09-14 366
09-14 366
| Board of Vet. App. | Jan 31, 2017Background
- Veteran served on active duty Jan 1986–Feb 1991 and filed for VA disability for a left knee condition claimed secondary to a service‑connected low back strain with left leg radiculopathy (sciatica).
- Initial RO decision in Oct 2008; appeals and remands followed (Board remanded in Mar 2013 and Aug 2015) for development and VA examinations; examinations were completed in Aug 2008 and Nov 2015.
- VA granted service connection in July 2012 for left lower extremity radiculopathy related to the service‑connected low back strain.
- August 2008 VA exam diagnosed left sciatica but found no musculoskeletal knee disability; November 2015 exam noted left knee degenerative joint disease (DJD) on x‑ray and opined the knee condition dated to 2007 and could be exacerbated by nonservice factors (e.g., obesity).
- Veteran reported episodes where his left leg "gave out" causing falls (including a 2007 work injury exiting a truck) and attributed subsequent knee problems to those falls caused by service‑connected radiculopathy.
- Board concluded the evidence is at least in equipoise that the left knee DJD is proximately due to or the result of the service‑connected low back disability with left leg radiculopathy and granted secondary service connection. TDIU claim was remanded as inextricably intertwined with the newly granted knee service connection.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for left knee as secondary to service‑connected low back/sciatica | Left leg numbness/weakness from service‑connected sciatica caused falls (e.g., 2007), producing or aggravating knee DJD | Knee DJD results from aging/obesity and a 2007 workplace injury, not service connection | Granted: evidence in equipoise; left knee DJD service‑connected as secondary to service‑connected low back/sciatica |
| Adequacy of VA development and exams | VA exams and file review support claim; development complete | VA satisfied duty to notify and assist; examinations adequate | VA satisfied notice and duty to assist; additional development unnecessary |
| TDIU (total disability based on individual unemployability) | Service‑connected conditions in combination render Veteran unemployable | Need current ratings and consideration of the new knee service connection before adjudicating TDIU | Remanded to AOJ for development/readjudication (TDIU inextricably intertwined with knee rating) |
| Application of benefit‑of‑the‑doubt/standard of proof | Close medical evidence favors service connection on equipoise | Denial appropriate if preponderance of evidence against claim | Where evidence is in approximate balance, benefit of the doubt awarded to claimant — here supports service connection |
Key Cases Cited
- Stegall v. West, 11 Vet. App. 268 (remand compliance requirement)
- Shedden v. Principi, 381 F.3d 1163 (service‑connection elements)
- Gilbert v. Derwinski, 1 Vet. App. 49 (benefit‑of‑the‑doubt rule)
- Barr v. Nicholson, 21 Vet. App. 303 (adequacy of examiner’s file review and opinion)
- Walker v. Shinseki, 708 F.3d 1331 (chronic disease/continuity of symptomatology principles)
- Kuppamala v. McDonald, 27 Vet. App. 447 (Board’s jurisdiction on extraschedular TDIU after Director denial)
- Ephraim v. Brown, 5 Vet. App. 549 (inextricably intertwined claims doctrine)
- Bagwell v. Brown, 9 Vet. App. 337 (framework for extraschedular TDIU referral)