultation.  During the March 2024 consultation, the orthopedic surgeon discussed the "severe bone-on-bone arthritis" shown in the x-rays, also noting that due to the "severe medial and lateral joint space loss he is actually starting to pseudosubluxation his joint in the partially flexed view." 

During his April 2025 knee and lower leg conditions VA examination, the Veteran stated that he experiences bilateral knee instability and constant aching pain, with a sharp pain if he is walking or going up or down stairs.  Rather than having total knee replacements given his age, he continued to receive cortisone injections in both knees every three to six months, and regularly wears braces for stability on both knees when doing anything out of the house.  The physician recorded that the Veteran does not have functional loss or functional impairment related to his knees or a history of instability related to his knees. 

The VA physician provided a negative direct service connection opinion for the Veteran's bilateral knee instability, right knee disability and left knee arthritis.  With respect to his bilateral knee instability, the physician reasoned that the Veteran does not have a diagnosis of knee instability because he was diagnosed with degenerative arthritis of both knees, osteoarthritis of the knees and right knee anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) tears, but there was no evidence of instability of either knee on physical examination, and the physician could therefore not diagnose knee instability.  Regarding his right knee disability and left knee arthritis, the physician explained that there "is a lack of substantiating evidence supporting a nexus between his current diagnosis of arthritis in the knees and right knee ACL, MCL tears and his military service," with medical records only showing knee pain in 2015, but no evidence of an in-service injury or event to establish a nexus. 

The Veteran is competent to report the onset and persistent nature of the observable symptoms related to his right knee disability and left knee arthritis, including pain, difficulty bending his knee or climbing up and down stairs, and knee instability.  Jandreau, 492 F.3d at 1377.  While his service treatment records three years after his reported onset note the continued presence of these symptoms, the Veteran's lay evidence concerning his continuity of symptoms is competent regardless of the lack of treatment records further discussing the frequency or severity of the symptoms until diagnosis.  See Buchanan v. Nicholson, 
 military service," with medical records only showing knee pain in 2015, but no evidence of an in-service injury or event to establish a nexus. 

The Veteran is competent to report the onset and persistent nature of the observable symptoms related to his right knee disability and left knee arthritis, including pain, difficulty bending his knee or climbing up and down stairs, and knee instability.  Jandreau, 492 F.3d at 1377.  While his service treatment records three years after his reported onset note the continued presence of these symptoms, the Veteran's lay evidence concerning his continuity of symptoms is competent regardless of the lack of treatment records further discussing the frequency or severity of the symptoms until diagnosis.  See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (holding lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence).

Despite the Veteran providing competent and credible lay evidence regarding the onset of symptoms in 2012 during his initial active duty training and the November 2015 evidence of continuing bilateral knee pain, the VA physician provided a negative opinion regarding the Veteran's right knee disability and left knee arthritis because of the "lack of substantiating evidence supporting a nexus."  Such reasoning indicates that the physician was relying solely on medical documentation to establish such nexus, and did not consider the Veteran's competent and credible statements regarding the onset and progression of symptoms, or the medical evidence showing and describing the progression of his severe arthritis as of 2023.  Moreover, with respect to his bilateral knee instability, the physician did not appear to consider the Veteran's competent and credible lay report of symptoms or that the Veteran regularly wears a brace for stability, and declined to record a diagnosis based on the physical examination results.  For this reason, the opinions are inadequate and not entitled to any probative weight.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("most of the probative value of a medical opinion comes from its reasoning"); Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (finding that an examiner impermissibly ignored the appellant's lay assertions that he had sustained a back injury in service). 

Here, evidence of record shows that the symptoms of the Veteran's right knee disability, left knee arthritis, and bilateral knee instability began during active service and continue to present, thereby warranting direct service connection.  See 38 C.F.R. § 3.303(a) ("Determinations as to service connection will be based on review of the entire evidence of record" consistent with the facts in each individual case, and service connection is warranted "when the facts, shown by evidence, establish that a particular injury ... resulting in disability was incurred coincident with service.").  To the extent that this grant of service connection is based primarily on credible lay evidence rather than complete medical opinions, "nothing in the regulatory or statutory provisions [relating to evidence to be considered] requires both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself."  Buchanan, 451 F. 3d at 1335.

While the Board could request an additional medical opinion specifically addressing the above-noted evidence and whether the Veteran's right knee disability, left knee arthritis, and bilateral knee instability is warranted, in light of the Veteran's competent and credible lay evidence, such a request might well be conceived of as an impermissible attempt to develop evidence with the exclusive intent of denying the Veteran's service connection claim.   38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews v. McDonough, 34 Vet. App. 216 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim").

For the above reasons, the evidence is at least evenly balanced as to whether the Veteran's right knee disability, left knee arthritis, and bilateral knee instability began during active service.  As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for right knee disability, left knee arthritis, and bilateral knee instability is warranted.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. T. Mowell, Associate Counsel

The Board's
 obtain more evidence so that it can properly deny the claim").

For the above reasons, the evidence is at least evenly balanced as to whether the Veteran's right knee disability, left knee arthritis, and bilateral knee instability began during active service.  As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for right knee disability, left knee arthritis, and bilateral knee instability is warranted.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. T. Mowell, Associate 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.