Entitlement to service connection for left knee arthritis is granted.

Citation Nr: A26069925 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 220214-318379 WahDATE: July 30, 2026 ORDER Entitlement to service connection for left knee arthritis is granted. Entitlement to service connection for right knee arthritis is granted. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran's currently diagnosed left knee disability had its onset during service. 2. The evidence is in equipoise as to whether the Veteran's currently diagnosed right knee disability had its onset during service. CONCLUSIONS OF LAW 1. The criteria to establish service connection for a left knee disability are met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria to establish service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1990 to June 2000. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2022 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran selected the hearing lane when submitting his VA Form 10182 (Decision Review Request: Board (Notice of Disagreement)). The Veteran testified before a Veterans law judge (VLJ) at an October 2025 videoconference hearing. The transcript has been associated with the electronic claims file. Since the Veteran elected the Board Hearing Lane, the Board will consider evidence of record at the time the Veteran opted into the AMA as well as evidence submitted at the hearing and within 90 days of the hearing. The Board notes that the Veteran submitted additional evidence in December 2022 with his VA Form 10182. However, as the Veteran selected the hearing lane, this evidence is ineligible for review in the current appeal. Under the hearing lane, the Board may only consider evidence available at the time of the August 2022 rating decision and any evidence submitted at the October 2025 hearing and 90 days after. 1. Entitlement to service connection for left knee arthritis 2. Entitlement to service connection for right knee arthritis The Veteran asserts entitlement to service connection for bilateral knee disabilities. Establishing service connection generally requires competent evidence showing: (1) the existence of a current 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. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as hypertension, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by evidence to the contrary. 38 C.F.R. §§ 3.307, 3.309. Where the veteran asserts entitlement to a chronic disease, but there is insufficient evidence of a diagnosis in service, the veteran can establish service connection by demonstrating a continuity of symptomatology since service, if the chronic disease is listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331, 1337-39 (Fed. Cir. 2013). For disabilities that are not listed as chronic under 38 C.F.R. § 3.303(b), service connection may be based upon a showing of in-service incurrence or aggravation under 38 C.F.R. § 3.303(a), or by showing that a disease that was first diagnosed after service is related to service under 38 C.F.R. § 3.303(d). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A review of the Veteran's service treatment records (STRs) shows no complaints, treatment, or diagnosis of any knee disability. A November 1990 STR does note that the Veteran reported a bump on his right shin with no history of trauma, assessed as lipoma. The Veteran has submitted a June 2019 private treatment record for his bilateral knees, by Dr. R.H. Dr. R.H. noted the Veteran's report of chronic bilateral knee pain since attending the Naval Academy and during service. Dr. R.H. reported that there is a high probability that the Veteran's bilateral knee disabilities started with heavy training in service and exacerbated by playing soccer for the Navy. Dr. R.H. noted that the Veteran does not have a family history of arthritis and has not had any major injuries since active duty. The Veteran has submitted a July 2019 private treatment record noting his chronic knee pain, by Dr. B.M. Dr. B.M. noted the Veteran's in service training including marches, calisthenics, and running. Dr. B.M. further noted that the Veteran attributed his bilateral knee pain to his athletic training in service. The Veteran has submitted a June 2020 affidavit by Dr. R.H. Dr. R.H. reported that he examined the Veteran's bilateral knees in June 2019, noting diagnoses of left knee advanced degenerative arthritis and a meniscus condition as well as right knee moderate arthritic changes and a medial meniscal tear. Dr. R.H. stated that there is a high probability that the Veteran's bilateral knee disabilities began with his heavy training in service. The Veteran was afforded a VA examination in August 2022. The VA examiner noted a diagnosis of bilateral degenerative arthritis. The Veteran reported bilateral knee pain beginning in service, due to running in combat boots with packs on his back. Following the examination, the VA examiner opined that the Veteran's left knee disability is less likely than not incurred in or caused by his service. In support of this opinion, the VA examiner reasoned that the Veteran's STRs are silent for complaints or treatment of a left or right knee condition. The VA examiner reported that the Veteran's current diagnosis of arthritis is more consistent with his age and normal wear and tear on the body. The Veteran has submitted medical articles documenting injuries during basic training. During his October 2025 Board hearing, the Veteran testified that he played soccer while on active duty as well as heavy training. See October 2025 Hearing Transcript. The Veteran reported that his knees were painful during this time and he would go to the athletic trainers who would give him ice as treatment but would not go to sick bay due to the stigma attached. Id. After reviewing the evidence, the Board concludes that service connection for bilateral knee disabilities is warranted. (Continued on the next page) ? The Board finds there is supportive lay evidence as well as both positive and negative medical evidence as to service connection for the Veteran's current bilateral knee disabilities. The Veteran is competent to report his in-service bilateral knee symptoms. Both the private physician and VA examiner reviewed the Veteran's prior medical history and lay statements in addition to conducting medical exams. The VA examiner determined there was no connection between the Veteran's service and current bilateral knee disabilities while the private physician opined the opposite. Thus, the overall evidence appears to be in relative equipoise as to whether the Veteran's current bilateral knee disabilities are related to service. Resolving reasonable doubt in favor of the Veteran, service connection is warranted for bilateral knee disabilities. 38 U.S.C. § 5107(b); Gilbert, supra. Ardie A. Bland Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Slaughter, 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.