Entitlement to service connection for the right knee disorder is denied.

Citation Nr: 26001393 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 18-48 842 DATE: January 30, 2026 ORDER Entitlement to service connection for the right knee disorder is denied. Entitlement to service connection for the left knee disorder is denied. REMANDED Entitlement to service connection for a disorder manifested with dizziness, to include an acquired psychiatric disorder, is remanded. FINDING OF FACT The Veteran's bilateral knee disorders were not incurred in or etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for the right knee disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for the left knee disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served in the United States from Army from December 1993 to April 1997. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2017 rating decision issued by a Department of Veterans Affairs (VA). The Veteran testified at a hearing before a now retired Veterans Law Judge of the Board in April 2022. A transcript of the hearing has been associated with the claims file. In December 2025 correspondence, the Veteran was given the opportunity to request another hearing and was notified that if he did not provide a response in 30 days, it would be assumed that he did not want another hearing. The Veteran responded to that letter stating he did not request another Board hearing, and the Board will therefore proceed. In July 2024, the Board issued a decision denying entitlement to service connection for a right ankle disability, dizziness, a right knee disability, and a left knee disability. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In an August 2025 Order, the Court granted a Joint Motion for Partial Remand of the parties and remanded the case to the Board for action consistent with the Joint Motion. The case has now been returned to the Board for appellate action. Service Connection The Veteran seeks entitlement to service connection for bilateral knee disorders as etiologically related to his active service. Specifically, the Veteran contends that he injured his knees during service but did not go to sick call as a result of a stigma, and did not seek treatment for his knee conditions because he was unaware of VA medical care. See Board hearing transcript, April 20, 2022. In addition, the Veteran testified that his bilateral knee disorders were as a result of the physical rigors related to his active service. Id. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 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"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he/she files his/her claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3rd 1391 (2021). It is undisputed from the record that the Veteran has currently diagnosed bilateral knee disorders. See VA examination report, January 23, 2024. In addition, the Board finds that the Veteran experienced knee injuries in service. Service treatment records indicated that the Veteran sought treatment for two right knee injuries. In June 1995, the Veteran injured his right knee during a "25 miler" and was diagnosed with a possible knee strain in service. The Veteran sought treatment for the right knee again in August 1995; at that time, he reported a medical history of two weeks of pain and was diagnosed with traumatic patellofemoral pain syndrome. Additionally, during the April 2022 Board hearing, the Veteran testified that his military occupational specialty (MOS) required him to carry heavy 100-poud rucks, which was physically demanding on his body, including his knees, but he claimed that he did not "go to sick call" and instead "just drove on." The Board finds the Veteran credible in this regard. Accordingly, the remaining question before the Board is whether the currently diagnosed bilateral knee disabilities were incurred in or etiologically related to service. Turning to the evidence, the Veteran was afforded a VA examination in July 2002. At that time, the Veteran reported bilateral knee pain since 1994. He explained that he hit the right knee against a tree during a "night operation" in military service with no specific injury to the left knee. The Veteran reported continuing knee pain that was exacerbated by navigating stairs; he experienced low-grade knee pain on a daily basis. The VA examiner diagnosed right knee strain with limited motion, and left knee strain without limited motion. The VA examiner did not render a medical opinion at this time. When VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, the Board finds the July 2002 VA examination report incomplete to decide the claim. The Veteran was afforded another VA examination in January 2024. At this time, the Veteran reported he tore his ACL around 2008 after separation but that was due to rolling his ankle. He reported knee issues that had gradual onset during service as a result of the physical rigors of service; he reported he was seen during service several times during active service. The VA examiner diagnosed a bilateral strain. The January 2024 VA examiner opined that the bilateral knee disorders were less likely than not due to the "special training, which included hikes with heavy weight, a Parachutist's Badge, Ranger training, and continued jumps to maintain the jump status" in service. In this regard, the VA examiner stated that the service treatment records only show two instances of acute right knee pain during the summer of 1995 and it was thought to be patellofemoral pain syndrome (PFPS). The VA examiner explained that PFPS does not necessarily lead to chronic issues and that there was no further report of continue knee pain until 2002. In addition, the VA examiner noted that symptoms related to right knee PFPS were not mentioned in any other service treatment records and therefore found that it resolved in service. The VA examiner noted that in 2012 post service treatment records, the Veteran reported "no prior knee problems." The VA examiner noted that the service treatment records were silent for a left knee injury. The VA examiner further explained that while being in the infantry and parachutist does require duties and repetitive use that could lead to a knee condition, there is insufficient objective evidence to show any signs of a chronic injury shortly after service, noting that the Veteran worked as an electrician after leaving military service. As to the left knee, the January 2024 VA examiner opined it was less likely than not due to the "special training, which included hikes with heavy weight, a Parachutist's Badge, Ranger training, and continued jumps to maintain the jump status" in service. The VA examiner noted that the service treatment records were silent for a left knee injury. In 2002, the Veteran reported left knee pain related to a strain with no objective, x-ray evidence of any other diagnosis. The VA examiner noted that the claims file is silent for a left knee disorder until 2012 and, at that time, the Veteran reported having no prior knee problems." According to the VA examiner, "[a]though being in the infantry and parachutist does require duties and repetitive use that could lead to a knee condition, there is insufficient objective evidence to show any signs of a chronic injury after service, other than subjective report 5 years later." The Board affords the January 2024 VA medical opinion highly probative. The VA medical opinion provided a thorough review and assessment of both the Veteran and his lay statements, including medical literature and the circumstances of his service. In addition, the VA doctor considered the lay statements and contentions of the Veteran, and provided an opinion supported by a clear rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In addition, the VA doctor considered the Veteran's circumstances of his service, to include the impact of the physical demands of the Veteran's specific service, injuries, and in-service diagnoses, when rendering the opinions. Accordingly, this opinion is afforded high probative weight. The Board acknowledges the statements of the Veteran as to the existence and etiology of his claimed bilateral knee disorder and acknowledges that the Veteran is competent to give evidence about what he experienced, including chronic post-service symptoms and pain. See Layno v. Brown, 6 Vet. App. 465 (1994). However, while the Veteran is competent to report his current symptoms, as a lay person he does not have the education, training, or experience to diagnose or opine as to the etiology of the condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1377-78 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). Therefore, the Veteran's statements are of low probative value and the Board affords more probative weight to the medical evidence of record. The Board also notes that in the August 2025 JMPR, the parties agreed that the Board failed to address several of the Veteran's contentions, including failure to report to sick call for his knee condition, that he did not seek treatment for his knee condition because he was unaware that he had VA insurance, and his wife also testified that the Veteran refused to seek treatment for his knees based on stigma. Although the Veteran contends that the bilateral knee pain was chronic starting from service and continuing until now, the medical examiner concludes that these knee disorders do not have a pathology of chronicity. Further, the Veteran was first diagnosed with bilateral knee strain in July 2002, five years after separation of service. The Board is sympathetic to the Veteran's contentions, however, Therefore, the Veteran's contentions are without merit. As noted above, the January 2024 VA opinion is highly probative as the VA examiner reviewed the claims file, interviewed the Veteran, relied on medical literature, and provided clear supporting rationale for the conclusions reached. Notably, the January 2024 VA examiner noted the Veteran's contentions, and clearly explained why his bilateral knee disorders were less likely than not related to his later diagnosis many years following separation from active service. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (a prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability); see also Horn v. Shinseki, 25 Vet. App. 231, 239 (2012). To the extent the Veteran believes that his current bilateral knee disorder is related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this regard, a bilateral knee disorder can have many causes and medical expertise is needed to determine the etiology of the disorder. Accordingly, the Veteran's opinion as to the etiology of his bilateral knee disorder, which was first shown by competent and credible evidence many years after service, is not competent medical evidence. The Board finds that the only probative medical evidence of record, the findings and opinion of the January 2024 VA examiner, to be of greater probative value than the Veteran's lay contentions. Therefore, the Board finds that the criteria for service connection for left and right knee disorders are not met. The appeals are denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra. REASONS FOR REMAND 1. Service Connection - Dizziness The Veteran seeks entitlement to service connection for dizziness as etiologically related to his active service. He also contends that the dizziness could be related to psychiatric medication he has been taking. See Board hearing transcript, April 20, 2022. Service connection is not currently in effect for any psychiatric disorder. In the August 2025 JMPR, the parties found the Board failed to address whether the Veteran was entitled to service connection for a psychological disorder resulting in his dizziness symptomatology. The parties noted that the January 2024 VA opinion indicated that the Veteran's dizziness was related to a psychological disorder rather than service. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed psychiatric disorder nor for his dizziness. VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to make a decision on the claim. 38 U.S.C. § 5103A (d) (2012); 38 C.F.R. § 3.159 (c)(4) (2019); Duenas v. Principi, 18 Vet. App. 512 (2004); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (holding that a lay person is competent to report a contemporaneous medical diagnosis); McLendon v. Nicholson, 20 Vet. App. 79 (2006). For below noted reasons, the Board finds that a VA examination is necessary in order to determine the nature and etiology of the Veteran's claimed disorders. The Veteran has not yet been afforded a VA examination to determine the etiology of his claimed dizziness. Therefore, on remand, such an examination with an opinion should be obtained. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claim file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Then, schedule the Veteran for a VA examination with a VA psychologist or psychiatrist and obtain an etiology opinion to determine the nature and etiology of the Veteran's claimed dizziness. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Identify any and all disorders, to include psychiatric disorders, that are manifested with the Veteran's symptoms of dizziness. The examiner's report must reflect consideration of the Veteran's entire documented medical history and lay statements that describes the symptoms, their onset, and to what the Veteran originally attributed the symptoms. Thereafter, the examiner should respond to the following questions: Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any currently present disorder manifested by dizziness, to include an acquired psychiatric disorder, had its onset during the Veteran's active service, or is otherwise etiologically related to such service? The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. Mariah N. Sim Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Costantino, Danielle K. 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.