OSTEOARTHRITIS

Summary

The veteran, who served in the U.S. Navy from March 2006 to August 2007, appeals the denial of service connection for a right knee disability, specifically degenerative arthritis other than post-traumatic. The veteran claimed the condition was caused by an in-service sports injury and stair-climbing incident. However, service treatment records did not indicate any right knee complaints or treatment during service, though they did note a left knee surgical scar and a history of left knee ACL repair and bilateral meniscectomies. The enlistment examination found the veteran sound regarding the right knee. Post-service treatment in September 2009 indicated a right knee injury from flag football. VA examinations in February and March 2025 concluded that the right knee degenerative arthritis was less likely than not incurred in or caused by service, citing the lack of in-service complaints, diagnosis, or treatment, and the post-service onset of the injury. The Board found these opinions probative and denied service connection for the right knee, noting the passage of time and lack of nexus evidence. The case is remanded for further development regarding the left knee disability, as the veteran had a pre-existing left knee condition (ACL repair) and the Board needs an opinion on whether this condition was aggravated during service, as the presumption of soundness does not apply.

Rationale

No in-service complaints, diagnosis, or treatment for right knee disability.; Right knee injury occurred post-service (flag football in 2009).; VA examiners opined less likely than not related to service.

Full Decision Text

Citation Nr: A26040890
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250901-580114
DATE: April 30, 2026

ORDER

Entitlement to service connection for right knee, degenerative arthritis, other than post-traumatic (right knee disability) is denied.

REMANDED

Entitlement to service connection for left knee, degenerative arthritis, other than post-traumatic and knee cartilage restoration surgery (left knee disability) is remanded.

FINDING OF FACT

The Veteran's right knee, degenerative arthritis, other than posttraumatic did not have its onset during active service, did not manifest within one year of service separation, and is not otherwise etiologically related to such service.

CONCLUSION OF LAW

The criteria for service connection for right knee, degenerative arthritis, other than posttraumatic have not been met. 38 U.S.C. §§ 1110, 5107 (2024); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2025).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from March 2006 to August 2007. 

These matters come to the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision.

In September 2025, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision, as well as any evidence submitted by the Veteran or his representative within 90 days following the receipt of the VA Form 10182. 38 C.F.R. § 20.302(a). 

If the Veteran would like VA to consider any evidence that was submitted and 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.

Service Connection - Right Knee Disability

The Veteran contends that his right knee disability was caused by service. Specifically, the Veteran reported that he injured his knees while playing sports (tore his anterior cruciate ligament (ACL)) in service and injured his knees going up and down stairs. 

A review of the Veteran's service treatment reports (STRs) does not reveal any complaints, findings, or treatment for a right knee disability. Of note, the December 2005 enlistment examination noted a left knee surgical scar. On a report of medical history form, the Veteran reported knee trouble and knee surgery. The clinician noted a left knee ACL repair and bilateral meniscectomies. However, at an examination in March 2006, a clinician noted only a surgery of the left knee prior to service in 2002 but no pre-existing right knee disability. As such, the Veteran was presumed sound at his entrance to service with regard to the right knee. 

Post-service VA outpatient treatment reports indicate that the Veteran sustained a right knee injury playing football in September 2009 (after service separation) and was seen in the emergency room.

At a February 2025 VA knee examination, the Veteran reported knee pain during service and right knee surgery in 2019. Following a clinical evaluation, the examiner diagnosed the Veteran with right knee, degenerative arthritis, other than post-traumatic and opined that it was less likely than not incurred in or caused by service. The examiner's rationale was that there is no direct service record evidence this condition occurred in service or was caused by service. Further, without objectively demonstrable complaints/diagnosis/care - to a degree to substantiate a disability - during service/within one year after separation, and without a previous diagnosis for the claimed right knee degenerative arthritis nor a precipitating cause for the condition in service, the nexus requirement is not established. Finally, the right knee condition was noted in 2009 when the Veteran complained of a right knee injury after playing flag football. Therefore, this injury occurred post service. 

In a March 2025 VA addendum opinion, a VA clinician reviewed the claims file and opined that the right knee disability was less likely than not incurred in or caused by service. The examiner's rationale was that the STRs are silent for complaint of or injury to the right knee in service. The right knee condition was noted in 2009 on
 disability - during service/within one year after separation, and without a previous diagnosis for the claimed right knee degenerative arthritis nor a precipitating cause for the condition in service, the nexus requirement is not established. Finally, the right knee condition was noted in 2009 when the Veteran complained of a right knee injury after playing flag football. Therefore, this injury occurred post service. 

In a March 2025 VA addendum opinion, a VA clinician reviewed the claims file and opined that the right knee disability was less likely than not incurred in or caused by service. The examiner's rationale was that the STRs are silent for complaint of or injury to the right knee in service. The right knee condition was noted in 2009 on a VA outpatient treatment report dated in November 2009 in which the Veteran complained of a right knee injury after playing flag football. Therefore, this injury occurred post service. 

In considering the evidence of record and the applicable laws and regulations, the Board concludes that the Veteran is not entitled to service connection for right knee, degenerative arthritis, other than post-traumatic.

As noted, the Veteran was not treated for a right knee disability in service, and a right knee disability was not diagnosed for many years after service. The passage of time between discharge from active service and the medical documentation of a claimed disability, while not dispositive on the issue of service connection, is a factor that tends to weigh against the claim. Additionally, arthritis did not manifest within one year of service separation. Moreover, there is no medical opinion or other medical evidence in the file linking the right knee disability to service. Indeed, the February and March 2025 VA examiners found that the Veteran's right knee disability was less likely than not incurred in or caused by service and included complete rationales with the opinions. Therefore, the Board finds that VA examiners' opinions significantly probative. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced. However, the ultimate questions of diagnosis and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance, and entitlement to service connection for right knee, degenerative arthritis, other than post-traumatic is not warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

REASONS FOR REMAND

A review of the claims file reveals that a remand is necessary to correct a pre-decisional duty to assist error with regard to the claim for a left knee disability.

The Veteran seeks service connection for a left knee disability. The Veteran's December 2005 enlistment examination clearly indicates that the Veteran had a left knee disability prior to service. Specifically, he was reported to have left anterior knee surgical scar secondary to ACL repair surgery in 2002. As such, the presumption of soundness does not apply, and the question is whether service connection is warranted based on aggravation of his pre-existing left knee disability during service. A preexisting injury or disease will be considered to have been aggravated during service when there is an increase in disability during service, unless there is a specific finding (clear and unmistakable evidence) that the increase in disability is due to the natural progression of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). That is, clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306(b).

The presumption of aggravation applies only when the Veteran shows the pre-service disability increased in severity during service. Beverly v. Brown, 9 Vet. App. 402 (1996). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; Falzone v. Brown
 (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306(b).

The presumption of aggravation applies only when the Veteran shows the pre-service disability increased in severity during service. Beverly v. Brown, 9 Vet. App. 402 (1996). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; Falzone v. Brown, 8 Vet. App. 398 (1995). See also Davis v. Principi, 276 F.3d 1341 (Fed. Cir. 2002) (which holds that evidence of a temporary flare up, without more, does not satisfy the level of proof required of a non-combat Veteran to establish an increase in disability). Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition itself, as contrasted with mere symptoms, has worsened. See Jensen v. Brown, 4 Vet. App. 304 (1993); Green v. Derwinski, 1 Vet. App. 320 (1991); Hunt v. Derwinski, 1 Vet. App. 292 (1991). Accordingly, "a lasting worsening of the condition" - that is, a worsening that existed not only at the time of separation but one that still exists currently is required. See Routen v. Brown, 10 Vet. App. 183 (1997); see also Verdon v. Brown, 8 Vet. App. 529 (1996). Moreover, the application of the presumption of aggravation is not automatic, for purposes of determining whether a disability is service-connected. Instead, application of the presumption aggravation first requires a showing of a permanent worsening of a preexisting condition during the relevant period of service. Hill v. McDonald, 28 Vet. App. 243 (2016).

In February 2025, the Veteran reported that he tore his ACL and hurt his knees while playing sports and going up and down stairs in the Navy. 

At a February 2025 VA knee examination, the Veteran reported knee pain in service. The examiner diagnosed the Veteran with left knee, degenerative arthritis, other than posttraumatic and knee cartilage restoration surgery and opined that it was less likely than not incurred in or caused by service. However, as noted, the Veteran's left knee disability pre-existed service and an addendum opinion should be obtained to determine whether the left knee disability was aggravated during service. 

The matters are REMANDED for the following action:

Obtain an addendum opinion from a qualified VA clinician addressing the etiology of the Veteran's left knee disability. The examiner must be provided with access to the electronic claims file and indicate review of the file in the examination report. 

If the requested opinion cannot be provided without examining the Veteran, then an examination must be scheduled. 

The examiner must indicate whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left knee disability was aggravated during service. The examiner must consider the Veteran's lay statements regarding knee trouble due to sports and climbing stairs during service. 

If aggravation is found, the examiner must indicate whether the aggravation, or worsening, was clearly and unmistakably due to the natural progression of the disease. 

 

 

David H. Robertson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Cryan, 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.