ARM IMPAIRMENT OF

L.M. YASUI · 2026 · Case ID: 26004871

DENIED

Summary

The veteran, who served in the U.S. Army from May 2007 to January 2008, appeals the denial of increased ratings for his left shoulder and left knee disabilities, and the denial of service connection for migraine headaches. The Board previously remanded the shoulder and knee claims for increased ratings, and the migraine claim for a new opinion. The RO granted service connection for an acquired psychiatric disability and lumbar spine disability in subsequent decisions, rendering those issues no longer on appeal. The Board reviewed the Veteran's claims for increased ratings for his left shoulder and left knee, considering multiple VA examinations from 2009 through 2024, lay statements, and medical opinions. For the left shoulder, rated at 20% for limitation of motion, the Board found the evidence persuasively weighed against a higher rating, noting that while pain and fatigability were present, the objective range of motion measurements did not support a higher disability evaluation. For the left knee, rated at 10% for chronic strain with painful motion, the Board found the evidence persuasively weighed against a higher rating, particularly regarding instability, and afforded greater weight to objective medical findings over the Veteran's subjective reports. For migraine headaches, the Board considered the Veteran's conflicting statements about onset and the unavailability of service treatment records. A VA examiner opined the migraines were less likely than not related to service, citing the reported onset after service and lack of in-service treatment. The Board found this opinion probative and persuasive, concluding the evidence weighed against service connection. The Board denied all appealed claims.

Rationale

Evidence persuasively weighs against a rating in excess of 20%; Objective range of motion measurements did not support higher rating; Veteran's lay reports of symptoms and noted functional loss did not result in higher limitation

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5003

Docket No.

10-34 467

Full Decision Text

Citation Nr: 26004871
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 10-34 467
DATE: April 22, 2026

ORDER

Entitlement to a rating in excess of 20 percent for left shoulder disability is denied.

Entitlement to a rating in excess of 10 percent for a left knee disability is denied.

Entitlement to service connection for migraine headaches is denied.

FINDINGS OF FACT

1. The Veteran's left shoulder disability is manifested by limitation of motion of, at worse, flexion endpoint of 105 degrees and abduction endpoint of 90 degrees.

2. The Veteran's left knee disability is manifested by painful motion and limitation of motion of, at worse, flexion endpoint of 85 degrees and extension endpoint of zero degrees.

3.The evidence of record persuasively weighs against finding that migraine headaches began during active service or are otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1.The criteria for a rating in excess of 20 percent for degenerative arthritis status post acromioclavicular joint injury of the left shoulder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5201.

2. The criteria for a rating in excess of 10 percent for left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003.

1. The criteria for service connection for migraines are not met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from May 2007 to January 2008.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2009 rating decision of the Department of Veterans Affairs Regional Office (RO). The issues of service connection for migraine headaches, an acquired psychiatric disability, and lumbar spine disability were previously remanded by the Board most recently in September 2024. The Veteran's claims for service connection for an acquired psychiatric disability and for lumbar spine disability were granted by the RO in February and March 2025 rating decisions. Considering those issues were granted in full there is no remaining allegation of error or fact of law for appellate consideration and these issues are no longer in appellate status. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997).

In the September 2024 decision, the Board denied entitlement to an increased rating for left shoulder disability and left knee disability. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court), which resulted in an October 2025 Joint Motion for Partial Remand (JMPR), requesting that the part of the Board's September 2024 decision denying the issues of increased rating for left shoulder disability and left knee disability be vacated and requesting the matters be remanded for readjudication. In October 2025, the Court issued an order granting the JMPR.

The October 2025 JMPR indicated the Board failed to address the 2017 and 2024 VA examinations in considering entitlement to increased ratings for the Veteran's left shoulder disability and left knee disability. The JMPR also indicated the Board failed to provide an adequate statement of reasons or bases addressing whether the record reflects a separate rating under the pre-amendment diagnostic code (DC) 5257 is warranted for the Veteran's left knee. Specifically, it noted the Board failed to address specific evidence including: the May 2016 VA Form 28-1902, which noted "[w]ares [sic] brace and uses cane. Getting worse....Gives out. Bending is creating shooting pains. Not strong as it was."; and the October 2014 VA knee examination report documented "[i]nstability of station" of left knee after repetitive use testing.

1. Entitlement to a rating in excess of 20 percent for left shoulder disability

The Veteran filed a claim for service connection for his left arm in December 2008. The Veteran was granted a 10 percent disability rating in a June 2009 rating decision. In August 2010, the Veteran filed a VA Form 9 appealing
address specific evidence including: the May 2016 VA Form 28-1902, which noted "[w]ares [sic] brace and uses cane. Getting worse....Gives out. Bending is creating shooting pains. Not strong as it was."; and the October 2014 VA knee examination report documented "[i]nstability of station" of left knee after repetitive use testing.

1. Entitlement to a rating in excess of 20 percent for left shoulder disability

The Veteran filed a claim for service connection for his left arm in December 2008. The Veteran was granted a 10 percent disability rating in a June 2009 rating decision. In August 2010, the Veteran filed a VA Form 9 appealing the decision. In a May 2017 statement, the Veteran indicated his condition has worsened since his last exam and requested an exam to reevaluate his condition. In a February 2018 rating decision, the Veteran's rating was increased to 20 percent effective February 1, 2008. The December 2018 Board remand directed the RO to obtain a VA examination for evaluation of the Veteran's left shoulder. Pursuant to the December 2018 Board remand, the Veteran was afforded a VA examination of his left shoulder in December 2021. For the reasons indicated in the discussion below, the examination conducted pursuant to the Board's remand instructions was adequate and the RO therefore complied with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998) (a Board remand confers a right on a claimant to compliance with the remand order).

The Veteran's left shoulder disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5003-5201, for limitation of motion of the arm at 20 percent. The hyphenated diagnostic code indicates that degenerative arthritis in the left shoulder has been rated based on limitation of motion of the shoulder. See 38 C.F.R. § 4.20. Ratings for disabilities of the shoulder vary with the extent of disability and with which arm is affected, and a distinction is made between major (dominant) and minor sides, or "handedness." 38 C.F.R. § 4.69. The Veteran is right-handed; thus, his left shoulder and arm are considered the minor upper extremity.

Under Diagnostic Code 5201 as in effect prior to February 7, 2021, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201.

The changes to Diagnostic Code 5201 made effective February 7, 2021, amended the criteria only to specify that "at shoulder level" refers to flexion and/or abduction limited to 90 degrees and "midway between side and shoulder level" refers to flexion and/or abduction limited to 45 degrees.

Diagnostic Code 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm." Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013).

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 and, therefore, not be reflected on range-of-motion testing. 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 DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 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 § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.
than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 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 § 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.").

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 (2011).

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 extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for the Veteran's left shoulder disability during the period on appeal.

The Veteran underwent a VA examination in January 2009. At that time, the Veteran reported daily symptoms of left shoulder pain with six out of ten intensity that occurred with repetitive reaching and lifting. It was noted when the pain intensified it radiated down his left arm with a sensation of aching and numbness. He also reported frequent popping sensation in his shoulder. It was noted no flare ups or use of devices. It was noted there was no history of dislocation and that the condition did not affect his ability to perform his previous occupation or daily activities.

The Veteran underwent another VA examination in September 2011. At that time, the Veteran reported his left shoulder condition was stable except for increased pain primarily due to weather changes or cold weather. With respect to effects on employment, it was noted the Veteran had decreased capacity to lift and carry and decreased capacity to work overhead. The Veteran reported flare ups impacting the function of his shoulder or arm and he reported he could not lift or carry much. The Veteran's flexion ended at 180 degrees and objective evidence of painful motion began at 80 degrees. After repetitive use testing, flexion ended at 180 degrees and abduction ended at 180 degrees. The examiner indicated pain on movement was a contributing factor to disability. Localized tenderness or pain on palpation was noted. Muscle strength testing was normal. No ankylosis or rotator cuff condition was noted. No history of recurrent dislocation was noted and no AC joint condition or any other impairment of the clavicle or scapula was noted.

In June 2013, an opinion regarding the Veteran's left shoulder was obtained in which the physician indicated the Veteran was limited to physical work that could be done below the left shoulder level as the Veteran has some impingement that would preclude hard physical work above head.

The Veteran underwent another VA examination in October 2014. At that time, it was noted he had left shoulder impingement syndrome and traumatic arthritis. The Veteran reported functional loss or impairment of pain and limited use and endurance above 90 degrees abduction and flexion. His initial range of motion was abnormal and noted as contributing to functional loss. Specifically, pain and loss of endurance over 90 degrees for abduction and flexion were noted. The Veteran's flexion was zero to 135 degrees and abduction was zero to 135 degrees. The examiner indicated pain, fatigue, lack of endurance, and incoordination significantly limit functional ability with repeated use over a period of time and with flare-ups. However, the examiner indicated they could not describe this
The Veteran underwent another VA examination in October 2014. At that time, it was noted he had left shoulder impingement syndrome and traumatic arthritis. The Veteran reported functional loss or impairment of pain and limited use and endurance above 90 degrees abduction and flexion. His initial range of motion was abnormal and noted as contributing to functional loss. Specifically, pain and loss of endurance over 90 degrees for abduction and flexion were noted. The Veteran's flexion was zero to 135 degrees and abduction was zero to 135 degrees. The examiner indicated pain, fatigue, lack of endurance, and incoordination significantly limit functional ability with repeated use over a period of time and with flare-ups. However, the examiner indicated they could not describe this in terms of range of motion. The examiner indicated the Veteran reported pain over 90 degrees flexion and abduction with repetitive use. Muscle strength testing was normal. The examiner indicated the Veteran could perform sedentary work and moderate work with no overhead work and no ladders, unprotected heights, and such.

The Veteran underwent another VA examination in August 2017. At that time, he reported flare ups and it was noted he experiences a flare up of his left shoulder pain almost everyday. The Veteran described his functional loss or functional impairment as avoiding overhead work activities and moderate to heavy lifting, and pushing and pulling with his left shoulder. Range of motion testing of the left shoulder revealed flexion of zero to 110 degrees, abduction of zero to 90 degrees, external rotation of zero to 80 degrees and internal rotation of zero to 90 degrees. It was noted the range of motion itself contributes to functional loss in avoiding overhead work activities, moderate to heavy lifting, and pushing and pulling with his left shoulder. It was noted that pain was noted on exam and caused functional loss. Specifically, flexion and abduction exhibited pain. There was also evidence of pain with weight bearing and objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, specifically anterior glenohumeral tenderness to palpation, without swelling or asymmetry. The Veteran was able to perform repetitive use testing with at least three repetitions and there was not additional functional loss or range of motion after three repetitions. It was noted that the Veteran was not being examined immediately after repetitive use over time and the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. It was noted the examination was not being conducted during a flare up and it was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during flare-ups. The examiner indicated that he was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time. He explained that accurate measurements of the range must be obtained at the time of increased pain, weakness, fatigue or incoordination. The Veteran's left shoulder muscle strength testing was normal. The Veteran was positive for all left shoulder rotator cuff condition testing. It was noted that the Veteran's left shoulder traumatic injury affects range of motion of the shoulder joint and there is tenderness on palpation of the left AC joint. The Veteran was positive for the left cross body adduction test. With respect to functional impact, the examiner indicated the Veteran should avoid overhead work activities and moderate to heavy lifting, pushing and pulling with his left shoulder.

The December 2021 VA examination reflects the evidence of record shows that the Veteran is right-handed. The Board acknowledges the Veteran's lay reports of symptoms, including daily pain, pain radiating down the left arm, weakness of the shoulder, and occasional numbness of the left hand. The examiner noted there was functional loss due to pain and fatigability. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by repetitive use over time would not result in symptoms more nearly approximating limitation of motion of the arm midway between side and shoulder level of the major extremity or limitation of motion of the arm to 25 degrees from the side of the major or minor extremity. Specifically, while the examiner noted that pain and fatigability significantly limit functional ability with repeated use over time, when providing an estimate range of motion for the joint immediately after repeated use over time, she indicated flexion endpoint of 105 degrees and abduction endpoint of 90 degrees.

The Veteran underwent another VA examination in March 2024. At that time, the examiner indicated the Veteran was ambidextrous. He included a diagnosis of degenerative arthritis status post acromioclavicular joint injury of the left shoulder, partial tear of left supraspinatus, and rotator cuff tendinosis. The Veteran reported flare ups. It was noted that flare ups of the left shoulder occur four times per week and are moderate to severe. It was noted that left shoulder flare ups last all day. With respect to functional loss, the Veteran reported pain with reaching, lifting, holding a book to read, holding phone up to face, putting on shoes, grabbing lunch tray, and getting dressed. Upon range of motion testing, it was noted the Veteran's left shoulder range of motion contributed to functional loss. Specifically, significant limited range of motion makes it objectively difficult to do tasks that require use of shoulder such as reaching overhead, putting on clothes, reaching down to put on shoes, and carrying items. It was noted that testing could not be performed on the right shoulder because it was damaged. The range of motion measurements for the left shoulder included flexion to 100 degrees and abduction to 90 degrees. Pain was noted with flexion, abduction, internal rotation, and external rotation. Passive range of motion was same as active range of motion. Pain was noted with reaching, lifting, holding a book to read, and putting a shirt on. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. It was described as moderate. The Veteran was able to perform repetitive use testing with at least three repetitions and there was not additional loss of function or range of motion after three repetitions. The examiner indicated that pain, fatigability, weakness, and lack of endurance significantly limit functional ability with repeated use over time and with flare ups. The examiner estimated range of motion immediately after repeated use over time or with a flare up as flexion to 90 degrees and abduction to 80 degrees. No additional factors contributing to disability were noted. The Veteran did not have muscle atrophy. There was no ankylosis of the scapulohumeral articulation. Labral pathology was suspected and an MRI from 2011 documented some labral degeneration and fraying. It was noted there was conservative treatment only since and it could not be tested due to severe pain and the Veteran's limited range of motion. There were no residuals of recurrent dislocation of the glenohumeral joint. The Veteran did not have loss of head, nonunion or fibrous union of the humerus or malunion of the humerus with moderate or marked deformity. With respect to functional impact, it was noted the Veteran reports pain with reaching, lifting, holding a book to read, holding phone up to face, putting on shoes, grabbing lunch tray, and getting dressed. It was noted that significant limited range of motion makes it objectively difficult to do tasks that require use of the shoulder such as reaching, carrying, etc. The examiner explained that the shoulder is not a weight-bearing joint.

Prior to the March 2024, VA examination report, in which the Veteran was noted as ambidextrous, the Veteran was consistently noted as being right hand dominant. The March 2024 VA examination report provides no explanation for how the determination that the Veteran is ambidextrous was made. 38 C.F.R. § 4.69 sets forth that "[t]he injured hand or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes." The Board finds the Veteran is right handed based on the 2009, 2014, 2017, and 2021 VA examination reports that consistently indicated he is right hand dominant. Little weight is afforded the assessment in the March 2024 VA examination report that the Veteran is ambidextrous considering the report does not suggest that any testing was done to confirm this finding. To the extent the finding was based on the Veteran's report, the Board does not find the Veteran's statement that he is ambidextrous credible considering it is inconsistent with four earlier reports.

None of the findings recorded during the VA examinations reflect that a higher rating is warranted. The Board notes that the examinations prior to the December 2021 VA examination did not include estimations of the Veteran's range of motion after repeated use over time or with flare ups. However, considering the Veteran reported in May 2017 that his left shoulder had gotten worse since his last exam, the Board finds that such estimations would not have resulted in a higher rating considering the estimations provided
does not suggest that any testing was done to confirm this finding. To the extent the finding was based on the Veteran's report, the Board does not find the Veteran's statement that he is ambidextrous credible considering it is inconsistent with four earlier reports.

None of the findings recorded during the VA examinations reflect that a higher rating is warranted. The Board notes that the examinations prior to the December 2021 VA examination did not include estimations of the Veteran's range of motion after repeated use over time or with flare ups. However, considering the Veteran reported in May 2017 that his left shoulder had gotten worse since his last exam, the Board finds that such estimations would not have resulted in a higher rating considering the estimations provided in the December 2021 VA examination do not reflect a higher rating is warranted. There is no suggestion that the Veteran's limitations temporarily worsened and then improved. Significant weight is afforded the December 2021 and March 2024 VA examiners' opinions considering their medical expertise and thorough examinations.

The Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. For example, the record does not reflect ankylosis of the scapulohumeral articulation or impairment of the humerus and the highest rating for dislocation of the clavicle or scapula is 20 percent, which is the Veteran's current disability rating.

Here, as discussed above, the Board has addressed the argument made by the parties of the October 2025 JMPR. As relevant to this discussion, the Court has provided guidance with regard to joint motions for remand. The Court has an interest in conservation of judicial resources and in avoiding piecemeal litigation. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) ("Court will [not] review BVA decisions in a piecemeal fashion"); Fugere v. Derwinski, 1 Vet. App. 103, 105 (1990) ("Advancing different arguments at successive stages of the appellate process does not serve the interests of the parties or the Court. Such a practice hinders the decision-making process and raises the undesirable specter of piecemeal litigation."), aff'd, 972 F.2d 331 (Fed. Cir. 1992); see also Gen. Elec. Co. v. Int'l Trade Comm'n, 692 F.3d 1218, 1220 (Fed. Cir. 2012) (quoting McLish v. Roff, 141 U.S. 661, 665-66, 12 S.Ct. 118, 35 L.Ed. 893 (1891) ("From the very foundation of our judicial system the object and policy of the acts of congress in relation to appeals and writs of error... have been to save the expense and delays of repeated appeals in the same suit, and to have the whole case and every matter in controversy in it decided in a single appeal.")). Indeed, the parties of the October JMPR identified no other deficiencies in the September 2024 Board decision.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's appeal for a rating in excess of 20 percent for left shoulder disability. As the evidence of record persuasively weighs against a rating in excess of 20 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to a rating in excess of 10 percent for a left knee disability

The Veteran seeks a higher rating for his left knee disability. The Veteran was initially granted service connection for chronic left knee strain in a June 2009 rating decision. His rating was increased to 10 percent in a December 2013 rating decision under diagnostic code 5260. The December 2018 Board remand directed the RO to obtain a VA examination for evaluation of the Veteran's left knee. Pursuant to the December 2018 Board remand, the Veteran was afforded a VA examination of his left knee in December 2021. The Veteran underwent another VA knee examination in March 2024.

The assigned Diagnostic Code 5260 suggests that the left knee is rated based on compensable limitation of flexion. 38 C.F.R. § 4.71a. A review of the evidence reflects that the chronic
chronic left knee strain in a June 2009 rating decision. His rating was increased to 10 percent in a December 2013 rating decision under diagnostic code 5260. The December 2018 Board remand directed the RO to obtain a VA examination for evaluation of the Veteran's left knee. Pursuant to the December 2018 Board remand, the Veteran was afforded a VA examination of his left knee in December 2021. The Veteran underwent another VA knee examination in March 2024.

The assigned Diagnostic Code 5260 suggests that the left knee is rated based on compensable limitation of flexion. 38 C.F.R. § 4.71a. A review of the evidence reflects that the chronic left knee strain has manifested as osteoarthritis and been rated based on painful noncompensable limitation of motion, and that the left knee has not had compensable limitation of motion (i.e. limitation of flexion or extension) at any time during the relevant rating period. Therefore, the Diagnostic Code assigned should have been Diagnostic Code 5003, to show that the chronic left knee strain with osteoarthritis is being rated based on noncompensable limitation of motion that is painful. Regardless, as discussed further below, the Veteran does not meet the criteria for a rating under Diagnostic Code 5260 or any other diagnostic codes for the knee.

Effective February 7, 2021, Diagnostic Code 5003 was amended to change the title of the diagnostic code to degenerative arthritis, other than posttraumatic, rather than arthritis (hypertrophic or osteoarthritis). This amendment is not a substantive change, but rather, was an amendment to accurately describe the disability covered by the rating code.

Diagnostic Code 5260 was not affected by the February 2021 amendments to the musculoskeletal system ratings. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited 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. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 10 percent for chronic left knee strain. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to excess fatigability, incoordination, pain on movement, swelling, instability of station, and disturbance of locomotion, and repetitive use over time. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran's statements, discussed further below, would not result in limitation of motion more nearly approximating flexion limited to 30 degrees.

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 duplic
weighs against a rating in excess of 10 percent for chronic left knee strain. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to excess fatigability, incoordination, pain on movement, swelling, instability of station, and disturbance of locomotion, and repetitive use over time. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran's statements, discussed further below, would not result in limitation of motion more nearly approximating flexion limited to 30 degrees.

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 or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment).

In a January 2009 VA examination, the Veteran was assessed with chronic left knee strain. In a June 2013 VA examination, the Veteran's flexion ended at 140 degrees or greater and evidence of painful motion began at 45 degrees. There was no limitation of extension. It was noted that pain on movement was a contributing factor to functional loss, functional impairment or additional limitation of range of motion of the knee and lower leg after repetitive use. The Veteran's muscle strength testing was normal. There was no evidence or history of recurrent patellar subluxation or dislocation. The examiner indicated the Veteran could do sedentary work. It was noted although he had some medial mild arthrosis it did not look to be limiting to climb ladders or paint, but harder physical work would not be possible due to the knees making him a risk to self and or others.

The Veteran underwent another VA examination in October 2014. The Veteran reported that flare-ups impacted the function of the knee. It was noted pain, weakness, fatigability, or incoordination significantly limit functional ability due to repeated use over a period of time. It was noted that the contributing factors of disability included excess fatigability, incoordination, pain on movement, swelling, instability of station, and disturbance of locomotion. It was noted that any limitation of range of motion or flares could not be estimated but loss of function when the joint is used repeatedly over a period of time was described as "flares with standing more than an hour requiring rest and then re-does the greeting work." Left knee flexion ended at 120 degrees. Painful motion began at 45 degrees. There was no limitation of extension. After repetitive use testing, flexion ended at 120 degrees. It was noted excess fatigability, incoordination, pain on movement, swelling, instability of station, and disturbance of locomotion contributed to functional impairment of additional limitation of range of motion of the knee and lower leg after repetitive use. Muscle strength testing was normal. Joint stability testing was normal. There was no evidence of patellar subluxation or dislocation. The examiner indicated sedentary work could be done and work at the moderate level could be done with no ladders, crawling, or unprotected heights.

In a VA Form 28-1902W Counseling Record Narrative Report from May 2016, it is noted, with respect to the Veteran's left knee, that he "[w]ares [sic] brace and uses cane. Getting worse. Pain all the time. Gives out. Bending is creating shooting pains. Not strong as it was. Not getting better even with PT. Does not walk far. Carrying weight."

The Veteran underwent another VA examination in August 2017. At that time, his diagnosis continued to be left knee strain. At that time, he reported that his left knee has gotten worse over the past two years despite taking Motrin. He was noted to have a history of chronic left knee pain. The Veteran reported flare ups and indicated flare ups of his left knee pain almost every day. With respect to functional impairment, the Veteran reported avoiding deep bending, stooping, squatting, kneeling, repetitive stair climbing, and moderate to heavy lifting and pulling. Range of motion testing included flexion to 110 degrees and extension of 110 to zero degrees. It was noted that range of motion itself contributes to functional loss and the Veteran avoids deep bending, stooping, squatting, kneeling, repetitive stair climbing, and moderate to heavy lifting and pulling. It was noted that pain was noted with flexion on exam and causes functional loss. There was evidence of pain with weight bearing. There was objective evidence of localized tenderness or pain on palpation of the
Veteran reported flare ups and indicated flare ups of his left knee pain almost every day. With respect to functional impairment, the Veteran reported avoiding deep bending, stooping, squatting, kneeling, repetitive stair climbing, and moderate to heavy lifting and pulling. Range of motion testing included flexion to 110 degrees and extension of 110 to zero degrees. It was noted that range of motion itself contributes to functional loss and the Veteran avoids deep bending, stooping, squatting, kneeling, repetitive stair climbing, and moderate to heavy lifting and pulling. It was noted that pain was noted with flexion on exam and causes functional loss. There was evidence of pain with weight bearing. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, specifically mild tenderness to palpation over the distal patella area both medially and laterally, without swelling or assymetry. It was noted the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time and the examiner was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time or with flare ups. The examiner explained that accurate measurements of the range of motion must be obtained at the time of increased pain, weakness or fatigue. The Board finds this opinion regarding speculation adequate. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). The examiner indicated there were no additional contributing factors of disability. Muscle strength testing was normal and there was no ankylosis. The examination indicates there was not a history of recurrent subluxation or lateral instability. Joint stability testing was performed and no joint instability was found. It was noted the Veteran did not have and never had recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment. The Veteran did not have a meniscus condition. It was noted the Veteran does not use any assistive device(s) as a normal mode of locomotion although occasional locomotion by other methods may be possible. With respect to functional impact, it was noted the Veteran should avoid deep bending, stooping, squatting, kneeling, repetitive stair climbing, and moderate to heavy lifting and pulling.

The Veteran underwent another VA examination in December 2021. At that time, the Veteran was diagnosed with chronic left knee strain. At that time, he reported symptoms of pain, stiffness, occasional swelling, and knee feeling weak. It was noted the Veteran did not report flare-ups of the knee. The Veteran reported functional loss or functional impairment of stairs, ladders, and squatting being difficult. No history of instability or recurrent subluxation was noted. Flexion endpoint was noted at 95 degrees and extension endpoint of zero degrees. Pain was exhibited on flexion. It was noted that pain limits full flexion. There was no additional loss of function or range of motion after three repetitions. It was noted pain and fatigability significantly limit functional ability with repeated use over time. The examiner estimated range of motion after repeated use over time of flexion ending at 85 degrees and extension ending at zero degrees. Intermittent swelling was noted as a contributing factor of disability. It was noted the Veteran requires a prescription of a brace that is used occasionally. Additionally, the Veteran does not have recurrent patellar instability. It was further noted the Veteran did not have recurrent patellar dislocation, shin splints, stress fractures or any other tibial or fibular impairment. The examiner indicated there was a worsening of the Veteran's symptoms but no change to the diagnosis or no additional diagnoses had been rendered.

The Veteran underwent another VA examination in March 2024. At that time, he was diagnosed with degenerative arthritis of the left knee with a diagnosis date of 2009. The Veteran reported pain at all times with flare up with walking more than a quarter mile. The Veteran denied major changes since the last exam other than worsening pain. The Veteran reported flare ups occur daily and it was noted they are moderate to severe and last until rest. It was noted left knee flare ups are precipitated by walking more than a quarter mile or prolonged weight bearing of more than 30 minutes. It was noted the left knee flare ups are alleviated by time and rest. Functional loss, including with repeated use over time was noted as pain with walking more than a quarter mile or prolonged standing greater than 30 minutes, climbing stairs. It was noted the Veteran does not report or have a history of instability or recurrent subluxation of the knee or report or have a history of frequent effusion of the knee. Upon his range of motion testing, the Veteran's flexion ended at 90 degrees and extension ended at zero degrees. Passive range of motion was the same and flexion exhibited pain.
. It was noted left knee flare ups are precipitated by walking more than a quarter mile or prolonged weight bearing of more than 30 minutes. It was noted the left knee flare ups are alleviated by time and rest. Functional loss, including with repeated use over time was noted as pain with walking more than a quarter mile or prolonged standing greater than 30 minutes, climbing stairs. It was noted the Veteran does not report or have a history of instability or recurrent subluxation of the knee or report or have a history of frequent effusion of the knee. Upon his range of motion testing, the Veteran's flexion ended at 90 degrees and extension ended at zero degrees. Passive range of motion was the same and flexion exhibited pain. It was noted there was evidence of pain with weight-bearing, nonweight-bearing, active motion, passive motion, and causes functional loss. It was noted there was pain with walking more than a quarter mile or weight-bearing more than 30 minutes, climbing stairs. There was no objective evidence of crepitus or of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was examined immediately after repeated use over time and during a flare up. It was noted that pain, fatigability, weakness, and lack of endurance significantly limit functional ability with repeated use over time. Estimated range of motion during a flare up or with repeated use over time was flexion endpoint to 90 degrees and extension endpoint of zero degrees. There were no additional contributing factors of disability. The Veteran did not have muscle atrophy or ankylosis. With respect to joint stability, it was noted there was not recurrent subluxation or persistent instability. Nor had there been a ligament tear. The Veteran did not have recurrent patellar dislocation, shin splints, stress fractures, or any other tibial or fibular impairment. The Veteran did not have a meniscus condition. It was noted the Veteran did not use any assistive devices as a normal mode of locomotion. With respect to functional impact, it was noted pain with prolonged standing for more than 30 minutes, walking greater than a quarter mile, climbing stairs. It was further noted that there is no medically sound mechanism to accurately measure a full range of motion in a weight bearing capacity and therefore, the request in the remand of weight bearing active and passive range of motion could not be completed.

Turning to the question set forth in the JMPR of whether the evidence reflects instability of the left knee and whether the record reflects a separate rating under the pre-amendment DC 5257, the Board finds it does not. Effective February 7, 2021, VA amended the rating criteria for disabilities of the knee and leg. The amended Diagnostic Code 5257 provides ratings for other impairment of the knee based on recurrent subluxation or instability, and patellar instability.

Prior to the amendment, under 38 C.F.R. § 4.71a, Diagnostic Code 5257, for other impairment of the knee a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257.

According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree.

Regarding the left knee instability, in English v. Wilkie, 30 Vet. App. 347 (2018), the United States Court of Appeals for Veterans Claims held that the Board cannot find objective medical evidence categorically more probative than lay evidence without explaining why that is the case. To be clear, the Board finds the objective medical evidence more probative than the Veteran's reports of perceived left knee instability by stating that his left knee gives out, has instability of station, and uses assistive devices such as a brace and cane. In reaching this finding, the Board notes that a medical professional physically examined the Veteran's left knee and found there was no instability. In this regard, the October 2014, August 2017 and December 2021, VA examination reports documented that the examiner had performed four tests to assess whether the left knee had instability. Here, the examiners found no instability. Specifically, the examiners tested for anterior instability, posterior instability, medial instability, and lateral instability (four tests), and found all four tests were normal. The four tests, which did not reveal instability, support the conclusion that the Veteran's perceived left knee instability is not due to anterior, posterior, medial, or lateral knee joint laxity
such as a brace and cane. In reaching this finding, the Board notes that a medical professional physically examined the Veteran's left knee and found there was no instability. In this regard, the October 2014, August 2017 and December 2021, VA examination reports documented that the examiner had performed four tests to assess whether the left knee had instability. Here, the examiners found no instability. Specifically, the examiners tested for anterior instability, posterior instability, medial instability, and lateral instability (four tests), and found all four tests were normal. The four tests, which did not reveal instability, support the conclusion that the Veteran's perceived left knee instability is not due to anterior, posterior, medial, or lateral knee joint laxity.

The Board acknowledges the report at the time of the October 2014 VA examination, which documented instability of station of left knee after repetitive use testing. However, as noted above, at that time, the joint stability testing was normal, and as discussed above, the objective medical evidence is more probative than the Veteran's lay statements. Furthermore, the May 2016 notation that the Veteran wears a brace and uses a cane is not consistent with any of the VA examination reports. Nor do the Veteran's service treatment records suggest that the Veteran's use of a brace and cane reflect objective medical evidence of instability. During the Veteran's December 2014 physical therapy consult, a left knee hinge brace was ordered for support and stability. A single point cane was ordered for additional stability and normal gait pattern. The stability testing at that time, including Valgus, Varus, and Lachman testing, was all negative. A treatment note a few weeks later from January 2015 indicates the Veteran arrived to clinic ambulating without an assistive device and normal gait pattern. It was noted the Veteran currently had no knee pain, demonstrated normal gait pattern, would benefit to lose weight and continue home exercise plan. The Veteran was instructed to pick up his left knee brace. The Board finds the record does not reflect the Veteran had recurrent subluxation or lateral instability for purposes of DC 5257 prior to its amendment. Greater weight is afforded the objective medical findings of the Veteran's treating physical therapists and the VA examiners who tested for instability. Greater probative weight is afforded the objective medical findings considering medical professionals physically examined the Veteran's left knee and found there was no instability. The Board notes that, while the Veteran's physical therapist ordered a cane and brace, the Veteran's gait had resolved by the time he came to pick up the brace less than a month after his initial appointment. While the physical therapist ordered the brace for stability, there was no suggestion that the Veteran was suffering from recurrent subluxation or lateral instability. He did not complain of instability or giving way at the time of the December 2014 physical therapy appointment and, as noted above, the objective testing done at that time related to stability was negative. Greater probative weight is afforded the findings at that time than the Veteran's statements indicating his knee gives out considering the Veteran was medically examined and not found to have instability.

Finally, ratings under diagnostic codes 5256, 5258, 5259, 5260, 5261, 5262, and 5263 are also not warranted as the Veteran, per the examination reports discussed above, does not have limitation of extension at a compensable level, limitation of flexion at a compensable level, ankylosis, a history of semilunar cartilage disability, a meniscal disability, tibia and fibia impairment, or genu recurvatum. Nor does the Veteran or his representative argue that a separate rating is warranted other than for instability, which has been addressed in detail above.

Here, as discussed above, the Board has addressed the argument made by the parties of the October 2025 JMPR. As relevant to this discussion, the Court has provided guidance with regard to joint motions for remand. The Court has an interest in conservation of judicial resources and in avoiding piecemeal litigation. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) ("Court will [not] review BVA decisions in a piecemeal fashion"); Fugere v. Derwinski, 1 Vet. App. 103, 105 (1990) ("Advancing different arguments at successive stages of the appellate process does not serve the interests of the parties or the Court. Such a practice hinders the decision-making process and raises the undesirable specter of piecemeal litigation."), aff'd, 972 F.2d 331 (Fed. Cir. 1992); see also Gen. Elec. Co. v. Int'l Trade Comm'n, 692 F.3d 1218, 1220 (Fed. Cir. 201
(1991) ("Court will [not] review BVA decisions in a piecemeal fashion"); Fugere v. Derwinski, 1 Vet. App. 103, 105 (1990) ("Advancing different arguments at successive stages of the appellate process does not serve the interests of the parties or the Court. Such a practice hinders the decision-making process and raises the undesirable specter of piecemeal litigation."), aff'd, 972 F.2d 331 (Fed. Cir. 1992); see also Gen. Elec. Co. v. Int'l Trade Comm'n, 692 F.3d 1218, 1220 (Fed. Cir. 2012) (quoting McLish v. Roff, 141 U.S. 661, 665-66, 12 S.Ct. 118, 35 L.Ed. 893 (1891) ("From the very foundation of our judicial system the object and policy of the acts of congress in relation to appeals and writs of error... have been to save the expense and delays of repeated appeals in the same suit, and to have the whole case and every matter in controversy in it decided in a single appeal.")). Indeed, the parties of the October JMPR identified no other deficiencies in the September 2024 Board decision.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 10 percent for left knee strain. As the evidence of record persuasively weighs against a rating in excess of 10 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021).

3. Entitlement to service connection for migraine headaches

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 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).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

In his December 2008 application for benefits, the Veteran noted his migraines began in October 2007 during service. At the time of the January 2009 VA examination, the Veteran reported a history of migraine headaches that began two months after his discharge from service. At the time of the January 2009 VA examination, which addressed several disabilities, the Veteran discussed sustaining an injury in October 2007 when the Bradley vehicle he was in went down the side of an 8-foot cliff. In a May 2009 periodic health assessment the Veteran reported he had migraine headaches from active duty and was hurt in the line of duty. While the record does not contain a direct explanation from the Veteran of why he believes his migraine headaches are related to service, the evidence suggests he is arguing that his migraines were caused by the October 2007 vehicle accident. In viewing the Veteran's December 2008 application for benefits notation that migraines began in October 2007 during service in the context of the record as a whole, the Board interprets this as an indication that the Veteran's headaches were caused by the incident in service in October 2007. To the extent the Veteran meant that he began experiencing migraine headaches while in service in October 2007, the Board does not find this statement credible as it is inconsistent with his report to the VA medical examiner in 2009. While both statements were made for compensation purposes, the Board finds the statement provided to a medical professional to be more likely to be true considering the application
that his migraines were caused by the October 2007 vehicle accident. In viewing the Veteran's December 2008 application for benefits notation that migraines began in October 2007 during service in the context of the record as a whole, the Board interprets this as an indication that the Veteran's headaches were caused by the incident in service in October 2007. To the extent the Veteran meant that he began experiencing migraine headaches while in service in October 2007, the Board does not find this statement credible as it is inconsistent with his report to the VA medical examiner in 2009. While both statements were made for compensation purposes, the Board finds the statement provided to a medical professional to be more likely to be true considering the application is solely for the purpose of compensation and while the 2009 VA medical examination was for compensation purposes, it was more likely to be true considering the information was provided in a medical context. See Pond v. West, 12 Vet. App. 341 (1999); Cartwright v. Derwinski, 2 Vet. App. 24 (1991); Federal Rule of Evidence 803(4).

VA is required to obtain the Veteran's service treatment records or other relevant service records held or maintained by a government entity. 38 U.S.C. § 5103A(c). When VA attempts to obtain records from a federal department or agency, the efforts to obtain these records must continue until they are obtained unless it is reasonably certain they do not exist or that further efforts to obtain them would be futile. 38 U.S.C. § 5103A(b); 38 C.F.R. § 3.159(c)(2), (c)(3). When service treatment records are lost or missing, the Court has held that VA has a heightened duty "to consider the applicability of the benefit of the doubt rule, to assist the claimant in developing the claim, and to explain its decision when the Veteran's medical records have been destroyed." Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) citing Russo v. Brown, 9 Vet. App. 46, 51 (1996). This standard for VA is very high.

A June 2009 formal finding of service record unavailability details the efforts taken to obtain the Veteran's service treatment records and indicates the determination was made that the Veteran's service treatment records were unavailable for review. The Veteran was notified of the determination in June 2009.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of migraine headaches, and reported being involved in an accident in October 2007 when the vehicle he was in went down the side of an 8-foot cliff causing him to be catapulted toward the hatch and back down, the evidence of record persuasively weighs against finding that the Veteran's migraine headaches began during service or are otherwise related to an in-service injury, event, or disease.

The Veteran underwent a VA examination in January 2009. At that time, the Veteran reported a history of migraine headaches that began two months after his discharge from service. The examiner included an assessment of migraine headaches.

The September 2024 Board remand directed the RO to obtain an opinion regarding the migraines. Pursuant to the September 2024 Board remand, VA opinions were obtained in December 2024 and February 2025. For the reasons indicated in the discussion below, the opinions obtained pursuant to the Board's remand instructions were adequate and the RO therefore complied with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998) (a Board remand confers a right on a claimant to compliance with the remand order).

In an opinion from December 2024 and an addendum opinion from February 2025, a VA examiner opined that the Veteran's migraines were less likely than not incurred in or caused by the claimed in-service injury, event, or illness.
2024 Board remand, VA opinions were obtained in December 2024 and February 2025. For the reasons indicated in the discussion below, the opinions obtained pursuant to the Board's remand instructions were adequate and the RO therefore complied with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998) (a Board remand confers a right on a claimant to compliance with the remand order).

In an opinion from December 2024 and an addendum opinion from February 2025, a VA examiner opined that the Veteran's migraines were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner indicated that the condition was first reported at the 2009 C&P exam. At the exam, the Veteran himself reported that the condition onset approximately two months after discharge from service, which would be at least a year since the reported Bradley accident. The examiner went on to explain that, "[i]f the Veteran's sustained head injury significant enough to cause the development of a long term headache condition, it is exceedingly likely he would have had to have sought evaluation out of necessity at time of injury. As the [V]eteran himself admitted at 2009 C&P exam that condition onset after service and in the absence of any evidence suggestive otherwise, and the fact that migraines are not a listed condition in the illness or condition is listed in Title 38, Code of Federal Regulation, 3.309(a), it is less likely than not that the [V]eteran's migraine condition was incurred in or caused by service." The Board finds the VA examiner's opinion probative because it is based on a review of the Veteran's records, considers the Veteran's statements, and provides reasoning for its conclusion.

The Veteran believes his migraines are related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

Consequently, the only competent evidence of record with respect to a nexus opinion is the VA examiner's opinion.

In addition, the persuasive evidence of record does not support the finding that the migraines are entitled to presumptive service connection as a chronic condition. Specifically, as discussed above, the persuasive evidence does not show that his migraines began during service or within the presumptive period, to include a continuity of symptomatology.

For the above reasons, the Board finds that the evidence is neither evenly balanced nor approximately so with regard to whether service connection for migraines is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). The Board has carefully considered the benefit of the doubt doctrine in this case in light of the Veteran's missing service treatment records and afforded the Veteran the benefit of the doubt in obtaining a VA medical opinion. However, even after careful consideration of the benefit of the doubt doctrine, the evidence is not evenly balanced nor approximately so and therefore, it is not for application in this matter.

L.M. YASUI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Vemulapalli, R.

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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