HEARING LOSS

A. J. SPECTOR · 2026 · Case ID: A26005951

DENIED

Summary

The veteran, who served in the Army from August 1975 to February 1977, appeals the denial of service connection for bilateral hearing loss, bilateral tinnitus, left knee disability, left hip disability, lumbar disability, left lower extremity radiculopathy, left thumb disability, adjustment disorder with anxiety and depression, and a compensable rating for a cesarean section scar. The Board denied all claims. For hearing loss and tinnitus, the Board found the VA examiner's opinion to be highly probative, concluding less likely than not related to service due to lack of in-service complaints and onset of symptoms 15-20 years post-service. A private opinion was found conclusory due to lack of rationale. For the left knee, the Board found the veteran's report of an in-service injury not credible due to inconsistencies with service treatment records and the VA examiner's findings. The private opinion was also found inadequate as it relied on the veteran's inconsistent reports. Consequently, the knee claim was denied, and the secondary claims for the hip, lumbar spine, and radiculopathy were also denied as they were predicated on the unservice-connected knee condition. The left thumb claim was denied due to an inadequate private opinion and lack of in-service treatment or complaints, with the VA examiner finding less likely than not related to service. The mental health claim was denied as the VA examiner found symptoms related to current living situations and no indication of in-service onset, and the private opinion was inadequate. The cesarean section scar claim was denied as the scar did not meet the criteria for a compensable rating under the relevant diagnostic codes.

Rationale

VA examiner opinion found less likely than not related to service; Lack of in-service complaints or treatment; Private opinion found conclusory due to lack of rationale

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250701-559559

Full Decision Text

Citation Nr: A26005951
Decision Date: 01/22/26 Archive Date: 01/22/26

DOCKET NO. 250701-559559
DATE: January 22, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for bilateral tinnitus is denied.

Entitlement to service connection for a left knee disability is denied.

Entitlement to service connection for a left hip disability is denied.

Entitlement to service connection for a lumbar disability is denied.

Entitlement to service connection for left lower extremity radiculopathy is denied.

Entitlement to service connection for a left thumb disability is denied.

Entitlement to service connection for adjustment disorder with anxiety and depression is denied.

Entitlement to a compensable rating for a cesarean section scar is denied.

FINDINGS OF FACT

1. The Veteran's bilateral hearing loss did not have its onset during, and is not otherwise related to, military service.

2. The Veteran's bilateral tinnitus did not have its onset during, and is not otherwise related to, military service.

3. The Veteran's left knee disability is not related to active military service.

4. The Veteran's left hip disability is not related to active military service or secondary to a service-connected disability.

5. The Veteran's lumbar disability is not related to active military service or secondary to a service-connected disability.

6. The Veteran's left lower extremity radiculopathy is not related to active military service or secondary to a service-connected disability.

7. The Veteran's left thumb disability is not related to active military service.

8. The Veteran's adjustment disorder with anxiety and depression is not related to active military service or secondary to a service-connected disability.

9. Throughout the period on appeal, the evidence does not show that the Veteran's cesarean section scar was with underlying tissue damage at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters); or associated with underlying tissue damage with an area of 144 square inches (929 square centimeters) or greater; or unstable or painful.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385.

2. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for a left knee disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for a left hip disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for entitlement to service connection for a lumbar disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

6. The criteria for entitlement to service connection for left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

7. The criteria for entitlement to service connection for a left thumb disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for entitlement to service connection for adjustment disorder with anxiety and depression are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

9. The criteria for entitlement to a compensable rating for a cesarean section scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, Diagnostic Codes (DCs) 7801, 7802, 7804, 7805.

REASONS AND BASES FOR FINDINGS AND CONCLUS
disorder with anxiety and depression are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1975 to February 1977.

These matters come before the Board on appeal of a June 2025 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

In July 2025, the Veteran submitted a timely VA Form 10182, Decision Review Request: Board Appeal, and elected the Evidence Submission docket in the Appeals Modernization Act (AMA) process.

Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the VA Form 10182 was received, or (2) evidence submitted more than 90 days after the VA Form 10182 was received. 38 C.F.R. § 20.303.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the claim. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board appreciates that the Veteran has the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); see Williams v. McDonough, 37 Vet. App. 305 (2024). Although the period to change dockets has not elapsed for the June 2025 rating decision, the Veteran is precluded from changing dockets at this juncture because evidence has been submitted. 38 C.F.R. § 20.202(c)(2). Thus, the Board may proceed with adjudication.

Service Connection

Generally, to establish service connection 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." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 U.S.C. § 1110; 38 C.F.R. § 3.303.

Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) aggravated by a service-connected disability.

For certain chronic disorders, to include organic diseases of the central nervous system (e.g., bilateral hearing loss and tinnitus), service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In such cases, the disease is presumed under the law to have had its onset in service even if there is
show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) aggravated by a service-connected disability.

For certain chronic disorders, to include organic diseases of the central nervous system (e.g., bilateral hearing loss and tinnitus), service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In such cases, the disease is presumed under the law to have had its onset in service even if there is no evidence of such disease during service. 38 C.F.R. § 3.307 (a); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker, 708 F.3d at 1331.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant.

1. Entitlement to service connection for bilateral hearing

2. Entitlement to service connection for bilateral tinnitus

For purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the above frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

However, "when audiometric test results at a Veteran's separation from service do not meet the regulatory requirements for establishing a 'disability' at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service." Hensley v. Brown, 5 Vet. App. 155, 160 (1993).

In March 2025, the Veteran was afforded a VA hearing loss and tinnitus examination. The Veteran was diagnosed with bilateral hearing loss, consistent with VA requirements, and bilateral tinnitus. The examiner noted that the Veteran's hearing loss began 15 to 20 years prior to the examination, and the tinnitus began 20 years prior to the examination. It was acknowledged that the Veteran was exposed to noise during military service as a pharmacy technician with the use of hearing protection. The Veteran reported post-military noise exposure of heavy machinery and small farming-lawn equipment with hearing protection being used.

The examiner opined that it is less likely than not that the Veteran's bilateral hearing loss is related to military service. The examiner explained that there is no significant permanent shift in hearing thresholds beyond test variability from entrance in 1975 to separation in 1977, which is objective evidence of no permanent auditory damage on active duty from conceded noise. The examiner considered that the service treatment records do not show any complaints or treatment of hearing problems during service or at separation. Based on the evidence, the examiner could not find that the Veteran suffered auditory damage during military service that would support a nexus between the Veteran's military service and her current bilateral hearing loss.

The examiner also opined that the Veteran's tinnitus is less likely than not related to military service. It was indicated that the Veteran's tinnitus is likely related to the bilateral hearing loss. The onset of the tinnitus was reported by the Veteran to be post-separation. The examiner considered that the Veteran had conceded noise exposure as a pharmacy technician during service, but it was explained that since there is no evidence of auditory damage related to service the evidence did not support a nexus between the Veteran's bilateral tinnitus and service.

The Board finds the March 2025 VA hearing loss and tinnitus examination and opinions to be highly probative. As an audiologist, the March 2025 examiner is an expert concerning hearing loss and tinnitus. The examiner provided a thorough examination, considered the Veteran's reports, reviewed the medical evidence, and fully explained the medical basis for the conclusions
tinnitus is likely related to the bilateral hearing loss. The onset of the tinnitus was reported by the Veteran to be post-separation. The examiner considered that the Veteran had conceded noise exposure as a pharmacy technician during service, but it was explained that since there is no evidence of auditory damage related to service the evidence did not support a nexus between the Veteran's bilateral tinnitus and service.

In December 2024, a private opinion concerning the Veteran's bilateral hearing loss and tinnitus was received from M.T, D.C. The Veteran reported that she was exposed to machinery, typewriters, and the motor pool during service. Dr. M.T. opined that it is at least as likely as not that the Veteran's bilateral hearing loss and bilateral tinnitus are related to her military service noise exposure. However, no rationale for this opinion was provided. See Id. Dr. M.T. simply concludes that the Veteran's diagnosed bilateral hearing loss and tinnitus are related to service without any discussion of the medical basis for the conclusions. Therefore, the Board finds the hearing loss and tinnitus opinions of Dr. M.T. to be conclusory and hold no probative value.

Based upon the foregoing, the Board finds service connection for bilateral hearing loss and tinnitus is not warranted. A hearing loss disability and tinnitus were not manifested in service and were not shown to have been manifested to a compensable degree within a year following the Veteran's discharge from service; at the March 2025 VA examination, the Veteran reported an onset of hearing loss and tinnitus 15 to 20 years prior to the examination, over twenty five years after discharge. Accordingly, service connection for her current hearing loss and tinnitus on the basis that they became manifest in service, and persisted, or on a chronic disease presumptive basis (under 38?U.S.C. §?1112; 38?C.F.R. §§?3.307, 3.309), is not warranted. Further, the allegations of onset in, and continuity since service are not supported by evidence of record, to include lay statements. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Therefore, service connection for bilateral hearing loss and tinnitus based on continuity of symptomatology is not warranted.

The Board recognizes that it is the Veteran's firm belief that her bilateral hearing loss and tinnitus are related to her military service. Although lay persons are competent to provide opinions on some medical issues, See Kahana v. Shinseki, 24 Vet. App. 428 (2011), as to the specific issue being decided herein, whether there is a nexus between the Veteran's bilateral hearing loss and tinnitus and her military service, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (lay persons not competent to diagnose cancer). The Veteran has not been shown to have possessed the requisite medical training, expertise, or credentials needed to render a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training, or acquired any medical expertise, in evaluating complex audiological conditions. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed.Cir.2012). Therefore, the Veteran's statements that her military noise exposure caused her current bilateral hearing loss and tinnitus are lay evidence that does not constitute competent medical evidence, and thus, lack probative value. As noted above, the Board finds the VA hearing loss and tinnitus opinions to be the most probative evidence of record concerning whether there is a nexus between the Veteran's bilateral hearing loss and tinnitus and her military service.

Accordingly, the Board finds the evidence is not at least in approximate balance, the benefit of the doubt rule is not applicable, and the claims for service connection for bilateral hearing loss and tinnitus must be denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Entitlement to service connection for a left knee disability

The Veteran contends that she should be service connected for a left
tinnitus opinions to be the most probative evidence of record concerning whether there is a nexus between the Veteran's bilateral hearing loss and tinnitus and her military service.

3. Entitlement to service connection for a left knee disability

The Veteran contends that she should be service connected for a left knee disability because she hurt her left knee during service and it has continued to hurt since.

In March 2025, the Veteran was afforded a VA knee examination. The examiner recognized a diagnosis of left knee strain. The Veteran reported that during military service she climbed over a six foot wall and hyperextended her left knee when landing and it has continued to hurt since. She stated that she did not go to sick call for the left knee. The examiner opined that it is less likely than not that the left knee disability is related to military service. The rationale was that the Veteran's left knee disability did not start as a result of activity in the military because there is no evidence that the Veteran had any left knee problem during service or at separation.

The Board acknowledges that a lack of evidence cannot be corroborating to conclude that there is no relationship between the Veteran's current disability and her military service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Board also recognizes that a layperson is competent to report on information that was observed and is personally known to them, including the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, in this instance, the opinion of the March 2025 VA examiner was not based solely on a lack of evidence but was based on affirmative evidence from the Veteran's own reports that during service and at separation she did not have a knee problem. Although the Board recognizes that the Veteran is competent to relate her own experiences, the Board finds the Veteran's report of a left knee injury during service that continued since is not credible, as this report is contrary to the evidence, as discussed further below.

In December 2024, a private opinion concerning the Veteran's left knee disability was received from M.T, D.C. The Veteran reported that she injured her knee during active duty and was evaluated by the medic. She also reported that she was put in quarters during her pregnancy due to decreased mobility of the knee, and that she followed up with military doctors and a civilian doctor. However, these reports are not consistent with the Veteran's report at the March 2025 VA knee examination, where she stated that she did not go to sick call. Nor is there any evidence showing that the Veteran received medical care for a knee injury or was followed by military and civilian doctors for a knee problem. Thus, as discussed above, the Veteran's reports are not consistent with the evidence, and as such, the reports are not found to be credible by the Board.

Dr. M.T. opined that the Veteran's left knee disability had its onset during service and that it is as likely as not that the Veteran's left knee disability is directly and causally related to military service. This opinion is predicated entirely upon the reports of the Veteran, which have been determined by the Board to not be credible. Bare transcription of the lay history provided by the Veteran is not transformed into competent medical evidence simply because it was transcribed by a medical professional, whether that professional is a VA or private physician, especially when it is contradicted, or at least not supported, by medical evidence of record. LeShore v. Brown, 8 Vet. App. 406 (1995). As such, the Board finds the left knee opinion of Dr. M.T. to be inadequate and holds no probative value.

Based on the probative evidence of record, the Board finds that the Veteran's diagnosed left knee disability did not have its onset during, and is not otherwise related to, military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303.

Accordingly, the Board finds the evidence is not at least in approximate balance, the benefit of the doubt rule is not applicable, and the claim for service connection for a left knee disability must be denied. See Lynch; 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4. Entitlement to service connection for a left hip disability

5. Entitlement to service connection for a lumbar
probative evidence of record, the Board finds that the Veteran's diagnosed left knee disability did not have its onset during, and is not otherwise related to, military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303.

4. Entitlement to service connection for a left hip disability

5. Entitlement to service connection for a lumbar disability

6. Entitlement to service connection for left lower extremity radiculopathy

The Veteran contents that she should be service connected for a left hip disability, lumbar disability, and left lower extremity radiculopathy because they are related to her left knee disability that began during military service and continued since. She also contends that she should be service connected for a lumbar disability because she began to have back pain after her cesarean section and the pain has continued.

In December 2024, a private opinion concerning the Veteran's left hip disability, lumbar disability, and left lower extremity radiculopathy was received from M.T, D.C. Dr. M.T. opined that the Veteran's left hip disability and lumbar disability are at least as likely as not directly and causally related to constant and chronic compensation and adaptation to the weight shifting and altered gait caused by the left knee disability. Thus, it was determined that the left hip disability and lumbar disability are secondary to the left knee disability. Dr. M.T. also opined that it is at least as likely as not that the Veteran's left lower extremity radiculopathy is directly related to the Veteran's lumbar disability. Thus, it was found that the left lower extremity radiculopathy is secondary to the lumbar disability.

Therefore, each of the nexus opinions of Dr. M.T. concerning the left hip, lumbar, and lower extremity radiculopathy, were based on a determination that those conditions are related to the Veteran's military service as they are related to her left knee disability. However, for the reasons discussed above, the Veteran's left knee disability is not service connected. Consequently, service connection for the Veteran's claimed left hip disability, lumbar disability, and left lower extremity radiculopathy cannot be established as secondary to, or aggravated by, a left knee disability. 38 C.F.R. § 3.310.

The Veteran has not provided any contention that her left hip disability began during service or is in some manner directly related to military service. The March 2025 VA hip examination shows that the Veteran reported that her left hip began to hurt due to her knee. Thus, the Veteran has presented no basis for a finding of direct service connection for a left hip disability.

At the March 2025 VA back examination, the Veteran reported that she started having back pain after her cesarean section in December 1976 and thought it was related to surgery but continued having back pain since. However, there are no medical records showing the Veteran had any complaints of back pain after the cesarean section delivery. The March 2025 examiner opined that the Veteran's lumbar disability and left lower extremity radiculopathy are less likely than not related to military service because there is no evidence supporting that the Veteran sustained lumbar or left lower extremity injuries during military service. Essentially, the March 2025 examiner found that the evidence does not support that the Veteran's lumbar disability and left lower extremity radiculopathy have been chronic conditions that had their onset in service. The Board finds the opinion of the March 2025 examiner to be probative as the examiner provided an examination of the Veteran, considered the Veteran's reports, thoroughly reviewed the evidence, applied medical knowledge and experience, and provided a sufficient opinion given the facts and evidence in the case.

The Board notes that the private opinion of Dr. M.T. did not find that the Veteran's lumbar disability or left lower extremity radiculopathy were related to military service due to the cesarean section in service. The Board appreciates that the Veteran believes that her lumbar disability is related to her military service. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428 (2011), the specific issue here, an opinion as to the etiology of her lumbar disability, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 137

The Veteran has not been shown to have possessed the requisite medical training, expertise, or credentials needed to render a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training, or acquired any medical expertise, in evaluating complex medical conditions. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed.Cir.2012). Therefore, the Veteran's claim that her lumbar disability is service related is lay evidence that does not constitute competent medical evidence, and thus, lacks probative value.

Based on the foregoing, the Board finds that the Veteran's left hip disability, lumbar disability, and left lower extremity radiculopathy did not have their onset during, and are not otherwise related to, military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303, 3.310.

Accordingly, the Board finds the evidence is not at least in approximate balance, the benefit of the doubt rule is not applicable, and the claims for service connection for a left hip disability, a lumbar disability, and left lower extremity radiculopathy must be denied. See Lynch; 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

7. Entitlement to service connection for a left thumb disability

In December 2024, a private opinion concerning the Veteran's left thumb was received from M.T, D.C. It was noted that the Veteran reported she was a typist during active duty and that she received medical care for her left thumb a few years after she separated from service. Dr. M.T. opined that it is at least as likely as not that the Veteran's left thumb disability was caused by her typing in service. However, the Board finds the private opinion inadequate and insufficient for adjudication, as it provided little to no medical rationale or evidence to support the conclusion. See Nieves-Rodriguez, Stefl, supra. Moreover, the opinion appears to be based solely on the Veteran's reports during the private examination. The Board is not bound to accept medical opinions based solely on history supplied by the Veteran. See Leshore v. Brown, 8 Vet. App. 406, 409 (1995) (mere fact that claimant statements linking disabilities to service are contained in medical report does not render such statements competent medical evidence).

In March 2025, the Veteran was afforded a VA hand and fingers examination. The Veteran reported that her left thumb condition began in 1975 because she was doing a lot of typing. The March 2025 examiner opined that it is less likely than not that the left thumb disability is related to military service. The basis for the conclusion was that there is no evidence in the record showing that the Veteran was ever evaluated or treated for a hand or finger condition during service. Therefore, there is no evidence that the Veteran's left thumb disability started as a result of service.

This finding is consistent with the September 1976 separation examination and separation Report of Medical History that shows the Veteran did not report having any complaints involving her left hand.

The Board finds the opinion of the March 2025 examiner to be probative as the examiner provided an examination of the Veteran, considered the Veteran's reports, thoroughly reviewed the evidence, applied medical knowledge and experience, and provided a sufficient opinion given the facts and evidence in the case.

Based on the foregoing, the Board finds that the Veteran's left thumb disability did not have its onset during, and is not otherwise related to, military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303, 3.310.

Accordingly, the Board finds the evidence is not at least in approximate balance, the benefit of the doubt rule is not applicable, and the claim for service connection for a left thumb disability must be denied. See Lynch; 38 U.S.C. § 5107
the Veteran, considered the Veteran's reports, thoroughly reviewed the evidence, applied medical knowledge and experience, and provided a sufficient opinion given the facts and evidence in the case.

8. Entitlement to service connection for adjustment disorder with anxiety and depression

The Veteran contends that she should be service connected for adjustment disorder with anxiety and depression because she suffered verbal aggression in service, she became pregnant and was isolated because she could not remain in the barracks while pregnant, and her decision to separate from military service due to her pregnancy and the birth of her child has caused regret.

The Veteran's service treatment records do not show that the Veteran had any psychiatric problems upon enlistment, during service, or at separation from service. See Enlistment Examination, February 1975; see also Separation Examination, September 1976.

In December 2024, a private mental disorders evaluation and opinion was received from P.M.M., Psy.D. The Veteran reported a very good marriage. Following military service, the Veteran graduated with her Bachelor of Science degree in chemistry in 1981. From 1981 to 1986 she worked odd jobs, managing a trucking company, and at the same time had two children. In 1986, she taught 7th grade. In 1988, she gained a teaching certificate and taught at a middle school. In 1998, she moved to Texas and taught at a middle school in San Antonio until 2012, when she decided to fully retire. The Veteran reported that during service she never deployed and never experienced traumatic events while in service. She related that physical issues arose during boot camp that with time became chronic. She reported that she was never reprimanded during her career and never experienced legal problems. The Veteran denied seeking psychological treatment during service or post-service.

Based on the evaluation, Dr. P.M.M. opined that the Veteran has a diagnosis of adjustment disorder with mixed anxiety and depressed mood that is mostly related to physical pain. Dr. P.M.M. indicated that the Veteran's anxiety and depression began to occur during boot camp while serving in the United States Army. However, the basis for this finding is unclear, as there is nothing in the medical records showing that the Veteran had any psychological issues during service. The service treatment records also do not show that the Veteran had any physical problems during military service. The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion." See Nieves-Rodriguez.

The determination that the Veteran's anxiety and depression began during boot camp, due to pain in her knees, hips, and lower back that have intensified over time, was based solely on the Veteran stating that she has had knee, hip, and low back problems since service, and was not grounded on a reasoned medical analysis. See LeShore. Therefore, the Board must find the private opinion of Dr. P.M.M. to be inadequate and hold no probative value.

Moreover, as discussed above, the Board finds that the Veteran's claimed left knee, left hip, and lumbar disabilities are not service connected. Consequently, service connection for the Veteran's claimed adjustment disorder with anxiety and depression cannot be established as secondary to, or aggravated by, a left hip disability, lumbar disability, or left lower extremity radiculopathy. 38 C.F.R. § 3.310.

In March 2025, the Veteran was afforded a VA mental disorders examination. The examiner recognized a diagnosis of adjustment disorder with anxiety and depression. The examiner opined that it is less likely than not that the Veteran's adjustment disorder with anxiety and depression is related to military service. The examiner acknowledged the Veteran's report that she was advised to separate from the military in order to care for her newborn child. The examiner also noted the Veteran's discontent with the environment in which she currently lives and did not want to stay where she is living. The examiner explained that the Veteran's mental disorder symptoms are due to her current living situation. The examiner found no indication that the Veteran had depression or anxiety while she was in service. It was also recognized by the examiner that the Veteran had a good job as a teacher for a long
examination. The examiner recognized a diagnosis of adjustment disorder with anxiety and depression. The examiner opined that it is less likely than not that the Veteran's adjustment disorder with anxiety and depression is related to military service. The examiner acknowledged the Veteran's report that she was advised to separate from the military in order to care for her newborn child. The examiner also noted the Veteran's discontent with the environment in which she currently lives and did not want to stay where she is living. The examiner explained that the Veteran's mental disorder symptoms are due to her current living situation. The examiner found no indication that the Veteran had depression or anxiety while she was in service. It was also recognized by the examiner that the Veteran had a good job as a teacher for a long time and she did not have depression or anxiety during that time.

The Board finds the opinion of the March 2025 examiner to be probative as the examiner examined the Veteran, considered the Veteran's reports, thoroughly reviewed the evidence, applied medical knowledge, expertise, and experience, and presented a well rationalized opinion considering the facts and evidence in the case. See Nieves-Rodriguez.

The Board recognizes that the Veteran has stated that she suffered verbal aggression in service. However, this is contrary to her report in the private psychiatric disorder evaluation, which indicated that she never experienced traumatic events while in service. Moreover, there is no reference whatsoever in the service treatment records that she had anxiety or depression issues in service. The September 2025 witness statement from the Veteran's husband did not mention anything about the Veteran experiencing verbal aggression in service. Rather, the statement correlated the Veteran's difficulties with her decision to separate from service. The Veteran's separation from service was fully considered by the March 2025 examiner. Moreover, the private psychiatric disorder opinion did not offer a conclusion that the Veteran's mental health disorder is associated with military service due to her choice to separate or due to verbal aggression. Thus, the medical evidence does not establish a relationship between the Veteran's adjustment disorder with anxiety and depression as a consequence of her separation or any perceived verbal aggression. Further, the Veteran did not contend that her psychiatric condition was related to verbal aggression in service until after the rating decision on appeal. As such, this is not a pre-decisional duty to assist error for which the Board can remand for an additional medical opinion.

The Board acknowledges that the Veteran, her daughter, and her husband have provided statements expressing the Veteran's struggles with anger, withdrawal, mood instability, and depression stemming from service related experiences, most notably the circumstances of her separation. The Board appreciates that the Veteran, her husband, and her daughter believe that her adjustment disorder with anxiety and depression are related to military service. However, although lay persons are competent to provide opinions on some medical issues, see Kahana the specific issue here, an opinion as to the etiology of the diagnosed mental health disorder, falls outside the realm of common knowledge of a lay person. See Jandreau. The Veteran, her husband, and her daughter have not been shown to have possessed the requisite medical training, expertise, or credentials needed to render a competent opinion as to medical causation. Nothing in the record demonstrates that they have received any special training, or acquired any medical expertise, in evaluating complex psychological conditions. See King. Therefore, their statements and assertions concerning the Veteran's psychiatric disorder are lay evidence that does not constitute competent medical evidence.

Based on the foregoing, the Board finds that the Veteran's adjustment disorder with anxiety and depression did not have its onset during, and is not otherwise related to, military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303, 3.310.

Accordingly, the Board finds the evidence is not at least in approximate balance, the benefit of the doubt rule is not applicable, and the claim for service connection for adjustment disorder with depression and anxiety must be denied. See Lynch; 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Increased Rating

Entitlement to a compensable rating for a cesarean section scar

Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C
on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1.

The Veteran is currently assigned a non-compensable rating for a cesarean section scar under DC 7802. Scars not of the head, face, or neck are rated under 38 C.F.R. § 4.118, DCs 7801, 7802, 7804, and 7805.

DC 7801 applies to a scar, or scars, due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage: A 10 percent rating is warranted for area, or areas, of at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters); a 20 percent rating is warranted for area, or areas, of at least 12 square inches (77 square centimeters) but less than 72 square inches (465 square centimeters). 38 C.F.R. § 4.118, DC 7801.

DC 7802 applies to a scar, or scars, due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage: A 10 percent rating is warranted for area, or areas, of at least 144 square inches (929 square centimeters). 38 C.F.R. § 4.118, DC 7802.

Under DC 7804 a 10 percent rating is warranted for one or two scars that are unstable or painful; a 20 percent rating is warranted for three or four scars that are unstable or painful. 38 C.F.R. § 4.118, DC 7804.

Under DC 7805 scars are evaluated for any disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code.

In March 2025, the Veteran was afforded a VA scars examination. The examiner indicated the Veteran had a single healed lower pelvic scar that was not painful, there was no frequent loss of covering of skin over the scar, the total area of the scar measured 1.6 square centimeters, there was no underlying tissue damage, no disfigurement, and no limitation of function. The Veteran was not found to have any additional findings, complications, conditions, signs or symptoms associated with the cesarean section scar.

The Board acknowledges that the private opinion report from Dr. M.T. noted that the Veteran continued to have itching and irritation of the scar. However, there is no evidence suggesting that the scar is painful, has frequent loss of covering of skin over the scar, has underlying tissue damage, or productive of any functional impact.

Based on the evidence, throughout the period on appeal, the Veteran's cesarean section scar was not associated with underlying tissue damage that was at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters); not associated with underlying tissue damage with an area of 144 square inches (929 square centimeters) or greater; and unstable or painful. 38 C.F.R. § 4.118, DCs 7801, 7802, and 7804.

The Board has also considered whether the Veteran had other disabling effects under DC 7805. However, the evidence does not support that the cesarean section scar has any disabling effects.

Accordingly, as the evidence is not at least in approximate balance, the Board finds that a compensable rating for a cesarean section scar is not warranted, the benefit of the doubt rule is not applicable, and the claim for entitlement to a compensable rating for a cesarean section scar must be denied. See Lynch; see also Gilbert; 38 U.S.C. § 5107; 38 C.F.R. §
.R. § 4.118, DCs 7801, 7802, and 7804.

The Board has also considered whether the Veteran had other disabling effects under DC 7805. However, the evidence does not support that the cesarean section scar has any disabling effects.

A. J. Spector

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. Temple, 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.

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