ANKLE IMPAIRMENT OF

MICHAEL A. HERMAN · 2026 · Case ID: 26001345

MIXED

Summary

The veteran, who served in the United States Marine Corps from October 1995 to October 1999, appeals the denial of service connection for a right ankle disorder, including degenerative joint disease and tendonitis, and increased ratings for bilateral shin splints. The Board previously granted initial 10 percent ratings for right and left lower extremity shin splints effective May 4, 2017, but denied higher ratings. The veteran also sought service connection for a respiratory disorder, which was initially denied but subsequently remanded for further development. The Board reviewed multiple VA examinations and treatment records concerning the right ankle disorder. While service treatment records showed in-service ankle sprains in 1996 and 1998, the diagnosis of degenerative joint disease did not appear until 2020, over two decades after service. VA examiners consistently opined that the current ankle condition was less likely than not related to service, citing the lack of chronicity, absence of objective findings during service or shortly after, and the possibility of post-service etiology given the time lapse and risk factors. The Board found the negative nexus opinions more probative, denying direct service connection for the ankle disorder. Secondary service connection was also denied, as medical opinions concluded the ankle condition was not caused or aggravated by the service-connected back condition. Increased ratings for shin splints were denied as the evidence did not support ratings beyond 10 percent based on limitation of motion or malunion criteria. The respiratory disorder claim was remanded for further examination to address allergic rhinitis and potential PACT Act toxic exposures.

Rationale

No chronicity of right ankle disorder shown in service or within one year of separation.; VA examiners consistently found no nexus between current right ankle disorder and service.; Right ankle disorder not caused or aggravated by service-connected back condition.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

19-19 110A

Full Decision Text

Citation Nr: 26001345
Decision Date: 01/30/26 Archive Date: 01/30/26

DOCKET NO. 19-19 110A
DATE: January 30, 2026

ORDER

Entitlement to service connection for a right ankle disorder, to include degenerative joint disease and tendonitis, is denied.

Entitlement to an initial rating in excess of 10 percent for right lower extremity shin splints with painful motion of the right knee is denied.

Entitlement to an initial rating in excess of 10 percent for left lower extremity shin splints is denied.

REMANDED

Entitlement to service connection for a respiratory disorder, to include allergic rhinitis, is remanded.

FINDINGS OF FACT

1. The evidence persuasively weighs against finding that a chronic right ankle disorder was shown as chronic in service, manifested to a compensable degree within one year of service, was incurred in or caused by active service, or is caused or aggravated by a service-connected disability.

2. At no point have the Veteran's right lower extremity shin splints with painful motion of the right knee resulted in limitation of flexion to 30 degrees or less, limitation of extension to 5 degrees or more, malunion of the tibia and fibula with moderate knee or ankle disability, shin splints of the right lower extremity that require treatment for no less than 12 consecutive months and are unresponsive to surgery and either shoe orthotics or other conservative treatment, nonunion of the tibia and fibula, instability of the right knee, ankylosis of the right knee or its functional equivalent, dislocated semilunar cartilage, symptomatic removal of the semilunar cartilage, or genu recurvatum.

3. At no point have the Veteran's left lower extremity shin splints resulted in limitation of flexion to 30 degrees or less, limitation of extension to 5 degrees or more, malunion of the tibia and fibula with moderate knee or ankle disability, shin splints of the left lower extremity that require treatment for no less than 12 consecutive months and are unresponsive to surgery and either shoe orthotics or other conservative treatment, nonunion of the tibia and fibula, instability of the left knee or its functional equivalent, dislocated semilunar cartilage, symptomatic removal of the semilunar cartilage, or genu recurvatum.

CONCLUSIONS OF LAW

1. The criteria for service connection for a right ankle disorder, to include degenerative joint disease and tendonitis, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

2. The criteria for an initial rating in excess of 10 percent for right lower extremity shin splints with painful motion of the right knee are not met. 38 C.F.R. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.59, 4.71a, Diagnostic Code 5262-5260.

3. The criteria for an initial rating in excess of 10 percent for left lower extremity shin splints are not met. 38 C.F.R. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.59, 4.71a, Diagnostic Code 5262-5260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Marine Corps from October 1995 to October 1999.

This appeal comes to the Board of Veterans' Appeals (the Board) following two rating decisions. In December 2017, the Agency of Original Jurisdiction (AOJ) granted service connection for bilateral shin splints and assigned initial noncompensable ratings. The AOJ also denied entitlement to service connection for a respiratory disorder. In January 2018, the AOJ denied service connection for a right ankle disorder.

During the period on appeal, the AOJ increased the evaluation assigned for the Veteran's right lower extremity shin splints with limitation of motion of the knee to 10 percent effective August 2, 2018. The AOJ later increased the rating assigned for left lower extremity shin splints to 10 percent effective February 2, 2021. Such created staged ratings.

The Veteran participated in a hearing before the undersigned Veterans Law Judge
of Original Jurisdiction (AOJ) granted service connection for bilateral shin splints and assigned initial noncompensable ratings. The AOJ also denied entitlement to service connection for a respiratory disorder. In January 2018, the AOJ denied service connection for a right ankle disorder.

The Veteran participated in a hearing before the undersigned Veterans Law Judge in March 2023. A transcript of this hearing is of record.

The claims for increased ratings for right and left lower extremity shin splints and the claims for service connection for a right ankle disorder and a breathing disorder were remanded in January 2024.

In August 2024, the Board issued a decision that awarded initial 10 percent ratings for right and left lower extremity shin splints effective May 4, 2017. The Board then denied ratings in excess of 10 percent for right and left lower extremity shin splints. Service connection for a respiratory condition was denied in the August 2024 decision. Finally, the Board remanded the claim for entitlement to service connection for a right ankle disorder to obtain a new Department of Veterans Affairs (VA) examination.

The Veteran appealed the portions of the August 2024 Board decision that denied ratings in excess of 10 percent for right and left lower extremity shin splints and service connection for a respiratory disorder to the United States Court of Appeals for Veterans Claims (the Court). In a July 2025 Order, the Court entered a Joint Motion for Partial Remand (JMPR) of the parties, vacating the Board's denial of increased ratings for right and left lower extremity shin splints and service connection for a respiratory disorder and remanding the matter to the Board. The contents of this JMPR are discussed in greater detail below.

1. Entitlement to Service Connection for a Right Ankle Disorder, To Include Right Ankle Degenerative Joint Disease and Tendonitis

The Veteran seeks service connection for a right ankle disorder. He contends that he injured his right ankle during boot camp and training exercises during his active service. In the alternative, he suggests that his right ankle disorder is secondary to his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

The appeal seeking service connection for a right ankle disorder has been remanded twice. In January 2024 and August 2024, the Board directed the AOJ to obtain a new VA examination that discussed the Veteran's diagnosed right ankle degenerative joint disease. The AOJ was also directed to obtain an opinion addressing whether the Veteran's right ankle disorder (1) was incurred in or caused by service, to include his in-service right ankle sprain and (2) was caused or aggravated by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. New VA medical opinions were obtained in September 2024, and another VA examination with addendum opinions was obtained in October 2024.

The Board concludes that there has been substantial compliance with the January 2024 and August 2024 remand directives. The assembled opinions address the Veteran's diagnosis of right ankle degenerative joint disease. They also answer all the questions and discuss all the evidence directed by the January 2024 and August 2024 remand directives. As substantial compliance has been established, the Board will continue to adjudicate this appeal.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted on a secondary basis for a disability that is due to or aggravated by a service-connected disease or injury. Establishing service connection on a secondary basis requires evidence sufficient to show that (1) a current disability exists and (2) the
(3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted on a secondary basis for a disability that is due to or aggravated by a service-connected disease or injury. Establishing service connection on a secondary basis requires evidence sufficient to show that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding "but for" causation or aggravation is enough to show entitlement to secondary service connection).

Certain chronic diseases are subject to presumptive service connection if they manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Arthritis is a chronic disease, as it is listed in 38 C.F.R. § 3.309(a).

Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden elements is through a demonstration of continuity of symptomatology if the claimed disability qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 780 F.3d 1331, 1336 (Fed. Cir. 2013). As arthritis is a chronic disease, service connection via the demonstration of continuity of symptomatology is applicable.

VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

The Board first turns to whether service connection is warranted for right ankle degenerative joint disease as a chronic disease.

VA treatment records from February 2020 show that the Veteran has a diagnosis of degenerative joint disease of the right ankle. The September 2024 VA medical opinion confirms that the Veteran has a diagnosis of degenerative joint disease of the right ankle based on a January 2020 X-ray. The October 2024 VA examination also shows a diagnosis of right ankle degenerative arthritis, other than post-traumatic. Degenerative joint disease is a form of arthritis, which is a chronic condition under 38 C.F.R. § 3.309(a). See Walker, 708 F.3d at 1331.

However, for the reasons to follow, the Board concludes that the Veteran's right ankle degenerative joint disease was not shown as chronic in service, did not manifest to a compensable degree within one year of separation from service, and was not noted in service or within one year of separation with attributable continuity of symptomatology.

Service treatment records (STRs) show a right ankle injury in June 1996. The Veteran reported that he had lost his balance and twisted his right ankle while unloading a box. At that time, he was assessed with a right ankle sprain. In September 1996, it was noted that his sprain had resolved, but he continued to report right ankle pain in October 1996 and December 1996. In December 1996, it was noted that he had a "non resolving ankle sprain." In April 199
in service, did not manifest to a compensable degree within one year of separation from service, and was not noted in service or within one year of separation with attributable continuity of symptomatology.

Service treatment records (STRs) show a right ankle injury in June 1996. The Veteran reported that he had lost his balance and twisted his right ankle while unloading a box. At that time, he was assessed with a right ankle sprain. In September 1996, it was noted that his sprain had resolved, but he continued to report right ankle pain in October 1996 and December 1996. In December 1996, it was noted that he had a "non resolving ankle sprain." In April 1998, he again sought treatment for pain in the right posterior medial ankle for four days. This pain began when he was running, and he denied trauma to the ankle. The Veteran was diagnosed with a first degree (grade I) sprain. Foot trouble was noted on his separation Report of Medical History, but no specific right ankle injury or diagnosis, to include degenerative joint disease, was noted upon his separation examination.

The evidence does not show a diagnosis of right ankle degenerative joint disease until the January 2020 X-ray. At that time, a radiology report noted, "No acute fracture or dislocation detected. 3.5 mm smooth ossicle present just distal to the medial malleolus. There is calcification or cortical thickening at the level of the distal tibia laterally likely from prior trauma. Mortise is well-maintained. Small enthesophyte present at the insertion of the Achilles tendon." In February 2020, his podiatrist noted right ankle degenerative joint disease secondary to old trauma. The September 2024 and October 2024 VA examinations and medical opinions indeed confirm that the Veteran was diagnosed with right ankle degenerative joint disease in 2020. This diagnosis occurred over two decades after his separation from service in 1999. Notably, the January 2018 VA examination did not show a diagnosis of any right ankle condition, to include degenerative joint disease or other forms of arthritis. The Veteran reported during this examination that he had been treated by a private doctor for his ankle pain, but he could not remember the name of this doctor or when he sought treatment.

The Board acknowledges the Veteran's report that his right ankle pain has continued and worsened since his initial in-service injuries. He is certainly competent to report a history of right ankle pain since service. However, there is no evidence attributing this chronic right ankle pain to his current right ankle degenerative joint disease. No VA examiner or treating physician has opined that the Veteran's reported right ankle pain during and immediately after service was due to right ankle degenerative joint disease. Furthermore, while the Veteran is competent to report having experienced right ankle pain during and after service, he is not competent to provide a diagnosis or determine that the pain was a manifestation of degenerative joint disease of the right ankle. The issue is medically complex, as it requires knowledge of the interpretation of complicated diagnostic medical testing and imaging. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

There is also some evidence weighing against the Veteran's report of having chronic right ankle pain since service. During the Veteran's March 2023 hearing, he acknowledged that he did not report having chronic right ankle pain following service. He indicated that he did not begin receiving treatment for right ankle pain until 2017 at the earliest, and he did not reference having right ankle pain prior to the time he sought treatment for it in approximately 2017. Moreover, he did not report having chronic right ankle pain since his separation from service in his May 2017 lay statement or during his January 2018 VA examination. Instead, the first mention of having continuous right ankle pain since service was during the February 2024 VA examination. Such undermines the credibility of his more recent reports that indicate that his right ankle pain has been continuous since service.

In sum, the evidence persuasively weighs against finding that the Veteran's right ankle degenerative joint disease was shown as chronic in service, manifested to a compensable degree within one year of discharge, or was noted in service with attributable continuity of symptomatology. 38 C.F.R. § 3.303(b); see also Walker, 708 F.3d at 1336.

Service connection for a right ankle disorder may still be granted on a direct or secondary basis, though.

Turning to direct service connection, the Veteran has a diagnosis of right ankle degenerative joint disease. His February 2024 VA examination also shows a diagnosis of right ankle tendonitis. The first element of service connection-a current diagnosis
service.

Service connection for a right ankle disorder may still be granted on a direct or secondary basis, though.

As for the second element of service connection-an in-service injury, event, or disease-the Veteran reports that he injured his right ankle during service. As discussed above, his STRs show treatment for right ankle sprains in June 1996 and April 1998. The evidence therefore supports the occurrence of an in-service injury, event, or disease sufficient to meet the second element of service connection. Shedden, 381 F.3d at 1166-67.

VA medical opinions addressing direct service connection were obtained in January 2018, February 2024, April 2024, September 2024, and October 2024.

The January 2018 VA examiner opined that the Veteran's claimed right ankle disorder was less likely than not incurred in or caused by service. The examiner acknowledged that the Veteran's STRs showed right ankle sprains in 1996 and 1998, but both conditions were noted as resolved. His 1999 separation physical did not show reports of a right ankle condition. Moreover, VA treatment records from 2012 to 2017 did not show reports of a right ankle disorder. The examiner also stated that a July 2017 Social Work note mentioned chronic pain of the ankles as a "risk factor," but the examiner explained that this is not objective evidence, as the Veteran appears to have merely reported this to the social worker, so there was no clinical evidence of such pain. The examiner's review of VA medical records from 2012 to 2017 show that the Veteran was seen by a VA primary care provider for annual physical examinations, which did not show reports or diagnosis of a right ankle disorder. Thus, the examiner concluded that, after a thorough review of the Veteran's records and physical examinations, there is no objective evidence or clinical findings to support the claim of a right ankle disorder that is related to the right ankle condition he experienced during service. She stated that his right ankle sprain in service was acute and had resolved.

The January 2018 opinion holds limited probative value. The examiner found that there was no objective evidence of a current right ankle abnormality. However, this finding contradicts the findings of subsequent VA examinations and treatment records, which show diagnoses of right ankle degenerative joint disease and tendonitis.

Another VA examination was performed in February 2024. At that time, the Veteran was diagnosed with right ankle tendonitis. The February 2024 VA examiner initially offered a positive nexus opinion. The examiner stated that the Veteran reported injuring his right ankle while rappelling, and he was put in a cast for three months because his ankle was "almost fractured." The examiner explained that the Veteran had no issues related to his right ankle prior to military service, and the examiner found that there is evidence of chronicity, thus establishing a nexus. However, the February 2024 VA examiner did not provide a rationale or explain how she concluded that there was evidence of chronicity. Her opinion is therefore conclusory and insufficient.

The same examiner offered a contradictory opinion later in February 2024. In this opinion, the examiner found that the Veteran's right ankle tendonitis is less likely than not due to service, as there is a lack of substantiating evidence supporting a nexus between the current diagnosis and military service. The examiner repeated the findings of the January 2018 VA examiner. The examiner also addressed the Veteran's claimed right ankle degenerative joint disease, finding that the Veteran's X-rays show no signs or symptoms of any arthritis developing in the right ankle and that imaging is negative for any acute findings in his X-ray reports. However, this opinion is also insufficient, as it does not reconcile the finding that he does not have arthritis with the January 2020 X-ray and subsequent February 2020 assessment of degenerative joint disease.

Due to the inadequacies and contradictions in the February 2024 opinions, an addendum VA medical opinion was obtained in April 2024. This examiner opined that the Veteran's right ankle tendonitis was less likely than not incurred in or caused by service. This examiner acknowledged that the Veteran's STRs showed right ankle sprains in 1996 and 1998 during service but that his separation physical in 1999 did not show a report of a right ankle disorder. She explained that his VA treatment records from 2012 to 2017 did not show treatment or diagnosis of a right ankle condition, and there is no indication of a right ankle condition during his annual physical examinations with his VA primary care provider during those years. Thus, she found that, after a thorough review of the records and physical examinations, there is no objective evidence or clinical findings to support the claim of a right ankle disorder that is related to the ankle condition in service. The ankle conditions in service were acute and noted to have resolved. Moreover, a right ankle X-ray from January 2020 showed calcification or cortical thickening at the level of the distal tibia laterally likely from prior trauma. The examiner noted that these X-rays were taken more than 20 years after the Veteran's service, and there is no chronicity to establish that the abnormalities noted on the X-ray are related to the acute, resolved ankle sprains in service. Without chronicity, the examiner concluded that a post-service injury is a far more likely etiology for the abnormalities noted on imaging.

The September 2024 VA examiner also provided a negative nexus opinion. The examiner cited Oxford's Textbook on Orthopedics and Trauma in support of his finding that it is less likely than not that the Veteran's right ankle degenerative joint disease had its initial onset in service or is otherwise etiologically related to his active service. The examiner explained that, while degenerative joint disease can present with distal cortical thickening, it will normally also present with joint space narrowing, subchordal sclerosis, osteophyte formation, and sometimes subchondral cysts. Findings other than distal cortical thickening are absent from the January 2020 X-ray. The examiner added that neither the January 2020 provider nor the February 2020 provider opined that the cortical changes seen in the distal tibia are more likely the result of the long-term effects of obesity, especially considering the Veteran's only reported right ankle injury was an in-service sprain that occurred more than 20 years earlier and had fully resolved. The examiner also explained that the Veteran had no intervening history of ankle issues. The January 2018 VA examination of the ankles was unremarkable, as was the podiatry examination in February 2020.

The examiner acknowledged that the Veteran had a grade I ankle sprain in 1996. While changes such as those seen on the January 2020 X-ray can result from severe sprains, the examiner explained that a grade I sprain is not severe. Moreover, he stated that all the other ankle symptoms reported in the Veteran's STRs were ultimately attributed to exertional compartment syndrome. The examiner stated that the history of trauma-free pain, the timing of the onset of his pain, and the physical findings were consistent with a diagnosis of exertional compartment syndrome, and the Veteran's separation examination indeed noted a diagnosis of exertional compartment syndrome. Based on this, the examiner concluded that the Veteran's right ankle degenerative joint disease was not related to his service.

The same examiner provided an addendum opinion later in September 2024. In this opinion, he acknowledged the February 2020 VA treatment records noting that the Veteran had degenerative joint disease "secondary to old trauma." However, he explained that an isolated, fully healed grade I ankle sprain that occurred more than 20 years prior to the X-ray findings of degenerative joint disease is not the cause of the Veteran's degenerative joint disease.

The October 2024 VA examiner likewise opined that the Veteran's right ankle disorder was less likely than not incurred in or caused by his active service. He stated that there is a lack of substantiating evidence supporting a nexus between the current diagnosis of right ankle degenerative arthritis and military service and that, without chronicity during or after service, a post-service event, illness, or injury is considered to be a more likely etiology. The examiner stated that the Veteran was diagnosed with a right ankle sprain in 1996, as documented in his STRs. More than 20 years later, his treatment records note a diagnosis of "degenerative joint disease of the right ankle, likely secondary to old trauma" in 2020. However, the October 2024 VA examiner found that there is not enough evidence to suggest that this degenerative joint disease was caused by the ankle sprain during service. The Veteran's discharge documents do not indicate that he had a right ankle disorder at the time of separation, and his records do not show treatment or complaints of any right ankle disorder until about 2018. The examiner further noted that the Veteran has many risk factors for right ankle degenerative joint disease, including age, gender, obesity, and gout.

Taken as a whole, the September 2024 and October 2024 opinions are probative. The opinions are based on an accurate medical history. They provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board acknowledges the Veteran's belief that his right ankle disorder, to include degenerative joint disease and tendonitis, is related to service. The issue is medically complex, as it requires knowledge of anatomical relationships and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case, as the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011). Consequently, the Board gives more probative weight to the VA medical opinions finding no nexus between the Veteran's current right ankle disorder and his active service.

Given the foregoing, the evidence persuasively weighs against finding that the Veteran's right ankle disorder, to include degenerative joint disease and tendonitis, was incurred in or caused by active service. Service connection may not be awarded on a direct basis. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303; Shedden, 381 F.3d 1166-67.

The Board next turns to whether service connection is warranted for a right ankle disorder, to include degenerative joint disease and tendonitis, as secondary to his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

The Veteran has diagnoses of right ankle did and tendonitis. The Veteran is also currently service connected for degenerative arthritis of the lumbosacral spine with lumbar strain. The first and second elements of secondary service connection are met. See 38 C.F.R. § 3.310; see also Allen, 7 Vet. App. at 448; see also Spicer, 61 F.4th at 1364. Thus, the remaining question for the Board is whether the Veteran's current right ankle disorder, to include degenerative joint disease and tendonitis, was caused or aggravated by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

The February 2024, April 2024, September 2024, and October 2024 VA medical opinions established that the Veteran's right ankle disorder was not caused or aggravated by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

The February 2024 VA examiner opined that the Veteran's right ankle tendonitis is not caused or aggravated by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. The rationale for this opinion is that there is no clear evidence from review of the orthopedic literature to suggest that an injury to one joint would have any significant impact or another or opposed uninjured joint or limb, unless the injury resulted in major muscle or nerve damage causing partial or complete paralysis or shortening of the injured limb resulting in length discrepancy of more than five centimeters such that the individual's gait pattern has been altered to the extent that there is an obvious Trendelenburg gait. The examiner stated that this level of severity is not shown based on the Veteran's treatment records, history, and examinations. The examiner further explained, "It is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it." The examiner cited Oxford's Textbook on Orthopedics and Trauma in support of this negative opinion.

The examiner who offered the April 2024 addendum VA medical opinion also opined that the Veteran's right ankle tendonitis was not aggravated beyond its natural progression by the Veteran's service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. She stated that these are two separate conditions that are not related to each other. She also cited medical literature showing that there is no clear evidence to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless that injury resulted in major muscle or nerve damage causing partial or complete paralysis or shortening of the injured limb resulting in length discrepancy of more than five centimeters so that the individual's gait pattern has been altered to the extent that, clinically, there is an obvious Trendelenburg gait. The examiner emphasized that no Trendelenburg gait due to the Veteran's service-connected back condition has been documented to date. Thus, she found that it is not plausible that the Veteran's degenerative arthritis of the lumbosacral spine with lumbar spine has aggravated his right ankle tendonitis.

The September 2024 VA examiner likewise opined that it is less likely than not that the Veteran's right ankle degenerative joint disease was caused by or underwent any incremental increase, regardless of its permanence, due to his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. He explained that it is common clinical knowledge that there is no pathophysiologic or pathoanatomical correlation or causation between degenerative joint disease of the right ankle and degenerative arthritis of the lumbosacral spine with lumbar strain. (The Board notes that the initial September 2024 opinion stated that there is a relationship between these two disabilities, but an addendum opinion obtained later in September 2024 clearly states that this was a typo and that there is not a relationship between the Veteran's right ankle and back disabilities.) The examiner went on to explain that the back and right ankle are two different parts of the body that do not connect. Rather, degenerative joint disease is caused by trauma over a period of time. It cannot "spread" in the blood.

In October 2024, another VA examiner opined that it is less likely than not that the Veteran's right ankle degenerative joint disease is caused by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. The rationale for this opinion was that arthritis in one joint does not cause arthritis in another joint, and a thorough review of the medical literature does not show any such causal relationship. Again, the examiner stated that it is not unusual for two joints to share properties in the same person, but one joint's disease does not "spread" to another or cause damage to it. The October 2024 examiner also opined that it is less likely than not that the Veteran's right ankle degenerative joint disease was aggravated beyond its natural progression by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. As rationale, however, the examiner merely stated that he was unable to determine that the Veteran's right ankle degenerative joint disease was aggravated beyond its natural progression by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

An addendum opinion addressing aggravation was obtained later in October 2024. The examiner stated,

Medical [o]pinion was already provided regarding the claimed condition. Veteran was diagnosed with right ankle sprain in 1966 as documented in service
examiner also opined that it is less likely than not that the Veteran's right ankle degenerative joint disease was aggravated beyond its natural progression by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. As rationale, however, the examiner merely stated that he was unable to determine that the Veteran's right ankle degenerative joint disease was aggravated beyond its natural progression by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

An addendum opinion addressing aggravation was obtained later in October 2024. The examiner stated,

Medical [o]pinion was already provided regarding the claimed condition. Veteran was diagnosed with right ankle sprain in 1966 as documented in service treatment records. Diagnosis of degenerative joint disease right ankle noted in 2020. Unable to determine that the right ankle sprain was aggravated by service since the [V]eteran did not continue to complain or seek treatments about the right ankle condition during service. 'Degenerative arthritis of right ankle, likely to an old trauma was noted over twenty years later'. Not enough evidence in the file to determine that the right ankle condition was aggravated during the time in service.

The October 2024 addendum opinion is insufficient. First, it is factually inconsistent with the record, as the Veteran's STRs show that he was diagnosed with a right ankle sprain in 1996, not 1966. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Moreover, the examiner provided an opinion as to whether a pre-existing condition was aggravated during service. The question at issue here is actually whether a non-service-connected condition was aggravated by a service-connected disability. These inadequacies render the October 2024 addendum opinion insufficient.

Although the October 2024 opinion is insufficient, the record contains other probative VA medical opinions that adequately address whether the Veteran's right ankle disorder, to include degenerative joint disease and tendonitis, was caused or aggravated by his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

In that regard, the combined opinion of the above VA examiners is probative. These opinions are based on an accurate medical history and provide an explanation with clear conclusions, supporting data, and reference to medical literature. Nieves-Rodriguez, 22 Vet. App. at 304. There is also no medical evidence of record that contradicts these negative nexus opinions, as the Veteran's treating physicians have not linked his right ankle disorder, to include degenerative joint disease and tendonitis, to his service-connected back condition.

The Veteran's believes that his right ankle disorder, to include degenerative joint disease and tendonitis, is related to his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain. The issue is medically complex, as it requires knowledge of anatomical relationships and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case, as the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24 Vet. App. at 434. Thus, the Board gives more probative weight to the VA medical opinions finding no nexus between the Veteran's current right ankle disorder and his service-connected degenerative arthritis of the lumbosacral spine with lumbar strain.

Thus, for the reasons and bases discussed, the evidence for the claim for entitlement to service connection for a right ankle disorder, to include degenerative joint disease and tendonitis, versus the evidence against the claim is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and, therefore, most persuasive evidence is against this claim. See Lynch, 21 F.4th at 781-82; see also Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). The claim for entitlement to service connection for a right ankle disorder, to include degenerative joint disease and tendonitis, is denied.

Increased Ratings

Disability ratings are determined in accordance with VA's Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability picture more closely approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran
right ankle disorder, to include degenerative joint disease and tendonitis, is denied.

Increased Ratings

The Board will consider whether staged ratings should be assigned to compensate for times when the disability may have been more severe than at other times during the pendency of the claim. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999).

Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change.

Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are equitable and just as contemplated by the requirements of the law. 38 C.F.R. § 4.6.

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis. However, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki 25 Vet. App. 1, 5 (2016).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and the extent of functional impairment of flare-ups from the veterans themselves when a flare-up is not observable at the time of examination.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use over time and therefore not be reflected on range of motion testing. Additionally, 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011); see also DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Nonetheless, even when the background factors listed in 38 C.F.R. §§ 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R.
motion testing. Additionally, 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011); see also DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Nonetheless, even when the background factors listed in 38 C.F.R. §§ 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a. A separate or higher rating under 38 C.F.R. §§ 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Relevant to the present appeal, the Board recognizes that where a diagnostic code does not explicitly contemplate the ameliorative effects of medication on a disability, it must evaluate the disability without regard to the ameliorative effects of the medication. See Ingram v. Collins, 38 Vet. App. 130, 132 (2025) (holding that because the applicable diagnostic codes and special musculoskeletal regulations do not reference medication, the Board must discount the beneficial effects of medication when assigning a rating); see also Jones v. Shinseki, 26 Vet. App. 56, 62 (2012); see also McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) ("[I]f [a diagnostic code] does not specifically contemplate the effects of medication, the Board is required pursuant to Jones to discount the ameliorative effects of medication."). The diagnostic codes pertaining to disabilities of the knee and lower leg do not explicitly contemplate the ameliorative effects of medication. See 38 C.F.R. § 4.71a.

1. Entitlement to an Initial Rating in Excess of 10 Percent for Right Lower Extremity Shin Splints with Painful Motion of the Right Knee

2. Entitlement to an Initial Rating in Excess of 10 Percent for Left Lower Extremity Shin Splints

In the August 2024 decision, the Board awarded initial 10 percent ratings for right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints from May 4, 2017. The Veteran contends that higher ratings are warranted throughout the entire period on appeal. In the July 2025 JMPR, the parties agreed that the Board did not adequately address the ameliorative effects of medications, if any, on the severity of the Veteran's bilateral knee disabilities.

The Veteran's right lower extremity shin splints with painful range of motion of the right knee are rated under Diagnostic Code 5262-5260. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after the hyphen. 38 C.F.R. § 4.27.

Meanwhile, the Veteran's left lower extremity shin splints are rated under Diagnostic Code 5299-5262. Prior to February 7, 2021, shin splints were not specifically listed in the Schedule for Rating Disabilities. When an unlisted condition is encountered, it is permissible to rate it under a closely related disease of injury in which not only the functions affected, but also the anatomical localization and symptomatology, are closely analogous. 38 C.F.R. § 4.20. According to the policy in the Schedule for Rating Disabilities, when a disability is not specifically listed, the diagnostic code will be "built up," meaning that the first two digits will be selected from the part of the schedule most closely identifying the part of the body involved, while the last two digits will be "99." 38 C.F.R. § 4.27.

A. Evaluations Based on Limitation of Motion

Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion of the knee to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees
when a disability is not specifically listed, the diagnostic code will be "built up," meaning that the first two digits will be selected from the part of the schedule most closely identifying the part of the body involved, while the last two digits will be "99." 38 C.F.R. § 4.27.

A. Evaluations Based on Limitation of Motion

Diagnostic Code 5261 provides a noncompensable rating where extension is limited to 5 degrees, a 10 percent rating where extension is limited to 10 degrees, a 20 percent rating where extension is limited to 15 degrees, a 30 percent rating where extension is limited to 20 degrees, a 40 percent rating where extension is limited to 30 degrees, and a 50 percent rating where extension is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

Normal ranges of motion of the knee are to 0 degrees in extension and to 140 degrees in flexion. See 38 C.F.R. § 4.71a, Plate II.

The revisions that went into effect on February 7, 2021 did not make any substantive changes to Diagnostic Codes 5260 or 5261.

At the time of the December 2017 VA examination, the Veteran exhibited right knee flexion to 110 degrees and extension to 0 degrees with pain on flexion. He had left knee flexion to 120 degrees and extension to 0 degrees with pain on flexion. He also had less movement than normal due to ankylosis, adhesions, etc. The Veteran reported flare-ups of the right and left knees at the time of the December 2017 VA examination. He rated his knee pain as a 4/10 in severity. His knee pain was aggravated by prolonged standing, walking, squatting, and kneeling, and it was worse in the early morning hours and during cold, rainy weather. He also reported feeling a grinding sensation in his knees. He took Aleve for his knee pain, and he used a brace and a cane. The examiner indicated that he was unable to estimate whether there was additional functional loss due to pain, weakness, fatigability, or incoordination of either knee during flare-ups without resorting to mere speculation. The examiner also indicated that the examination was being performed immediately after exercise, but he confusingly indicated that he was unable to opine on whether the Veteran experienced additional functional loss of the right or left knees after repetitive use over time because the Veteran was being examined immediately after exercise. The December 2017 VA examination therefore does not fully comply with the requirements of Sharp, as it must be clear whether estimates cannot be provided due to a lack of knowledge among the medical community at large or due to insufficient knowledge of the specific examiner. Sharp, 29 Vet. App. at 33.

During the June 2019 VA examination, the Veteran again had right knee flexion to 110 degrees and extension to 0 degrees, while he had left knee flexion to 120 degrees and extension to 0 degrees. He had pain on both flexion and extension of the right knee, as well as pain with weight-bearing. However, he did not have pain on flexion or extension of the left knee, nor did he have pain with weight-bearing of the left knee. He also reported less movement than normal, interference with standing, and pain with standing and walking long distances bilaterally. He treated his bilateral knee pain with gabapentin, diclofenac, and Motrin as needed. The Veteran continued to report flare-ups of the right and left knees after walking.

However, the June 2019 VA examination again does not fully comply with the requirements of Sharp. The examiner did not elicit sufficient information as to the severity, frequency, duration, and extent of functional impairment of these flare-ups, nor did he provide information about alleviating factors. Sharp, 29 Vet. App. at 35-36. The examiner estimated that, during flare-ups and after repetitive use over time, the Veteran would have right knee flexion to 110 degrees and extension to 0 degrees due to pain, while he would have left knee flexion to 120 degrees and extension to 0 degrees due to pain.

Another VA examination was performed in April 2021. At that time, he had
.

Another VA examination was performed in April 2021. At that time, he had right and left knee flexion to 120 degrees and extension to 0 degrees. He again had pain with both flexion and extension of the right and left knees, but he did not have pain with weight-bearing or non-weight-bearing. The Veteran treated his bilateral knee pain and stiffness with Motrin. He did not report flare-ups of the right or left knees during the April 2021 VA examination. The examiner further concluded that the Veteran did not have additional functional loss of either knee after repetitive use over time due to pain, fatigability, weakness, lack of endurance, or incoordination.

During the March 2023 hearing, the Veteran testified that his shin splints had gotten worse, especially when walking on hard surfaces. He stated that he treated his pain with topical medications and that he had repeatedly increased his dosage of this medication. He also used a transcutaneous electrical nerve stimulation (TENS) unit to treat his shin splints.

At the time of the most recent VA examination pertaining to the knees in February 2024, the Veteran had right knee flexion to 120 degrees and extension to 0 degrees. He had left knee flexion to 135 degrees and extension to 0 degrees. He did not report pain on active motion of the right knee, but he did have pain with passive motion in both flexion and extension. He did not have pain with active or passive motion of the left knee, nor did he have pain with weight-bearing or non-weight-bearing of either knee. He also reported difficulty with prolonged standing, walking, bending, squatting, kneeling, and lifting heavy items, as well as interference with sitting, less movement than normal, and weakened movement of the right knee only. The Veteran treated his bilateral knee pain with physical therapy, anti-inflammatory medications, and topical creams. He did not report flare-ups of the right and left knees. The examiner estimated that, after repetitive use over time, pain would additionally limit the Veteran's right knee range of motion to 115 degrees in flexion and 0 degrees in extension. The examiner also estimated that, after repetitive use over time, the Veteran's left knee range of motion would be limited to 130 degrees in flexion and 0 degrees in extension due to pain.

Based on the foregoing, the Board finds that initial ratings in excess of 10 percent are not warranted for right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints. The Board acknowledges the Veteran's reports of painful motion of the right and left knees that limit his range of motion and his ability to stand, walk, bend, squat, kneel, and lift. However, these reports of painful motion do not warrant ratings in excess of 10 percent for right lower extremity shin splints with painful motion of the right knee or left lower extremity shin splints. Even considering these reports of painful motion, the Veteran did not have limitation of flexion of the right or left knee to 30 degrees or more at any point during the period on appeal. Furthermore, there is no indication that painful motion limited his right or left knee extension to 5 degrees or more at any time. 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261.

The Board has also considered the effects of flare-ups and repetitive use over time on the Veteran's functional ability.

The December 2017 and June 2019 VA examinations did not fully comply with the requirements of Sharp. Guidance on how to evaluate flare-ups and repetitive use over time has not been particularly clear. However, the Board finds overall guidance in Mitchell. Flare-ups and loss after repetitive use over time must be quantifiable and must result in limitation of motion or function beyond that contemplated by the already provided evaluation. In addition, because there is a regulation addressing stabilization of ratings, the flare-ups and loss after repetitive use over time must be of such length as to establish that the overall impairment is more severe than currently evaluated, rather than a brief snapshot in time.

With that in mind, the Board has considered whether the Veteran experienced additional functional loss of either knee during
2017 and June 2019 VA examinations did not fully comply with the requirements of Sharp. Guidance on how to evaluate flare-ups and repetitive use over time has not been particularly clear. However, the Board finds overall guidance in Mitchell. Flare-ups and loss after repetitive use over time must be quantifiable and must result in limitation of motion or function beyond that contemplated by the already provided evaluation. In addition, because there is a regulation addressing stabilization of ratings, the flare-ups and loss after repetitive use over time must be of such length as to establish that the overall impairment is more severe than currently evaluated, rather than a brief snapshot in time.

With that in mind, the Board has considered whether the Veteran experienced additional functional loss of either knee during flare-ups or after repetitive use over time. The available VA examinations, treatment records, and lay statements do not show that the Veteran experienced functional loss of either knee during flare-ups or after repetitive use over time beyond that already contemplated by the 10 percent ratings currently assigned. The evidence does not show that the Veteran has had right or left knee flexion to 30 degrees or less or extension to 5 degrees or more during flare-ups or after repetitive use over time during the period on appeal. Any loss that the Veteran has experienced during flare-ups or after repetitive use over time is not shown to additionally limit his functional ability in a quantifiable way and is not of such a length or duration that a staged rating would not violate the rule regarding stabilization of ratings.

The Board has considered the Veteran's lay reports of symptoms and that he experiences functional loss of the right knee due to pain, limited range of motion, weakness, and interference with sitting, standing, walking, bending, squatting, kneeling, and lifting, as well as less movement than normal and weakened movement. Even considering these lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by these statements would not result in right knee flexion limited to 30 degrees or less or extension limited to 5 degrees or more at any point during the period on appeal. 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261.

A remand for an addendum opinion regarding the ameliorative effects of medications is not warranted. Diagnostic Codes 5260 and 5261 do not specifically contemplate the ameliorative effects of medications. However, the evidence does not suggest that the Veteran's right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints have been alleviated by medications.

The Veteran reported use of numerous medications, including Aleve, Motrin, gabapentin, diclofenac, and topical creams, as well as a TENS unit, during the period on appeal. Importantly, his VA examinations and lay statements do not show that his right or left knee pain was alleviated by any of these medications. He also testified that he was prescribed increasingly higher dosages of his topical cream with little relief. The Veteran did not list any of these medications as an alleviating factor of his bilateral knee pain, and he continued to report significant symptoms despite his use of these medications. Thus, the record does not establish that the Veteran experienced ameliorative effects from any medications on his right and left lower extremity disabilities, and a remand under Jones and Ingram is not required.

Thus, for the reasons and bases discussed, the evidence for the claims for initial ratings in excess of 10 percent for right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints versus the evidence against the claims is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and, therefore, most persuasive evidence is against these claims. See Lynch, 21 F.4th at 781-82; see also Ortiz, 274 F.3d at 1364. The claims for entitlement to initial ratings in excess of 10 percent for right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints are denied.

B. Evaluations Under Diagnostic Code 5262 for Impairment of the Tibia and Fibula

Diagnostic Code 5262 addresses impairment of the tibia and fibula. Under the version of Diagnostic Code 5262 in effect prior to February 7, 2021, a 10 percent rating is warranted for malunion of the tibia and fibula with slight knee or ankle disability. A 20 percent rating is warranted for malunion of the tibia and fibula with moderate knee or ankle disability. A 30 percent rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability. A maximum 40 percent rating is warranted for nonunion of the tibia and fibula with loose motion
Evaluations Under Diagnostic Code 5262 for Impairment of the Tibia and Fibula

Diagnostic Code 5262 addresses impairment of the tibia and fibula. Under the version of Diagnostic Code 5262 in effect prior to February 7, 2021, a 10 percent rating is warranted for malunion of the tibia and fibula with slight knee or ankle disability. A 20 percent rating is warranted for malunion of the tibia and fibula with moderate knee or ankle disability. A 30 percent rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability. A maximum 40 percent rating is warranted for nonunion of the tibia and fibula with loose motion requiring a brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2020).

The words "slight," "moderate," and "marked," as used in the pre-amendment version of Diagnostic Code 5262 are not defined in the rating schedule. According to Merriam-Webster's Dictionary, "slight" means "small of its kind or in amount." See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/slight (last visited Jan. 21, 2026). "Moderate" means "limited in scope or effect." See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/moderate (last visited Jan. 21, 2026). "Marked" means "having a distinctive or emphasized character." See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/marked (last visited Jan. 21, 2026).

The amended version of Diagnostic Code 5262 in effect from February 7, 2021 continues to provide ratings for impairment of the tibia and fibula. The rating criteria are split into three categories: medial tibial stress syndrome (MTSS), or shin splints; malunion; or nonunion. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2021).

Under the amended version of Diagnostic Code 5262, MTSS of one or both lower extremities requiring treatment for less than 12 consecutive months warrants a noncompensable rating. MTSS of one or both lower extremities that requires treatment for no less than 12 consecutive months and is unresponsive to either shoe orthotics or other conservative treatment warrants a 10 percent rating. MTSS of one lower extremity that requires treatment for no less than 12 consecutive months and is unresponsive to surgery and either shoe orthotics or other conservative treatment warrants a 20 percent rating. MTSS of both lower extremities that requires treatment for no less than 12 consecutive months and is unresponsive to surgery and either shoe orthotics or other conservative treatment warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2021).

Malunion of the tibia and fibula is to be evaluated under Diagnostic Codes 5256, 5260, or 5261 for the knee or Diagnostic Codes 5270 or 5271 for the ankle, whichever results in the highest evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2021).

Nonunion of the tibia and fibula with loose motion requiring a brace is assigned a 40 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2021).

During the December 2017 VA examination, the Veteran was diagnosed with shin splints of the right and left lower extremities. The examiner stated that these shin splints did not affect the range of motion of the Veteran's bilateral knees or ankles. Although the examiner stated that the Veteran's shin splints did not affect the range of motion of his knees, the Board nonetheless notes that the Veteran's right knee range of motion was from 0 to 110 degrees with pain on flexion. His left knee range of motion was from 0 to 120 degrees with no pain on flexion, extension, or weight-bearing.

The December 2017 VA examiner did not adequately estimate the degree of functional loss of the Veteran's right or left knees during flare-ups or after repetitive use over time. He reported constant use of braces and a walker for his lower back pain and knees, and he also reported use of Aleve for his shin splints. There was no indication that the Veteran had malunion or nonunion of the right or left tibia and fibula at the time of the December 2017 VA examination.

In June 2019, the VA examination
0 to 110 degrees with pain on flexion. His left knee range of motion was from 0 to 120 degrees with no pain on flexion, extension, or weight-bearing.

In June 2019, the VA examination showed a diagnosis of right and left lower extremity shin splints that affected the range of motion of the knees. These shin splints also resulted in knee pain, especially with walking long distances. As discussed above, the Veteran's right knee range of motion was from 0 to 110 degrees with pain on flexion, extension, and weight-bearing. His left knee range of motion was from 0 to 120 degrees with no pain on flexion, extension, or weight-bearing. During flare-ups and after repetitive use over time, his right knee range of motion was limited to 0 to 110 degrees due to pain. His shin splints did not affect the range of motion of his right or left ankles. There was no evidence showing malunion or nonunion of the right or left tibia and fibula. The Veteran reported that he constantly used braces and regularly used a cane for his shin splints. He also stated that he used gabapentin, diclofenac, and Motrin for his shin splints.

The April 2021 VA examination showed a diagnosis of bilateral lower extremity shin splints that required treatment for less than 12 consecutive months. The Veteran's shin splints resulted in occasional pain with prolonged standing. The Veteran's right and left knee range of motion was from 0 to 120 degrees with pain on both flexion and extension. He did not experience any additional functional loss during flare-ups or after repetitive use over time. There was no evidence of nonunion or malunion of the right or left tibia and fibula. He did not report the use of any assistive devices for his right or left lower extremity shin splints. The Veteran reported use of Motrin for his right and left lower extremity shin splints.

In February 2024, the examiner indicated that the Veteran had bilateral lower extremity shin splints that were unresponsive to shoe orthotics or other conservative treatment. An April 2024 addendum opinion also stated that the Veteran's shin splints required treatment for less than 12 consecutive months. His right knee range of motion was from 0 to 120 degrees, while his left knee range of motion was from 0 to 135 degrees. He did not have pain on active motion of the right knee, but he had pain on flexion and extension during passive range of motion testing of the right knee. He did not have pain on active or passive range of motion of the left knee. He did not experience additional functional loss during flare-ups, and pain limited his right knee range of motion from 0 to 115 degrees and his left knee range of motion from 0 to 130 degrees after repetitive use over time. There was no indication that the Veteran had malunion or nonunion of the right or left tibia and fibula. He indicated constant use of a cane for painful motion of the right knee, but he did not use any assistive devices for his left knee.

At the time of the February 2024 VA examination, the Veteran stated that he had used anti-inflammatories and topical creams and attended physical therapy for his right and left lower extremity pain.

The Board finds that ratings in excess of 10 percent are not warranted for right lower extremity shin splints with painful range of motion of the right knee and left lower extremity shin splints under Diagnostic Code 5262 at any time during the period on appeal. There is likewise no basis to assign a separate compensable rating under that diagnostic code.

As it pertains to the version of Diagnostic Code 5262 in effect prior to February 7, 2021, there is no basis for assigning ratings greater than 10 percent or separate compensable ratings. The Veteran's VA examinations and treatment records do not show that he had malunion or nonunion of the right or left tibia and fibula. A 20 percent rating under the pre-amendment version of Diagnostic Code 5262 requires malunion of the tibia and fibula with moderate knee or ankle disability. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2020). Although the Board acknowledges that
is likewise no basis to assign a separate compensable rating under that diagnostic code.

As it pertains to the version of Diagnostic Code 5262 in effect prior to February 7, 2021, there is no basis for assigning ratings greater than 10 percent or separate compensable ratings. The Veteran's VA examinations and treatment records do not show that he had malunion or nonunion of the right or left tibia and fibula. A 20 percent rating under the pre-amendment version of Diagnostic Code 5262 requires malunion of the tibia and fibula with moderate knee or ankle disability. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2020). Although the Board acknowledges that the Veteran's VA examinations show complaints of pain and limited range of motion of the right and left knees due to shin splints, this disability did not result in malunion or nonunion of the tibia and fibula.

Consideration has been given as to whether the Veteran's right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints are more analogous to malunion of the tibia and fibula with moderate knee or ankle disability, as shin splints were not specifically listed in the rating schedule prior to February 7, 2021. See 38 C.F.R. § 4.20. However, the Veteran's right lower extremity shin splints with painful motion and left lower extremity shin splints did not result in moderate knee or ankle disability. At no point was the Veteran's right or left knee flexion limited to less than 110 degrees, even considering the effects of flare-ups and repetitive use over time. Flexion of the knee limited to 110 degrees would not result in a compensable rating under Diagnostic Code 5260. See 38 C.F.R. § 4.124a, Diagnostic Code 5260. His right and left knee extension was not limited at all during the period on appeal.

Although the Veteran seeks service connection for a right ankle disorder, such has not been granted. There is also no evidence suggesting that the Veteran's shin splints have caused ankle disability.

The Board thereby concludes that the Veteran's right lower extremity shin splints with painful motion of the right and left lower extremity shin splints are best described as slight, or small of its kind or in amount, because they have only resulted in painful motion and minimal range of motion loss of the knee. See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/slight (last visited Jan. 21, 2026). Additionally, because the symptoms of the Veteran's right and left lower extremity shin splints result in limited range of the knee with no other manifestations, it would violate the rule against pyramiding to assign separate compensable ratings for the same symptoms under Diagnostic Code 5260 and Diagnostic Code 5262. See 38 C.F.R. § 4.14.

Based on the foregoing, ratings in excess of 10 percent or separate compensable ratings are not warranted for right lower extremity shin splints with painful motion and left lower extremity shin splints under the pre-amendment version of Diagnostic Code 5262.

There is also no basis to assign ratings in excess of 10 percent or separate compensable ratings under the post-amendment version of Diagnostic Code 5262. The April 2021, February 2024, and April 2024 VA examinations show that the Veteran's right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints required treatment for less than 12 consecutive months. The February 2024 VA examination also indicated that the Veteran's right and left lower extremity shin splints were unresponsive to shoe orthotics or other conservative treatment. However, there is no evidence that the Veteran's right or left lower extremity shin splints were unresponsive to surgery. Further, the evidence of record still fails to show malunion or nonunion of the tibia and fibula. Ratings in excess of 20 percent under the amended version of Diagnostic Code 5262 are therefore not appropriate. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2021).

The Veteran's use of medications to treat his right and left lower extremity pain has been considered. However, for the reasons discussed above, the evidence does not show that these medications alleviated his right lower extremity shin splints with painful motion of the right knee or left lower extremity shin splints. See Ingram, 38 Vet. App. at 132; see also Jones, 26 Vet. App. at 62.

Thus, for the reasons and bases discussed, the evidence for the claims versus the evidence against
excess of 20 percent under the amended version of Diagnostic Code 5262 are therefore not appropriate. 38 C.F.R. § 4.71a, Diagnostic Code 5262 (2021).

Thus, for the reasons and bases discussed, the evidence for the claims versus the evidence against the claims is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and, therefore, most persuasive evidence is against these claims. See Lynch, 21 F.4th at 781-82; see also Ortiz, 274 F.3d at 1364. The claims for entitlement to ratings in excess of 10 percent for right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints under Diagnostic Code 5262 are denied.

C. Evaluations Under Diagnostic Code 5257 for Instability

Diagnostic Code 5257 addresses other impairment of the knee. Under the criteria in effect before February 7, 2021, recurrent subluxation and lateral instability of the knee warranted a 10, 20, or 30 percent rating for slight, moderate, or severe instability, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2020).

These terms (slight, moderate, and severe) are not defined in the pre-amended diagnostic code. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6.

It is again noted that the use of terminology within a VA examination report is not in and of itself dispositive. The definitions for "slight" and "moderate" have been discussed above. "Severe" means "very painful or harmful or of a great degree." See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/severe (last visited Jan. 21, 2026).

Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257. Objective evidence cannot be categorically found more probative than lay evidence with respect to Diagnostic Code 5257. English v. Wilkie, 30 Vet. App. 347, 350 (2018).

Effective February 7, 2021, Diagnostic Code 5257 was amended to provide for more explanation as to the terminology. Although not in effect until February 7, 2021, the Board finds the definitions within the amended version of Diagnostic Code 5257 instructive. The Board will therefore apply either the Merriam-Webster Dictionary definition or the amended Diagnostic Code 5257 definitions, whichever is most favorable for the veteran in light of the evidence.

Under the criteria in effect as of February 7, 2021, Diagnostic Code 5257 contains two sections for rating instability of the knee. The first addresses recurrent subluxation or instability, The second addresses patellar instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2021).

For recurrent subluxation or instability under Diagnostic Code 5257, a 30 percent rating requires an unrepaired or failed repair of a complete ligament tear which causes persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. A 20 percent rating is assigned with either (a) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device for ambulation, or (b) an unrepaired or failed repair of a complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A 10 percent rating is assigned for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability without a prescription from a medical provider for an assistive device or bracing for ambulation. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2021).

Regarding patellar instability under Diagnostic Code 5257, a 30 percent rating requires a diagnosed condition involving the patellofemoral complex
ive device for ambulation, or (b) an unrepaired or failed repair of a complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A 10 percent rating is assigned for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability without a prescription from a medical provider for an assistive device or bracing for ambulation. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2021).

Regarding patellar instability under Diagnostic Code 5257, a 30 percent rating requires a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or walker. A 20 percent rating requires a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. A 10 percent rating requires a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2021).

The Board will consider the claim under the old criteria prior to February 7, 2021 and both the old and the new criteria from February 7, 2021. The criteria that are most favorable to the Veteran will be applied.

In December 2017, the Veteran did not report a history of recurrent subluxation or lateral instability of the right or left knees. Joint stability testing showed normal anterior, posterior, medial, and lateral stability of the right and left knees. The Veteran reported constant use of a knee brace and walker for his lower back pain and knees. However, he did not specify that these assistive devices were used for stability.

During the June 2019 VA examination, the Veteran again did not report a history of recurrent subluxation or lateral instability of either knee. Joint stability testing continued to show normal anterior, posterior, medial, and lateral stability of the right and left knees. He reported constant use of a knee brace and regular use of a cane for his shin splints, but there is no indication that these assistive devices were used for stability.

In April 2021, the Veteran again did not have recurrent subluxation or persistent instability of the right or left knee. He did not have a ligament tear (sprain) of the right or left knee, and the examination report did not indicate that he had recurrent patellar instability of the right or left knee. The Veteran did not report use of any assistive devices for his right or left knee during the April 2021 examination.

In February 2024, the Veteran did not have recurrent subluxation, persistent instability, a ligament tear (sprain), or patellar instability of the right or left knee. He indicated that he constantly used a cane for painful motion of the right knee. However, he did not state that this cane was used for instability. Moreover, he did not report the use of any assistive devices for his left knee.

At no point in the Veteran's VA examinations, treatment records, or lay statements did he indicate that he experienced instability of the right or left knee. The record also fails to show that he had a sprain, ligament tear, or patellar instability affecting either knee. Accordingly, separate ratings under either the former or revised version of Diagnostic Code 5257 are not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5257.

The Board has again considered the ameliorative effects of medications on the severity of the Veteran's right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints. Although the Veteran used various medications to treat these disabilities during the period on appeal, the evidence does not show that such medications alleviated his right or left knee instability, especially given that the Veteran did not report instability of the right or left knee to begin with. See Ingram, 38 Vet. App. at 132; see also Jones, 26 Vet. App. at 62.

Thus, for the reasons and bases discussed, the evidence for the claims versus the evidence against the claims is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and, therefore, most persuasive evidence is against these claims. See Lynch, 21 F.4th at 781-82; see also Ortiz, 274 F.3d at 1364. The claims for entitlement to separate ratings
not show that such medications alleviated his right or left knee instability, especially given that the Veteran did not report instability of the right or left knee to begin with. See Ingram, 38 Vet. App. at 132; see also Jones, 26 Vet. App. at 62.

Thus, for the reasons and bases discussed, the evidence for the claims versus the evidence against the claims is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and, therefore, most persuasive evidence is against these claims. See Lynch, 21 F.4th at 781-82; see also Ortiz, 274 F.3d at 1364. The claims for entitlement to separate ratings for right or left knee instability under Diagnostic Code 5257 are denied.

D. Additional Diagnostic Codes Applicable to the Knee and Leg

The Board has also considered the other diagnostic codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative of or overlapping with the symptomatology of any other disability. 38 C.F.R. § 4.14.

Diagnostic Code 5256 provides compensation for ankylosis of the knee. The Veteran does not contend that he has, nor have his VA examinations or treatment records shown, ankylosis of the right or left knee. The Board acknowledges that the December 2017 and June 2019 VA examination reports indicate that the Veteran had "less movement than normal due to ankylosis, adhesions, etc." However, while the December 2017 examination report does not include a completed section about ankylosis, the June 2019, April 2021, and February 2024 examination reports specifically conclude that the Veteran did not have ankylosis of either knee. Nor do his records show that he experiences functional impairment that approximates ankylosis. See Chavis v. McDonough, 34 Vet. App. 1, 11 (2021). Although the Veteran reported symptoms including difficulty walking and bending, as well as impaired range of motion, he has not suggested that he is unable to move his right or left knees or that they are fixed in position. Thus, his symptoms do not represent the functional equivalent of ankylosis of the right or left knees. Ratings under Diagnostic Code 5256 are not appropriate.

Diagnostic Codes 5258 and 5259 address disorders of the semilunar cartilage. Diagnostic Code 5258 assigns a 20 percent rating for dislocated semilunar cartilage with episodes of "locking," pain, and effusion into the joint. Diagnostic Code 5259 provides a 10 percent rating for the symptomatic removal of the semilunar cartilage. None of the Veteran's examinations or treatment records show the dislocation or removal of the semilunar cartilage of the right or left knees. There is therefore no basis for the assignment of separate ratings under Diagnostic Code 5258 or 5259.

Diagnostic Code 5263 provides a 10 percent rating for genu recurvatum. However, the VA examinations and treatment records do not show genu recurvatum of the right or left knees. The Veteran is therefore not entitled to ratings under Diagnostic Code 5263.

The Board has once again considered the ameliorative effects of medications on the severity of the Veteran's right lower extremity shin splints with painful motion of the right knee and left lower extremity shin splints. However, the Board again emphasizes that the evidence does not show that such medications alleviated his bilateral knee disability, especially considering the Veteran does not have right or left knee ankylosis, dislocated semilunar cartilage, removal of the semilunar cartilage, or genu recurvatum. See Ingram, 38 Vet. App. at 132; see also Jones, 26 Vet. App. at 62.

Thus, for the reasons and bases discussed, the evidence for the claims for separate ratings for the right and left knees under Diagnostic Codes 5256. 5258, 5259, and 5263 versus the evidence against the claims is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and persuasive evidence is against these claims. See Lynch, 21 F.4th at 781-82; see also Ortiz, 274 F.3d at 1364.

REASONS FOR REMAND

1. Entitlement to Service Connection for a Respiratory Disorder, To Include Allergic Rhinitis

The Veteran seeks service connection for a respiratory disorder. He reports that he has had trouble breathing since having walking pneumonia during his active service. Alternatively, he suggests that he was exposed to lithium battery gas during service and that he has had respiratory issues since such exposure
, and 5263 versus the evidence against the claims is not in "approximate" balance (i.e., nearly equal). Instead, the most probative and persuasive evidence is against these claims. See Lynch, 21 F.4th at 781-82; see also Ortiz, 274 F.3d at 1364.

REASONS FOR REMAND

1. Entitlement to Service Connection for a Respiratory Disorder, To Include Allergic Rhinitis

In August 2024, the Board denied entitlement to service connection for a respiratory disorder, finding that the Veteran did not have a chronic respiratory disorder during or approximate to the pendency of the claim. However, in the July 2025 JMPR, the parties agreed that the Board did not address the Veteran's diagnoses or assessments of allergic rhinitis, which is a disability of the respiratory system.

VA treatment records show diagnosis and treatment for allergic rhinitis. No examiner has opined on whether this allergic rhinitis was incurred in or caused by service, to include as due to his in-service walking pneumonia and claimed exposure to lithium battery gas. As such, this claim must be remanded for a new VA examination and medical opinion addressing this question. 38 U.S.C. § 5108A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).

Moreover, on August 10, 2022, the President of the United States signed into law the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act). See Honoring our PACT Act of 2022, Pub. L. No. 117-168, 136 Stat. 1759 (2022). The PACT Act created additional procedural rights for veterans who claimed participation in a toxic exposure risk activity (TERA). One such right is consideration of the records, such as review of an exposure tracking system for that veteran to determine participation in a TERA. 38 U.S.C. § 1119(a); see also VBA Letter 20-24-06 at 7, Updated Guidance on Processing Claims Involving the PACT Act (June 12, 2024). This may include a review of a veteran's Individual Longitudinal Exposure Record (ILER) for documentation of a known TERA. See 38 U.S.C. § 1119(c)(2)(B); see also VBA Letter 20-24-06 at 7. VA has directed its claims processors to perform an ILER inquiry to determine if a veteran participated in a TERA. See VBA Letter 20-24-06 at 11, Reference to ILER Guidance.

The Veteran asserts exposure to lithium battery gas during service. However, there is insufficient evidence to establish participation in that alleged TERA. The claims file does not contain a TERA memorandum or documentation showing that an ILER search has been completed. Therefore, remand is necessary to attempt to verify whether the Veteran was exposed to lithium battery gas or any other TERAs during his active service and to prepare a TERA memorandum and ILER search for the claims file.

The matter is REMANDED for the following action:

1. Request the Veteran's Individual Longitudinal Exposure Record (ILER). Then, associate this record with the Veteran's claims file. Alternatively, if a claims processor runs an ILER inquiry and obtains no results, the processor is directed to take a screenshot indicating the lack of an exposure record and associate this record with the Veteran's claims file.

2. If there is still insufficient information to verify exposure to toxic agents, such as lithium battery gas, after completing directive (1), issue a formal finding outlining the steps taken to assist the Veteran and notify him of VA's inability to verify the in-service toxic exposure. If more details are needed, contact the Veteran to request the information.

3. After completing the development requested in directives (1) and (2) above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his allergic rhinitis. The Veteran's claims file must be made available to the examiner. After reviewing the claims file and examining the Veteran, the examiner must opine on the following:

(a.) Identify/diagnose any respiratory disorder, to include allergic rhinitis, that presently exists or that has existed during the period on appeal.

If a diagnosis of allergic rhinitis is
assist the Veteran and notify him of VA's inability to verify the in-service toxic exposure. If more details are needed, contact the Veteran to request the information.

(a.) Identify/diagnose any respiratory disorder, to include allergic rhinitis, that presently exists or that has existed during the period on appeal.

If a diagnosis of allergic rhinitis is not made, the examiner must reconcile this finding with the VA treatment records showing diagnosis of and treatment for allergic rhinitis.

If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment of earning capacity, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below.

(b.) For any diagnosed respiratory disorder, to include allergic rhinitis, or functional impairment, is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher) that it had its initial onset in service or is otherwise etiologically related to his active service? The examiner must address:

i. The Veteran's February 27, 1996 to March 2, 1996 hospital admission for left lower lobe pneumonia, bilateral interstitial edema, and pleural effusions;

ii. The Veteran's contention that he has had trouble breathing since his separation from service; and

iii. The Veteran's claimed exposure to lithium battery gas in service.

4. If participation in a TERA is shown after directives (1) and (2) have been completed, schedule the Veteran for a TERA examination regarding his respiratory disorder, to include allergic rhinitis in compliance with the PACT Act, considering (1) potential exposure to lithium battery gas and/or any other TERAs identified in his ILER and (2) the synergistic, combined effects of all TERAs.

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R.M. Sachs, 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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