Entitlement to service connection for a bilateral knee disability, to include as secondary to service-connected cold injury residuals and bilateral lower extremity peripheral neuropathy, remanded.

Citation Nr: 26001445 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 12-06 586 DATE: January 30, 2026 REMANDED Entitlement to service connection for a bilateral knee disability, to include as secondary to service-connected cold injury residuals and bilateral lower extremity peripheral neuropathy, remanded. REASONS FOR REMAND The Veteran had honorable active-duty service from August 1976 to July 1979. He also had a subsequent period of service which was not honorable, and which does not qualify him for VA benefits related to injuries or illness related to this service. This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued in November 2008 by a Department of Veterans Affairs (VA) Regional Office (RO). In an October 2024 Decision, the Board denied entitlement to service connection for a bilateral knee condition. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (CAVC). The Veteran and the Office of the General Counsel for VA (collectively referred to as "the Parties") resolved that appeal by way of an August 2025 Joint Motion for Remand (JMR). The Parties agreed that the Board needed to readjudicate the issue and it was vacated and remanded to the Board. 1. Entitlement to service connection for a bilateral knee disability, to include as secondary to service-connected cold injury residuals and bilateral lower extremity peripheral neuropathy remanded. As noted above, in August 2025, CAVC granted a JMR and remanded the Veteran's claim of entitlement to service connection for a bilateral knee condition. The JMR noted that the Board erred when it relied upon the inadequate March 2021 VA opinion. In the March 2021 VA opinion, the examiner acknowledged the 1977 cold weather injury, and a May 1978 note of a strained muscle after lifting a safe. The Veteran's service treatment records were negative for any other diagnosis or treatment of knee pathology while in the service. The examiner noted that March 2002 treatment records reflected that the Veteran complained of his right knee giving out while using the stairs. A treatment note from June 2002 referred to an incident in 1993 when the Veteran was assaulted with a baseball bat to the right knee which required surgery to the tibia and fibula. A July 2003 treatment record reflected that he reported continued bilateral knee pain and a diagnosis of bilateral knee degenerative arthritis. An X-ray of the right knee in August 2004 showed an old, healed fracture of the tibia and fibula. Treatment records from October 2006 reflected that the Veteran reported pain in his left and right knees. The Veteran's service treatment records did not show any injury to his knees in service that would be the cause or contribute to his current diagnosis of degenerative arthritis of both knees and/or a meniscal tear of the right knee. The examiner stated that it was more plausible that normal wear and tear associated with aging, or from previous traumatic injuries (after service) would be a more likely reason for the Veteran's current conditions. With respect to the cold exposure in 1977, frostbite arthritis usually manifested several months or years after cold exposure and mainly affected the small joints of the hands or feet. The time interval between the frost injury and clinical symptoms were variable-and generally ranged from three to 10 years. It did not seem medically likely that the cold exposure would manifest itself just in the knee joints (and spare the smaller joints) some 25 years after the cold exposure. Examination of service treatment records from May 1978 showed that he was seen and diagnosed with a strained muscle after lifting a safe. The medical records noted that the "pain started on the left groin area to knee." There was no specific complaint to the knee itself, but it was only describing a location of the muscle pain between the groin and knee. The examiner explained that post-traumatic arthritis (PTA) developed after acute direct trauma to the joint. Symptom onset could be as long ago as two to five years after an injury to the joint was sustained. As the Veteran's May 1978 injury was not directly involving the joint, and there was only one isolated treatment record for this injury, it was not medically plausible to equate this injury to the current conditions of left or right knee arthritis and/or a meniscus tear in the right knee nearly 25 years later. The examiner also denied continuity of symptomatology as the symptoms of knee pain were not present while the Veteran was in service and there was a large gap between discharge and the start of symptoms. As such, nexus was denied. The Parties noted that the March 2021 examiner denied nexus as the symptoms of knee pain were not present while the Veteran was in the service and as there was a 20 to 25 year gap before the knee pain was documented in the treatment records. This was despite the Veteran's May 2023 Board hearing, during which he testified that, following his cold injury in service, he noticed swelling and pain in his knees. He also testified that following discharge, he continued to experience knee swelling and pain, which he described as continuous and worsening over time. The VA examiner did not address the Veteran's lay statements in the opinion. See Miller v. Wilkie, 32 Vet. App. 249, 257 (2020) ("There is no question that adequately informing the Board of the veteran's disability while considering prior medical history requires addressing the veteran's lay reports of symptomatology."). As such, the Board finds that remand is required in order to obtain an adequate VA opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's bilateral knee condition from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not that the bilateral knee condition had onset in, or is otherwise related to, active service, to include an in-service cold injury. The examiner must specifically address the Veteran's lay statements regarding the onset and continuity of his symptoms, to include his report that he noticed swelling and pain in his knees following his cold injury in service and that he experienced worsening knee swelling and pain following service. The examiner is asked to address whether these reported in-service and post-service "knee" symptoms are related to his bilateral knee disabilities versus his already-service connected cold injury residuals of the bilateral lower extremities. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AK 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.