KNEE IMPAIRMENT OF

J. B. FREEMAN · 2026 · Case ID: A26040765

DENIED

Summary

The Veteran, an Army Veteran who served from October 1986 to August 1995, appeals the denial of service connection for right knee degenerative joint disease (DJD). The Board found that the Veteran's claim for right knee DJD warranted readjudication, as new and relevant evidence, including VA treatment records from 2013-2020 and hearing testimony, was submitted with his August 2020 supplemental claim. The Veteran testified that his right knee condition began during service and that he self-treated it, explaining the lack of notation in his service treatment records (STRs). However, the Board found the evidence insufficient to establish direct service connection, noting that STRs were silent for right knee complaints, while left knee issues were documented. The Board also denied secondary service connection, finding no medical evidence that the right knee condition was caused by or aggravated by the service-connected left knee disability. The Veteran's testimony regarding the secondary theory, raised at the Board hearing, was deemed too vague and outweighed by the medical records. The Board concluded that the evidence failed to support either direct or secondary service connection for the right knee condition, and therefore, the benefit of the doubt doctrine did not apply.

Rationale

New and relevant evidence submitted for readjudication; STRs silent for right knee complaints; Veteran's testimony regarding in-service onset and self-treatment deemed insufficient

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201021-116601

Full Decision Text

Citation Nr: A26040765
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 201021-116601
DATE: April 30, 2026

ORDER

Readjudication of the claim for entitlement to service connection for right knee degenerative joint disease is granted.

Entitlement to service connection for right knee degenerative joint disease, including secondary to a service connected left knee disability, is denied.

FINDINGS OF FACT

1. The Veteran's claim for service connection for right knee degenerative joint disease was denied in a March 2014 rating decision.

2. New and relevant evidence has been presented for Veteran's claim for entitlement to service connection for right knee degenerative joint disease.

3. The Veteran's right knee degenerative joint disease did not begin during active service, is not otherwise related to an in-service injury, event, or disease, and is not secondary to a service-connected left knee condition.

CONCLUSIONS OF LAW

1. The March 2014 rating decision denial of service connection for right knee degenerative joint disease became final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103.

2. The criteria for readjudication of the claim for entitlement to service connection for right knee degenerative joint disease are met. 38?U.S.C. §?5108; 38?C.F.R. §§?3.156(d), 3.2501.

3. The criteria for entitlement to service connection for right knee degenerative joint disease, including secondary to a service-connected left knee disability, are not met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.309, 3.310.

INTRODUCTION

The Veteran served on active duty in the United States Army from October 1986 to August 1995.

This matter comes before the Board of Veterans' Appeals (Board) on an appeal from a September 2020 rating decision issued by the Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ).

In the Veteran's October 2020 VA Form 10182, Decision Review Request: Board Appeal, he elected the Hearing docket. On December 6, 2024, the Veteran was afforded a Board hearing. Therefore, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issue(s) on appeal, and evidence submitted by the appellant or his or her representative within 90 days following his Board hearing. 38 C.F.R. §§ 20.300(a), 302(a). If additional evidence was submitted between the dates of the AOJ decision and the Board hearing, the Board will not consider it unless it is resubmitted during the 90 days following the Board hearing. If evidence is not resubmitted, the appellant is welcome to file a supplemental claim to have this evidence considered. Id.; Cook v. McDonough, 36 Vet. App. 175 (2023).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship also known as a "nexus" between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service
aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

1. Readjudication of the claim for entitlement to service connection for right knee degenerative joint disease

The Veteran contends he is entitled to service connection for right knee degenerative joint disease (DJD). See August 2020 VA Form 20-0995 Supplemental Claim.

In a September 2004 rating decision, the AOJ denied service connection for right knee degenerative joint disease. In a September 2004 letter, the Veteran was notified of the September 2004 rating decision and his procedural and appellate rights at his address of record. The Veteran filed a March 2013 supplemental claim and in a March 2014 rating decision, the AOJ found the Veteran did not submit new and material evidence and continued the denial for right knee degenerative joint disease. The Veteran was notified of the March 2014 rating decision and his procedural and appellate rights in a March 2014 notification letter at his address of record. His representative was copied on the notice. He did not file a notice of disagreement within one year of notice of the March 2014 rating decision. No additional evidence was received within one year of notice of the March 2014 rating decision. For this reason, the March 2014 rating decision denial of service connection for right knee degenerative joint disease became final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103.

VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(d). New evidence is evidence that was not of record at the time of a prior final determination. "Relevant evidence" is evidence that tends to prove or disprove a matter in issue, i.e., the elements of the claim found not met in the earlier adjudication. 38 C.F.R. § 3.2501(a)(1); see Kisor v. McDonough, 995 F.3d 1316, 1324 n. 6 (Fed. Cir. 2020). As the statutory definition of "relevant" does not require that the evidence relate to an unestablished fact necessary to substantiate the claim or raise a reasonable possibility of substantiating the claim, "new and relevant" evidence is a lower standard than the "new and material" evidence standard.

In the March 2014 rating decision, the AOJ denied service connection for right knee degenerative joint disease finding the evidence submitted with the March 2013 supplemental claim was not new and material, as there was no evidence to show that the Veteran was diagnosed with a right knee condition during service or within one year from separation from service.

In August 2020, the Veteran submitted another supplemental claim for service connection for right knee DJD. See August 2020 VA Form 20-0995. Along with the request, the Veteran submitted VA medical treatment records from 2013 to 2020 that indicate treatment for a right knee condition. See August 2020 VA Medical Treatment Records. No additional lay or medical evidence was submitted with his supplemental claim.

During his December 2024 Board hearing, the Veteran testified that his right knee condition started during service and that he received treatment for the condition but that it was never noted in his medical records. See December 2024 Hearing Transcript at 7. He explained that while in service he was running five to six miles a day while carrying heavy equipment and sometimes his right knee would fail. He stated that because he worked as a medic during service that when he had issues with his knee he did not go to sick call, he would just self-treat the condition with medication and that is why there was no record of the condition in his STRs. Id.

As stated above, when a veteran files a supplemental claim, new and relevant evidence must be presented or secured for VA to readjudicate the claim. Along with his August 2020 supplemental claim, the Veteran submitted VA medical treatment records indicating treatment for a
noted in his medical records. See December 2024 Hearing Transcript at 7. He explained that while in service he was running five to six miles a day while carrying heavy equipment and sometimes his right knee would fail. He stated that because he worked as a medic during service that when he had issues with his knee he did not go to sick call, he would just self-treat the condition with medication and that is why there was no record of the condition in his STRs. Id.

As stated above, when a veteran files a supplemental claim, new and relevant evidence must be presented or secured for VA to readjudicate the claim. Along with his August 2020 supplemental claim, the Veteran submitted VA medical treatment records indicating treatment for a right knee disability. In addition, the Veteran provided hearing testimony that the right knee disability had its onset during service and that as a medic, he self-treated for the disability. The Board finds that this evidence is new, as it was not of record at the time of the March 2014 rating decision and that it is relevant because it attempts to prove the Veteran has a current disability that is related to an in-service event.

Therefore, the Board finds that readjudication of the Veteran's claim for entitlement to service connection for right knee DJD is warranted as new and relevant evidence has been presented to support his August 2020 supplemental claim for service connection for a right knee condition. 38 U.S.C. § 1110; 38 C.F.R. § 3.2501(a)(1); see Kisor, 995 F.3d at 1324 n.6.

2. Entitlement to service connection for right knee degenerative joint disease, including secondary to a service connected left knee disability

The Veteran contends that his right knee condition is due to his military service. See August 2020 VA Form 20-0995 Supplemental Claim. In the alternative, he contends that his right knee condition was caused by his service-connected left knee condition. See December 2024 Hearing Transcript.

In a September 2020 rating decision, the AOJ made a favorable finding that the Veteran had a current diagnosis of right knee derangement resulting in a right knee arthroscopy performed on June 26, 2020. The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c).

As stated above, during his December 2024 Board hearing, the Veteran testified that his right knee condition started during service but was not noted in his medical records. See December 2024 Hearing Transcript at 7. While in service he was running five to six miles a day carrying heavy equipment and sometimes his right knee would fail. He stated he fell a few times due to his knee and was taken to the hospital and was either given Motrin or ice but nothing was written in his record. He stated he didn't realize it wasn't in his record until he returned to civilian life. Id.

The Veteran's service treatment records (STRs) indicate that in July 1987, he reported a sore left knee and was diagnosed with, and treated for, a left knee strain. See October 1996 STRS. In October 1989, he reported a left knee injury from a soccer game and was treated for the injury. In addition, he reported left knee pain during his July 1995 separation examination. Id. However, his STRs are silent for any complaints, treatment, symptoms or diagnosis of a right knee condition.

The Veteran's VA medical treatment record note complaints of right knee pain in 2013; however, a May 2013 x-ray indicated an unremarkable examination and normal right knee. See March 2014 VA Medical Treatment Records. In June 2018, the Veteran reported his right knee gave out causing him to fall and x-rays indicated medium joint effusion in the right knee. See August 2018 VA Medical Treatment Records. In June 2020, the Veteran had a right knee arthroscopy and partial medial lateral meniscotomy to treat his diagnosed right knee derangement condition. See August 2020 VA Medical Treatment Records.

During a September 2018 VA examination for knee conditions, the Veteran reported pain and swelling of the left knee. Both knees were examined, and while his right knee did have decreased range of motion with flexion limited to 130 degrees, no pain was noted during the examination with or without weight-bearing or with palpation, and there was no evidence of crepitus, instability or decreased muscle strength. The examiner confirmed the diagnosis of left knee joint osteoarthritis. There was no diagnosed right knee condition. Id.

The Board finds the Veteran's right knee condition is not due to, or caused by, his military service. The evidence of record is silent for any treatment, complaints or diagnosis of a right knee condition until his report of right knee pain in 2013, approximately 18 years after service. While the Veteran testified that he had issues with his right knee during service and was treated in the hospital for the condition, his STRs indicate he was seen and treated on multiple occasions for pain and injury to his left knee, not his right knee. See December 2024 Hearing Transcript and October 1996 STRS. Further, even if the Veteran's statements regarding the failure of his doctors to note treatment for his right knee in his STRs were credible despite documenting treatment for his left knee condition, the Veteran failed to explain why he only reported left knee pain during his separation examination and not also his alleged right knee pain. Id. The Veteran's VA medical treatment records first indicate reports of right knee pain in 2013; however, contemporaneous imaging was normal. See March 2014 VA Medical Treatment Records. During a September 2018 VA examination, the Veteran denied right knee pain and there was no diagnosed right knee condition. See September 2018 VA Examination.

While the Veteran believes his right knee condition is related to his service, the evidence fails to support that his current condition is related to an in-service injury, event, or disease. Further, the Veteran is not competent to provide a diagnosis or causal relationship in this case. The issues are medically complex and require specialized medical education and knowledge to determine the nature and etiology of the conditions. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, including his STRs, VA medical treatment records and the September 2018 VA examination.

The Board finds the evidence fails to support that the Veteran's right knee condition was due to service and therefore the benefit-of-the-doubt doctrine does not apply. Accordingly, the claim for entitlement to direct service connection for a right knee condition must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc).

However, as stated above, secondary service connection may still be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310; Spicer, 61 F.4th at 1365.

During his December 2024 Board hearing, the Veteran raised a new theory of causation, that his right knee condition was secondary to his service-connected left knee disability. While the Veteran testified that his right knee condition started during service, he stated that it was also possible that his right knee symptoms were exacerbated or worsened due to compensating for the left knee for so long. See December 2024 Transcript at 3. In addition, he testified that he was told by his doctor that his right knee condition may have started in service or may have been caused by compensating for the left knee condition. See December 2024 Transcript at 8. He stated that he was unable to get a medical opinion from that doctor because the doctor had died. The hearing judge explained to the Veteran and his representative that they had 90 days to obtain and submit a medical nexus opinion from either a private or VA doctor and they stated they understood. Id. No such evidence was submitted to the Board.

The medical evidence of record does not support the Veteran's assertions at the December 2024 Board hearing. The 2018 records mentioned above indicate that the right knee "gave way" without reference to the left knee. The Veteran was seen for a 2018 VA examination in connection with his prior claims. At that time, the examiner indicated that the functional limitation caused by the service-connected left knee disability was that the Veteran could not walk

While the Veteran is competent to report what his doctor told him, he is not competent to provide a diagnosis or causal relationship in this case, as
obtain and submit a medical nexus opinion from either a private or VA doctor and they stated they understood. Id. No such evidence was submitted to the Board.

While the Veteran is competent to report what his doctor told him, he is not competent to provide a diagnosis or causal relationship in this case, as there is no evidence he has the specialized medical education and knowledge to determine the nature and etiology of the condition. Jandreau, 492 F.3d at 1377. To the extent that he testified that he overused his right knee due to his left, the Board finds this testimony outweighed by his VA treatment records.

As discussed above, the Veteran's VA medical treatment records indicate reports and treatment for right knee pain in 2013, June 2018 and June 2020. See March 2014 and August 2020 VA Medical Treatment Records. He also received a cane solely for right knee pain in December 2017. He was noted to have an unsteady gait at an April 2019 primary care visit, but only right knee effusion was noted. The left knee was not referenced. He had a normal gait in September and October 2019 and March 2020, before receiving a walker due to increasing problems with the right, not left, knee in June 2020. He underwent surgery in August 2020. The pre- and post-operative notes and physical therapy records do not mention the left knee disability. The VA treatment records simply do not reference any problems created by the left knee disability.

The September 2018 VA medical opinion indicated decreased range of motion in the Veteran's right knee, however no pain was reported and there was no diagnosed right knee condition. See September 2018 VA Examination. Further, the Veteran stated that his left knee condition limited his walking, which suggests that his right knee was not overly impacted as he was not walking long distances and placing increasing strain on his right knee. Id.

Within 90 days of his Board hearing, the Veteran did not submit additional medical evidence in support of his claim that his right knee condition was caused or aggravated by his service-connected left knee condition.

A claimant has the burden to "present and support a claim for benefits" and the benefit of the doubt standard in section 5107(b) is not applicable based on pure speculation or remote possibility. 38 U.S.C. § 5107(a); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009). Even where uncontradicted, competent evidence is of record, the evidence may fail to support the claim. Fagan, 573 F.3d at 1289-90. The Board finds that the Veteran's testimony is too vague and, without more, is insufficient to find that, but for the left knee disability, he would not have the right knee disability, or the right knee disability would be less severe.

As the Veteran raised the theory of secondary service connection during his Board hearing, there is no pre-decisional duty to assist error in developing that theory of entitlement, including requesting a VA medical opinion. 38 C.F.R. § 20.802(a). While the AOJ did obtain a medical opinion regarding direct service connection, they did not request a medical opinion regarding secondary service connection as the theory was not raised until the Board hearing and the record at the time of the AOJ's decision did not contain any indication that the Veteran's right knee condition was related to his left knee condition. Therefore, VA did not have an obligation to obtain a medical opinion regarding secondary service connection in this case. 38 U.S.C. § 5103A(e)(1).

Based on a review of the evidence, the Board finds the Veteran's right knee condition is not due to, or aggravated by, his left knee condition. There is no medical evidence of record supporting the Veteran's service-connected left knee condition caused or aggravated his current right knee condition. See March 2014 and August 2020 VA Medical Treatment Records and September 2018 VA Examination.

The Board finds the evidence fails to support that the Veteran's right knee condition was due to, or aggravated by, his service-connected left knee condition and therefore the benefit-of-the-doubt doctrine does not apply. Accordingly, the claim for entitlement to secondary service connection for a right knee condition must be denied. See
5103A(e)(1).

J. B. FREEMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. Aubee, 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.

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