## Facts

- Melba J. Saunders served on active duty in the U.S. Army from November 1987 to October 1994.
- During service, she sought treatment for knee pain and was diagnosed with patellofemoral pain syndrome.
- Her separation examination recorded normal lower extremities but noted a history of swollen joints.
- In 1994, she sought disability compensation for knee and other conditions; the claim was denied after she failed to report for a VA examination and she did not appeal.
- In 2008, she filed a new claim for a bilateral knee disability; the VA reopened the claim but denied it for lack of current medical evidence of a knee condition.
- A 2011 VA examination recorded bilateral knee pain with activities but found no anatomic abnormality, weakness, or reduced range of motion.
- The examiner recorded functional limits, including difficulty walking, inability to stand for more than a few minutes, occasional use of a cane or brace, and effects on daily activities and work attendance.
- Although the examiner opined the condition was at least as likely as not related to service, the examiner declined to provide a diagnosis due to “no pathology to render a diagnosis,” labeling it subjective bilateral knee pain.

## Issues

1. Whether “disability” in 38 U.S.C. § 1110 requires a diagnosed disease or injury, or instead includes pain that causes functional impairment.
2. Whether pain alone, without an identified underlying condition, can satisfy the “current disability” element for service connection when it functionally impairs earning capacity.

## Decision

- The Federal Circuit reversed the Court of Appeals for Veterans Claims.
- The court held that “disability” in § 1110 refers to functional impairment of earning capacity, not to the presence of a diagnosed condition.
- The court held that pain alone can qualify as a disability if it reaches the level of functional impairment of earning capacity.
- The court rejected the categorical rule that pain without an underlying diagnosis can never constitute a disability.
- The case was remanded for application of the correct standard, including whether Saunders’s pain caused functional impairment of earning capacity and whether it was connected to service.

## Legal Principles

- For § 1110, “disability” means functional impairment of earning capacity.
- A diagnosis is not required if the claimant proves functional impairment of earning capacity.
- Pain, even without an identified underlying disease or injury, can be a compensable disability if it causes functional impairment of earning capacity.
- Subjective reports of pain are insufficient unless the pain results in functional impairment.
- Service connection still requires (1) a present disability (including qualifying pain-based impairment), (2) an in-service event, injury, or disease, and (3) a nexus between service and the present disability.

## Conclusion

The Federal Circuit held that veterans may establish a compensable disability under 38 U.S.C. § 1110 based on pain without a diagnosis when the pain causes functional impairment of earning capacity, and it remanded for determination of whether Saunders’s knee pain met that standard and was service connected.


Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018)