TEETH LOSS OF

Summary

The veteran, who served in the Army from February to November 1970 and completed active duty for training in June 1975, appeals the denial of service connection for multiple conditions, including dental issues, bilateral hip, knee, and foot disabilities, and hearing loss. The veteran claimed these conditions stemmed from a 30-foot fall during training in June 1975 and, for foot conditions, from ill-fitting boots. The Board denied the dental claim, finding no evidence of service-incurred trauma or a compensable dental disability, noting the veteran's periodontal disease was likely age-related. For the hip, knee, and foot claims, the Board acknowledged the in-service fall as an injury, but found the evidence weighed against a service connection. VA examinations in January 2023 and December 2024 opined it was less likely than not that the hip and knee osteoarthritis were related to the fall, citing normal service records for these joints and post-service onset of symptoms. For the foot claims, VA examiners also found it less likely than not that metatarsalgia and calcaneal spurs were related to the fall or ill-fitting boots, noting the long gap between service and diagnosis and the lack of in-service complaints. The Board found the January 2023 VA opinions most probative for the hip and knee claims, and the January 2023 and December 2024 opinions for the foot claims, concluding the weight of evidence was against service connection. For hearing loss, the Board acknowledged the veteran's bilateral hearing loss but denied service connection, noting normal hearing tests at enlistment and separation, no in-service complaints or treatment for hearing loss, and unfavorable VA opinions that the loss was less likely than not due to service noise exposure or the fall, attributing it instead to aging and a later left ear tumor. The Board found the evidence failed to show onset during or within one year of service, and that medical opinions weighed against service connection.

Rationale

No evidence of service-incurred dental trauma.; Periodontal disease and tooth loss likely age-related.; No compensable dental disability shown.

Full Decision Text

Citation Nr: 26004968
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 14-15 414
DATE: April 27, 2026

ORDER

Service connection for a dental condition is denied.

Service connection for a bilateral hip disability is denied. 

Service connection for a bilateral knee disability (originally claimed as a bilateral leg disability other than sciatic nerve radiculopathy of the left lower extremity (LLE) and right lower extremity (RLE)) is denied. 

Service connection for a bilateral foot disability is denied. 

Service connection for hearing loss of the right ear is denied.

Service connection for a left ear disability, to include cholesteatoma with hearing loss, is denied.

FINDINGS OF FACT

1. The Veteran does not have a dental disability for VA compensation purposes.

2. The persuasive evidence of record is insufficient to show that the Veteran's current diagnosed bilateral osteoarthritis of the hips, bilateral osteoarthritis of the knees (claimed as a bilateral leg disability) and bilateral calcaneal spurs and metatarsalgia of the feet began during or were otherwise related to a June 1975 fall from a telephone pole during active duty for training (ACDUTRA) or from having to wear ill-fitting boots (bilateral calcaneal spurs and metatarsalgia of the feet), or that they were manifested within one year after separation from his active service (arthritis); or that he continuously experienced bilateral hip, bilateral knee/leg pain and foot pain since service.

3. The Veteran's hearing loss is not shown to have either begun during, or been otherwise caused by his military service.   

4. The Veteran's left ear tumor is not shown to have either begun during, or been otherwise caused by his military service 

CONCLUSIONS OF LAW

1. The criteria for service connection for a dental condition is denied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.150.  

2. The criteria for service connection for a bilateral hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

3. The criteria for service connection for a bilateral knee disability (originally claimed as bilateral leg disability (other than sciatic nerve radiculopathy of the LLE and RLE)) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

4. The criteria for service connection for a bilateral foot disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for service connection for hearing loss in the right ear have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

6. The criteria for service connection for a left ear disability, to include cholesteatoma with hearing loss, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from February to November 1970; and a period of active duty for training from June 7 to June 21, 1975.

This matter was most recently before the Board in September 2024. At that time, the Board remanded the appeal to the Agency of Original Jurisdiction (AOJ) for additional development. The requested development has been accomplished, and the appeal has been returned to the Board for further adjudication. 

By a January 2026 rating action, the Regional Office (RO) granted service connection for an ingrown toenail right great toe; an initial noncompensable rating was assigned, effective December 29, 2024 which represents a complete grant of his appeal in regard to this claim. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). This issue is no longer before the
 recently before the Board in September 2024. At that time, the Board remanded the appeal to the Agency of Original Jurisdiction (AOJ) for additional development. The requested development has been accomplished, and the appeal has been returned to the Board for further adjudication. 

By a January 2026 rating action, the Regional Office (RO) granted service connection for an ingrown toenail right great toe; an initial noncompensable rating was assigned, effective December 29, 2024 which represents a complete grant of his appeal in regard to this claim. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). This issue is no longer before the Board.

Service Connection Claims: Dental Disability; Bilateral Hip Disability; Bilateral Knee Disability (originally claimed as bilateral leg disability (other than sciatic nerve radiculopathy of the LLE and RLE); Bilateral Foot Disability; and Bilateral Hearing Loss.

The Veteran contends that his dental disability; bilateral hip; bilateral knee; (originally claimed as bilateral leg disability other than sciatic radiculopathy of the bilateral lower extremities); and bilateral foot disabilities are the result of a 30 foot fall while on ACDUTRA in June 1975. After a brief discussion of the laws and regulations governing service connection, the Board will adjudicate each claim separately in the analysis that follows. 

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain chronic diseases (to include arthritis) may be presumed to br service-connected if manifested to a compensable degree within a specified period of time following separation from service (one year for arthritis). 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309(a). For chronic diseases listed in 38 C.F.R. § 3.309 (a), nexus to service may be established by showing continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013).

Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that it was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Dental Condition

The Veteran seeks service connection for residuals of dental trauma. As stated previously herein, he maintains that he sustained dental trauma as a result of a fall while on ACDUTRA in June 1975. He also maintains that he had all of his third molars removed in 1969, (age 17) prior to service. He stated that he had no teeth removed in service. The Veteran avers that his teeth started to get loose during service, and as a result, he had several of them removed around 1982. He contends that in 1985, his remaining teeth were removed due to periodontitis on 13 teeth. See January 2023 VA Dental Disability Benefits Questionnaire (DBQ). 

Dental disabilities which may be awarded compensable disability ratings are set forth under 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916.  

Rating activity should consider each defective or missing tooth and each disease of the teeth and periodontal tissues separately to determine whether the condition was incurred or aggravated in line of duty
union of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916.  

Rating activity should consider each defective or missing tooth and each disease of the teeth and periodontal tissues separately to determine whether the condition was incurred or aggravated in line of duty during active service and, when applicable, to determine whether the condition is due to combat or other in-service trauma, or whether the veteran was interned as a prisoner of war.  38 C.F.R. § 3.381 (b).

For loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by suitable prosthesis. Id.

In order to establish service connection for VA compensation purposes, it is not enough to show that the teeth were lost due to trauma during active-duty service. The evidence must demonstrate that the trauma resulted in loss of substance of the maxilla or mandible, which then resulted in the loss of the teeth. VA's General Counsel has held that dental treatment of teeth, even extractions, during service does not constitute dental trauma. See VAOPGCPREC 5-97, 62 Fed. Reg. 15,566 (1997); see also Nielson v. Shinseki, 607 F.3d. 802, 808 (Fed. Cir. 2010). Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease (pyorrhea) are not disabling conditions. See 38 C.F.R. § 3.381.

The Veteran has a current disability.  He has been diagnosed as having periodontal disease and being edentulous. See January 0223 VA Dental DBQ. Thus, Shedden element number one (1), evidence of a current disability, has been met. 

Regarding Shedden element number two (2), evidence of inservice disease or injury, the Veteran's service treatment records (STRs) pertinently reflect that a dental examination performed at service entrance in February 1970 pertinently reflects that the Veteran had four missing teeth: One and 32 on the right, and 16 and 17 on the left. Treatment and hospitalization records do not show any dental trauma, or chipped or missing teeth contemporaneous to the Veteran's June 1975 fall during ACDUTRA. A dental examination at discharge in October 1970 reflects the same missing teeth as those noted at entrance in February 1970. As there is no evidence of any dental trauma, or any other dental condition during service, the claim fails on Shedden element number two, evidence of inservice incurrence. Here, a January 2023 VA clinician addressed the in-service element in a January 2023 VA opinion. After a dental examination of the Veteran and review of the Veteran's STRs, the VA examiner opined that while his timeline was not perfect and there were gaps, based on the fact that there were only two teeth that were listed as having decay in 1985 and that "long standing periodontitis" was noted as the diagnosis for 13 of the Veteran's other 14 teeth, it was reasonable to state that the majority of his teeth were lost due to periodontitis and that there was no evidence that they were lost due to trauma. See January 2023 VA dental opinion. 

Overall, no evidence has been received to show that the Veteran has a compensable dental disability, such as osteomyelitis or osteoradionecrosis of the maxilla or mandible; loss of the mandible, maxilla, ramus, or coronoid process; loss of the hard palate, not replaceable by prosthesis; nonunion of the mandible; limited motion of the temporomandibular articulation; or loss of teeth due to loss of substance of the body of the maxilla or mandible, which was incurred in service. 38 C.F.R. § 4.150. The Veteran is not shown to have a compensable condition.  As the
2023 VA dental opinion. 

Overall, no evidence has been received to show that the Veteran has a compensable dental disability, such as osteomyelitis or osteoradionecrosis of the maxilla or mandible; loss of the mandible, maxilla, ramus, or coronoid process; loss of the hard palate, not replaceable by prosthesis; nonunion of the mandible; limited motion of the temporomandibular articulation; or loss of teeth due to loss of substance of the body of the maxilla or mandible, which was incurred in service. 38 C.F.R. § 4.150. The Veteran is not shown to have a compensable condition.  As the Veteran does not have a compensable dental disorder, there is no basis to award service connection based on the Veteran's claim, and it is denied.  

However, it is noted that because the Veteran is rated at 100 percent for several service connected disabilities, he is eligible for Class IV dental treatment through VA.  38 U.S.C. § 1712

Bilateral Hip, Bilateral Knee (originally claimed as bilateral lower leg disabilities (originally claimed as bilateral leg disability other than sciatic nerve radiculopathy of the LLE and RLE) and Bilateral Foot Disabilities

As noted previously herein, the Veteran seeks service connection for bilateral hip; bilateral knee (originally claimed as bilateral lower leg disabilities (other than sciatic nerve radiculopathy of the LLE and RLE)) and bilateral foot disabilities as a result of a 30 foot fall from a telephone pole while on ACDUTRA in June 1975. During a hearing before the undersigned, the Veteran's attorney asserted that the Veteran suffered from a conversion disorder that caused his disabilities to be misdiagnosed following the June 1975 fall, or otherwise kept the disabilities from being sufficiently identified in the years after the initial injury.

The Board will collectively discuss the first two Shedden elements, current disabilities and in-service incurrence, with respect to all of the disabilities prior to adjudicating them on the third element, nexus to service, separately.

First, and with respect to Shedden element number (1), the Veteran has been diagnosed as having metatarsalgia and calcaneal spur, bilateral osteoarthritis of the hips and bilateral hip strains, and bilateral knee osteoarthritis. See January 2023, December 2024 VA Foot, Hip and Knee Disability Benefit Questionnaires (DBQs). Thus, as the Veteran has been found to have current bilateral foot, bilateral hip, bilateral knee (originally claimed as bilateral lower leg disability (other than sciatic radiculopathy of the bilateral lower extremities), Shedden element number (1), current disability, has been met with respect to each claim. 

Regarding Shedden element number two, the Veteran's STRs from his initial period of active duty (February 1970 to November 1970) are silent to any subjective complaints or clinical findings referring to the Veteran's lower extremities and feet. An October 1970 service separation examination report reflects that the Veteran's lower extremities and feet were evaluated as "normal." On an accompanying Report of Medical History, the Veteran denied having had a "Trick" or locked knee and foot trouble, bone, joint or other deformity, neuritis and paralysis. However, on June 7, 1975, during a period of active duty for training, the Veteran fell from a telephone pole, and landed in the upright position sustaining an injury to his neck and back at Camp Beauregard, Louisiana. 

A June 1975 line of duty determination found that the incident was in the line of duty. He was treated locally. His condition worsened over a two-week period, and he was air-evacuated to Brooke Army Medical Center. His treatment at United States Army Hospital, Fort Polk, Louisiana, was with collar and cervical traction. The Veteran was noted to have a dislocation of the C7 and T1 vertebrae, as well as a cervical and lumbar sprain with residual numbness in the right C7 distribution. He was assigned a temporary physical profile that prohibited climbing and lifting objects weighing more than 30 pounds. A psychiatric consult felt that he had a status post conversion reaction and an anxiety neurosis with mixed depressive features. As the Veteran incurred a fall during his period of ACDUTRA, and he alleged that it is the etiological cause of his current orthopedic lower extremity and foot disabilities, the Board finds that Shedden element number two, evidence of an in-service injury, has been met with respect to each of the Veteran's lower extremity and foot claims. 

Thus, each of the claims for service connection for bilateral hip, bilateral knee (originally claimed as bilateral lower leg) and bilateral
ness in the right C7 distribution. He was assigned a temporary physical profile that prohibited climbing and lifting objects weighing more than 30 pounds. A psychiatric consult felt that he had a status post conversion reaction and an anxiety neurosis with mixed depressive features. As the Veteran incurred a fall during his period of ACDUTRA, and he alleged that it is the etiological cause of his current orthopedic lower extremity and foot disabilities, the Board finds that Shedden element number two, evidence of an in-service injury, has been met with respect to each of the Veteran's lower extremity and foot claims. 

Thus, each of the claims for service connection for bilateral hip, bilateral knee (originally claimed as bilateral lower leg) and bilateral foot disabilities turn on Shedden element number three (3), nexus to military service. The Board finds that the weight of the evidence is against this aspect of each claim. The Board will adjudicate each disability as it pertains to Shedden element number three in the analysis below. 

Bilateral Hip Disability

VA examiners in January 2023 and December 2024 provided nexus opinions that are against the nexus element of the claim for service connection for a bilateral hip disability. The January 2023 and December 2024 VA examiners opined, after physical evaluations of the Veteran's hips and review of the record, notably the Veteran's STRs and the June 1975 fall, that it was less likely than not (less than 50 percent probability) that the Veteran's diagnosed bilateral hip osteoarthritis and hip strains were incurred in or caused by the claimed in-service injury, event or illness. 

In reaching their respective conclusions, the January 2023 VA examiner reiterated the fact that the Veteran had sustained a fall on June 7, 1975 from an approximate 25-30 feet causing a compression fracture at T2 with reported bilateral lower extremity pain, and that the leg or lower extremity pain was most likely related to a neurological (spinal cord) condition which was evident as he reported in 1977 of his legs "giving way and falling," and that he had been diagnosed with radiculopathy. The January 2023 examiner noted that the Veteran's STRs did not reveal any hip joint condition. The January 2023 VA examiner stated that if the Veteran had sustained a fracture to the hip or pelvis during service, the pain immediately after the fall would have been significant enough for him not to have been able to sit or stand and would have resulted in him having undergone a hip or pelvis x-ray. The record failed to show that that was the situation for the Veteran. The Veteran's initial report of hip pain, according to the January 2023 VA examiner, was in 2014, when the Veteran would have been approximately 62 years of age. The January 2023 examiner stated that although the record revealed a documented hair line fracture in 2021, the x-ray to confirm the condition could not be located. The January 2023 VA examiner found the 2021 hairline fracture to have been separate and unrelated to the Veteran's 1975 fall. To this end, the January 2023 VA examiner maintained that if the Veteran had an untreated hip fracture from the fall in 1975, the fracture would have either healed and become arthritic or not healed and would have caused necrosis of the hip joint which would warrant a total hip replacement, and that neither of those scenarios were applicable per the record. Thus, the January 2023 examiner opined that the evidence supported a finding that the 2014 hip pain was likely due to aging and that the hair line fracture noted was a separate injury. Overall, the January 2023 examiner concluded that it was less likely than not the Veteran's left hip and right hip osteoarthritis were a result of the fall in 1975, and a nexus was not established.

In denying the claim, the December 2024 examiner noted that the Veteran's entrance and separation examinations from 1970 were both silent for complaints of any right or left hip disorder. However, according to the 2024 examiner, there were post-service notes from 2010 and 2022 with documentation of arthritis of the hips. The examiner noted that the Veteran's lay statement of a fall that occurred in 1975 was not during active duty. The examiner maintained that the Veteran was currently diagnosed with bilateral hip osteoarthritis, which can develop over time with age, due to wear and tear, injuries, surgeries and/or trauma. The examiner opined that although the fall might have led to development of the arthritis of the hips, this did not occur during active duty. The Board notes that while the VA examiner's conclusion could be read to be favorable because the fall occurred during a period of ACDUTRA, it was equivocal in finding that the fall "
 there were post-service notes from 2010 and 2022 with documentation of arthritis of the hips. The examiner noted that the Veteran's lay statement of a fall that occurred in 1975 was not during active duty. The examiner maintained that the Veteran was currently diagnosed with bilateral hip osteoarthritis, which can develop over time with age, due to wear and tear, injuries, surgeries and/or trauma. The examiner opined that although the fall might have led to development of the arthritis of the hips, this did not occur during active duty. The Board notes that while the VA examiner's conclusion could be read to be favorable because the fall occurred during a period of ACDUTRA, it was equivocal in finding that the fall "might have led" to the development of the Veteran's bilateral hip arthritis. In addition, the 2024 examiner did not address the 2021 hairline hip fracture. For these reasons, the Board finds the 2024 VA examiner's opinion to be of reduced probative value it its adjudication of the claim for service connection for a bilateral hip disability. 

The Board finds that the January 2023 VA medical opinion is the most probative evidence as to the etiology of the Veteran's current bilateral hip disability because it was  provided by the medical professional after careful review of the Veteran's claim's file and was supported by the medical records. While the STRs show that the Veteran fell 30 feet from a telephone pole while on ACDUTRA in June 1975, and sustained dislocation of the C7 and T1 vertebrae, as well as a cervical and lumbar sprain with residual numbness in the right C7 distribution, there was no separate injury to either his right or left hip. The Veteran's lower extremities were evaluated as normal at a September 1970 separation examination. In addition, medical records did not show that he had complained of, or sought treatment within one year after he separated from service.  In fact, the earliest post-service medical records documenting arthritis of the hips, according to the January 2023 examiner, was in 2010. Accordingly, the weight of the evidence is against a finding that the Veteran's current right hip or left hip disability occurred during or within one year after service or was otherwise related to the 1975 fall during ACDTURA. 

Bilateral Knee Disability (originally claimed as bilateral lower leg disability (other than radiculopathy of the LLE and RLE)) is denied. 

Here, a January 2023 VA examiner provided a nexus opinion that is against the nexus element of the claim for service connection for a bilateral knee disability. The January 2023 VA examiners opined, after a physical evaluation of the Veteran's knees and a review of the record, notably the Veteran's STRs and June 1975 fall, that it was less likely than not (less than 50 percent probability) that the Veteran's diagnosed bilateral knee osteoarthritis was incurred in or caused by the claimed in-service injury, event or illness. 

In reaching her conclusion, the January 2023 VA examiner reiterated the fact that the Veteran did not have a generalized "leg disability," and was diagnosed with right and left knee degenerative arthritis, as well as right and left lower extremity radiculopathy. The VA examiner reiterated the fact that the Veteran sustained a fall on June 7, 1975 from an approximate 25-30 feet causing a compression fracture at T2 with reported bilateral lower extremity pain. The January 2023 VA examiner found the Veteran's leg or lower extremity pain was most likely related to a neurological (spinal cord) condition which was evident as he reported in 1977 of his legs "giving way and falling" which was diagnosed as radiculopathy. The VA examiner, however, found that the medical record did not reveal he had any knee joint condition at the time of the fall. According to the examiner, if the Veteran had a fracture or knee condition immediately after the fall, the injury would have presented with swelling and knee pain, which would have been significant enough for him to report the knee pain in the emergency room, which did not happen in the Veteran's case. The Veteran's medical record did not reflect any isolated knee joint complaints or concerns; the lower extremity pain had continuously been reported as "radiating" from his back which has been diagnosed as radiculopathy. The VA examiner opined that the medical record lacked sufficient evidence of a chronic knee disability which resulted from the fall in June 1975, and that it was likely the result of aging. Thus, the VA examiner concluded that it was less likely than not the Veteran's right and left knee degenerative arthritis was a result of the fall in June 1975, and a nexus had not been established. See January 2023 VA knee opinion
 the knee pain in the emergency room, which did not happen in the Veteran's case. The Veteran's medical record did not reflect any isolated knee joint complaints or concerns; the lower extremity pain had continuously been reported as "radiating" from his back which has been diagnosed as radiculopathy. The VA examiner opined that the medical record lacked sufficient evidence of a chronic knee disability which resulted from the fall in June 1975, and that it was likely the result of aging. Thus, the VA examiner concluded that it was less likely than not the Veteran's right and left knee degenerative arthritis was a result of the fall in June 1975, and a nexus had not been established. See January 2023 VA knee opinion.

The Board finds the January 2023 VA medical opinion to be the most probative evidence as to the etiology of the Veteran's current bilateral knee disability because it was provided by the medical professional after careful review of the Veteran's claim's file and is supported by the medical records. While the STRs show that the Veteran fell 30 feet from a telephone pole while on ACDUTRA in June 1975, and sustained dislocation of the C7 and T1 vertebrae, as well as a cervical and lumbar sprain with residual numbness in the right C7 distribution, as correctly indicated by the January 2023 VA examiner, there was no separate injury to either his right or left knee. The Veteran's lower extremities were evaluated as normal at a September 1970 separation examination. In addition, medical records did not show that he had complained of or sought treatment within one year after he separated from service. Accordingly, evidence is insufficient to show that the Veteran's current right hip or left knee disability occurred during or within one year after service or was otherwise related to the 1975 fall during ACDTURA. 

Other evidence against the claim for service connection for a bilateral knee disability is a December 2024 VA examiner's opinions. The December 2024 VA examiner opined that the Veteran was claiming right and left leg disabilities due to service. His entrance and exit exams from 1970 were both silent for complaints of right and left knees, but there were two post-service notes from 2014 and 2024 with documentation of arthritis of the knee. The Veteran's lay statement of a fall that occurred in 1975 was not during active duty. The Veteran is currently diagnosed with right and left knee osteoarthritis. According to the December 2024 VA examiner, osteoarthritis developed over time with age, due to wear and tear, injuries, surgeries and/or trauma. Although the fall may have (italics added for emphasis) led to development of the arthritis of the knees, this did not occur during active duty. Therefore, according to the December 2024 VA examiner, the claimed left and right knee disabilities were less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. See December 2024 VA knee opinions. The Board notes that while the VA examiner's conclusion could be read to be favorable because the fall occurred during a period of ACDUTRA, it was equivocal in finding that the fall "may have led" to the development of the Veteran's bilateral knee osteoarthritis. For these reasons, the Board finds the 2024 VA examiner's opinion to be of reduced probative value it its adjudication of the claim for service connection for a bilateral knee disability (originally claimed as a bilateral leg disability). 

Bilateral Foot Disability

The Veteran contends that his bilateral foot disability is the result of having to wear ill-fitted boots. According to an April 2024 VA skin examination report, the Veteran stated that the boots he wore were too small and that he requested boots in a larger size, but rather than receiving boots in the proper size, he was told to "break them in." 

In January 2023 and December 2024, VA examiners provided opinions that are against the claim for service connection for a bilateral foot disability. 

In January 2023, the VA examiner concluded, after a physical evaluation of the Veteran's feet and review of the STRs, notably to include the June 1975 fall during ACDUTRA, that he was diagnosed with metatarsalgia and calcaneal spur, as well as a diagnosis of left and right lower extremity radiculopathy. The examiner noted the Veteran's June 1975 fall finding that it had caused a compression fracture at T2 with reported bilateral lower extremity pain, which had been diagnosed as radiculopathy. The examiner stated that the medical record coincidence with the fall did not reveal any foot injury at the time of the fall. According to the examiner, if the Veteran had a fracture or foot injury at the
3, the VA examiner concluded, after a physical evaluation of the Veteran's feet and review of the STRs, notably to include the June 1975 fall during ACDUTRA, that he was diagnosed with metatarsalgia and calcaneal spur, as well as a diagnosis of left and right lower extremity radiculopathy. The examiner noted the Veteran's June 1975 fall finding that it had caused a compression fracture at T2 with reported bilateral lower extremity pain, which had been diagnosed as radiculopathy. The examiner stated that the medical record coincidence with the fall did not reveal any foot injury at the time of the fall. According to the examiner, if the Veteran had a fracture or foot injury at the time of the fall, the injury would have presented with swelling and reported foot pain which would have been significant enough for him to be evaluated in the emergency room. The record failed to show that that was situation for the Veteran. The examiner further reported that the Veteran's medical record did not reflect any isolated foot complaints or concerns, and that the lower extremity pain had continuously been reported as "radiating" from his back which had been diagnosed as radiculopathy. The January 2023 examiner concluded that the Veteran's medical record lacked sufficient evidence of a foot disability which had resulted from the fall in June 1975, and that his diagnosed metatarsalgia and calcaneal spur was likely that of aging. Thus, it was the January 2023 VA examiner's conclusion that it was less likely than not the Veteran's metatarsalgia and calcaneal spur was a result of the fall in June 1975, and a nexus was not established. See January 2023 VA opinion.

In December 2024, a VA examiner provided a negative nexus opinion with respect to the Veteran's contention that his bilateral foot disability was the result of ill-fitting boots during service. The VA examiner opined that it was less likely than not that the Veteran's diagnoses of calcaneal spur and metatarsalgia (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. More specifically, and in addressing the Veteran's diagnosis of calcaneal spur, the examiner stated that this occurred over time due to stress and strain on the ligaments and tendons of the foot due to repetitive activities, poor fitting shoes, age, and/or obesity, among others. Regarding the diagnosis of metatarsalgia, the examiner noted that this occurred due to overuse and stress, deformities of the foot, trauma, and/or ill-fitting shoes, among others. In denying the claim, the examiner pointed to the Veteran's entrance and exit exams from 1970, which were both silent for complaints of foot condition. The examiner noted that a post-service report, dated in 2022, confirmed a diagnosis of bilateral calcaneal spurs. The Veteran is claiming his boots did not fit properly, which may have led to the development of the calcaneal spurs and the metatarsalgia, but there is lack of chronicity with a gap of time of 52 years from separation and documentation of calcaneal spurs and 54 years from separation and diagnosis of metatarsalgia. See December 2024 VA opinion. 

The January 2023 and December 2024 VA opinions against the claim.  There is no other opinion that is supportive of the claim. The claim for service connection for a bilateral foot disability is denied. 

Conclusion

The Board acknowledges the statements and hearing testimony from the Veteran that bilateral hip, bilateral knee (claimed as bilateral leg disability) and bilateral foot disabilities had their onset coincident with the June 1975 fall during ACDUTRA and from having to wear ill-fitted boots (bilateral foot disability), but notes that because the causative factors for these disabilities are not lay-observable, his statements are not competent to opine as to their etiology, and no evidence of record establishes a competence on the matter through education, training, or experience. 38 C.F.R. § 3.159; see Charles v. Principi, 16 Vet. App. 370, 374-75 (2002); Layno v. Brown, 6 Vet. App. 465 (1994).

The VA examiners' opinions throughout the appeal are competent medical evidence regarding the etiologies of the Veteran's bilateral hip, bilateral knee (claimed as bilateral leg disability), and bilateral foot disabilities. The VA examiners have advanced medical training, experience, and had the opportunity to examine both the Veteran and review his claims file and to provide a competent diagnosis and medical opinion. See Cox v. Nicholson, 20 Vet. App. 563 (2007). The VA examiners are qualified through education, training, and experience to competently offer such medical
. Principi, 16 Vet. App. 370, 374-75 (2002); Layno v. Brown, 6 Vet. App. 465 (1994).

The VA examiners' opinions throughout the appeal are competent medical evidence regarding the etiologies of the Veteran's bilateral hip, bilateral knee (claimed as bilateral leg disability), and bilateral foot disabilities. The VA examiners have advanced medical training, experience, and had the opportunity to examine both the Veteran and review his claims file and to provide a competent diagnosis and medical opinion. See Cox v. Nicholson, 20 Vet. App. 563 (2007). The VA examiners are qualified through education, training, and experience to competently offer such medical evidence. Moreover, competent evidence has not been presented to undermine the examiners' conclusions.

The competent evidence of record weighs against a finding that the Veteran's bilateral hip, bilateral knee (claimed as bilateral lower leg) and bilateral foot disabilities were incurred during or caused by his military service. Thus, the claims for service connection for bilateral hip, bilateral knee (claimed as bilateral lower leg) and bilateral foot disability are denied. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303.

Bilateral Hearing Loss 

First, the Board notes that the Veteran has bilateral hearing loss for VA compensation purposes pursuant to 38 C.F.R. § 3.385. See January 2023 VA Hearing Loss DBQ.  However, service connection requires that it be shown that hearing loss be caused by military noise exposure (or onset during active military service). 

At a VA examination in April 2014, the Veteran was diagnosed with hearing loss in both ears for VA purposes.  The examiner noted normal hearing tests at enlistment and at separation in 1970 (the Veteran was on active duty for training from February to November 1970).  The Veteran reported exposure to howitzers, helicopters, small arms in the Army; he reported construction work and working as a merchant marine after Army service; and he denied recreational noise exposure.  It was noted that the Veteran had undergone multiple surgeries on his left ear, and hearing tests dating back to 2005 indicated profound hearing loss in that ear.  The examiner opined that the audiometric testing results were not consistent with hearing loss due to noise exposure.

In December 2022, another hearing examination was provided. It was noted that the Veteran had a cancerous tumor in his left ear that was detected in 1984 and excised in 1990.

In January 2023, a VA examiner concluded, after an audiological evaluation of the Veteran, and review of his STRs, that the Veteran's bilateral hearing loss disability was less likely than not incurred in or result of his military service. The VA examiner reasoned that the Veteran's hearing was normal in both ears during service, that there were no complaints of, diagnosis of, or treatment for hearing loss indicated in his STRs, and he had not been diagnosed with hearing loss within one year of separation from service. Therefore, it was less likely than not that his current hearing loss is due to military noise exposure or a fall, or any other event during service. See January 2023 VA hearing loss opinion.  The examiner also concluded that the fall on active duty for training did not cause the tumor to develop.

Here, the evidence of record fails to show hearing loss in either ear at separation from active duty for training and it fails to show the onset within a year of separation from either active duty or active duty for training.  Moreover, the only medical opinions of record weigh against service connection for either hearing loss or the let ear tumor. Accordingly, service connection is denied.

 

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Carole Kammel, 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. 


20.1303.