Case A25109042

MICHAEL J. SKALTSOUNIS · 2025 · Case ID: A25109042

MIXED

Summary

The veteran, who served from December 2015 to December 2021, appealed the denial of service connection for left and right leg radiculopathy and left and right hip strain, left ankle pain, and bilateral plantar fasciitis. The veteran claimed these conditions were secondary to his service-connected bilateral knee disability. The Board found that the veteran's bilateral hip strain, left ankle pain, and bilateral plantar fasciitis constituted current disabilities, satisfying the first element for secondary service connection. The Board also confirmed the service connection for bilateral knee strain, satisfying the second element. Citing the "benefit of the doubt" doctrine, the Board found that the evidence was in approximate balance and granted service connection for the hip strains, ankle pain, and plantar fasciitis as secondary to the service-connected knee disability. The Board dismissed the claims for left and right leg radiculopathy as they had been granted service connection on a direct basis in a prior Board decision, rendering the appeal moot. The case was remanded for further development and adequate medical opinions regarding allergic rhinitis, chronic sinusitis, chronic headaches, chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), GERD, residuals of TBI, and left lower leg pain, as the initial opinions were found inadequate.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250327-532437

Full Decision Text

Citation Nr: A25109042
Decision Date: 12/17/25 Archive Date: 12/17/25

DOCKET NO. 250327-532437
DATE: December 17, 2025

ORDER

Entitlement to service connection for left leg radiculopathy is dismissed.

Entitlement to service connection for right leg radiculopathy is dismissed.

Entitlement to service connection for left hip strain, to include as secondary to service-connected bilateral knee disability, is granted.

Entitlement to service connection for right hip strain, to include as secondary to service-connected bilateral knee disability, is granted.

Entitlement to service connection for left ankle pain, to include as secondary to service-connected bilateral knee disability, is granted.

Entitlement to service connection for right ankle pain, to include as secondary to service-connected bilateral knee disability, is granted.

Entitlement to service connection for bilateral plantar fasciitis, to include as secondary to service-connected bilateral knee disability, is granted.

REMANDED

Entitlement to service connection for allergic rhinitis is remanded.

Entitlement to service connection for chronic sinusitis is remanded.

Entitlement to service connection for chronic headaches is remanded.

Entitlement to service connection for chronic fatigue syndrome (CFS) is remanded.

Entitlement to service connection for irritable bowel syndrome (IBS) is remanded.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

Entitlement to service connection for residuals of a traumatic brain injury (TBI) is remanded.

Entitlement to service connection for post traumatic residual pain and cramping of the left lower leg is remanded.

FINDINGS OF FACT

1. A December 2025 Board decision granted entitlement to service connection for left leg radiculopathy and there is therefore no remaining case or controversy pertaining to this claim.

2. A December 2025 Board decision granted entitlement to service connection for right leg radiculopathy and there is therefore no remaining case or controversy pertaining to this claim.

3. Resolving reasonable doubt in the Veteran's favor, his left hip strain was caused or aggravated by his service-connected bilateral knee disability.

4. Resolving reasonable doubt in the Veteran's favor, his right hip strain was caused or aggravated by his service-connected bilateral knee disability.

5. Resolving reasonable doubt in the Veteran's favor, his left ankle pain was caused or aggravated by his service-connected bilateral knee disability.

6. Resolving reasonable doubt in the Veteran's favor, his right ankle pain was caused or aggravated by his service-connected bilateral knee disability.

7. Resolving reasonable doubt in the Veteran's favor, his bilateral plantar fasciitis was caused or aggravated by his service-connected bilateral knee disability.

CONCLUSIONS OF LAW

1. The criteria for dismissal of entitlement to service connection for left leg radiculopathy have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for dismissal of entitlement to service connection for right leg radiculopathy have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

3. The criteria for service connection for left hip strain as secondary to a bilateral knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for right hip strain as secondary to a bilateral knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for left ankle pain as secondary to a bilateral knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for service connection for right ankle pain as secondary to a bilateral knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

7. The criteria for service connection for bilateral plantar fasciitis as secondary to a bilateral knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 2015 to December 2021.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 AMA rating decision by the Department of Veterans Affairs (VA)
.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

7. The criteria for service connection for bilateral plantar fasciitis as secondary to a bilateral knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 2015 to December 2021.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 AMA rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In March 2025, the Veteran submitted VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 AOJ decision on appeal, and any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.

Dismissal

1. Entitlement to service connection for left leg radiculopathy

2. Entitlement to service connection for right leg radiculopathy

By way of background, the Veteran filed an initial formal claim for entitlement to service connection for a back disability in July 2023. A November 2023 rating decision denied the claim. In November 2024, the Veteran appealed directly to the Board.

In January 2025, the Veteran filed a separate claim for entitlement to service connection for left and right leg radiculopathy. A March 2025 AOJ rating decision denied the claim.

In December 2025, the Board granted entitlement to service connection for the Veteran's back disability. As the evidence of record indicated that the Veteran's bilateral lower extremity radiculopathy stemmed from the Veteran's back disability, the Board also granted entitlement to service connection for left and right leg radiculopathy as secondary to the Veteran's back disability.

As the Veteran's claim for a back disability pre-dates his claim for left and right leg radiculopathy, the benefits sought on appeal are considered granted in full.

In light of the full grant, there is no case or controversy presently before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Therefore, the appeal seeking entitlement to service connection for left and right leg radiculopathy must be dismissed. 38 U.S.C. § 7105.

Service Connection

Service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7?Vet. App.?439, 448 (1995) (en banc).

To establish entitlement to service connection on a secondary basis, there must be (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. Wallin v. West, 11?Vet. App.?509 (1998). Service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest after active service in the Southwest Asia theater of operations during the Persian Gulf War. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Unlike service connection on a direct basis, the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 do not require competent medical nexus of a link between the qualifying chronic disability and military service. Service connection is presumed unless there is affirmative evidence to the contrary, where the criteria are met. See 38 C.F.R. § 3.317(c); Gutierrez v. Principi, 19?Vet. App.?1 (2004).

The term "Persian Gulf Veteran" means a Veteran who, during the Persian Gulf War, served on active military, naval, or air service in the Southwest Asia theater of operations. 38 C.F.R. § 3.317(e)(2).

The term "qualifying chronic disability" means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; (B) a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) functional gastrointestinal disorders (excluding structural gastrointestinal disorders). 38 C.F.R. § 3.317(a)(2)(i).

On August 10, 2022, the President of the United States signed into law the PACT Act. A notable element of the PACT Act is that it establishes chronic sinusitis and chronic rhinitis, among other conditions, as presumptive diseases associated with exposure to burn pits and other toxins. See Honoring our PACT Act of 2022, Pub. L. No. 117-168, § 406(b) (2022).

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12?Vet. App.?307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, VA shall give the benefit of the doubt to the Veteran. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to service connection for left hip strain

4. Entitlement to service connection for right hip strain

5. Entitlement to service connection for left ankle pain

6. Entitlement to service connection for right ankle pain

7. Entitlement to service connection for bilateral plantar fasciitis

The Veteran contends that he developed bilateral hip strain, bilateral ankle pain, and bilateral plantar fasciitis secondary to his service-connected bilateral knee disability. See January 2025 VA Form 21-526EZ and November 2024 private evaluation.

Regarding the first element of secondary service connection, a current disability, the Board notes that the AOJ made favorable a finding that the Veteran is currently diagnosed with bilateral hip strain. The Board is bound by this favorable finding. 38 C.F.R. § 3.104 (c).

As to the bilateral ankle disorder, the file contains differing opinions as to the existence of the diagnosis. In a November 2024 private evaluation, the clinician noted that the Veteran has suffered from progressive left ankle pain since involvement of his bilateral knees. He reports daily pain in varying degrees which is intensified with standing and walking. Physical examination revealed mildly decreased range of motion with inversion and eversion. The examiner diagnosed the Veteran with bilateral ankle pain. A February 2025 VA examination report noted the Veteran's current symptoms of stiffness and aching pain in both ankles
is currently diagnosed with bilateral hip strain. The Board is bound by this favorable finding. 38 C.F.R. § 3.104 (c).

As to the bilateral ankle disorder, the file contains differing opinions as to the existence of the diagnosis. In a November 2024 private evaluation, the clinician noted that the Veteran has suffered from progressive left ankle pain since involvement of his bilateral knees. He reports daily pain in varying degrees which is intensified with standing and walking. Physical examination revealed mildly decreased range of motion with inversion and eversion. The examiner diagnosed the Veteran with bilateral ankle pain. A February 2025 VA examination report noted the Veteran's current symptoms of stiffness and aching pain in both ankles that make it difficult for him to walk or be in his feet for prolonged periods of time. The VA examiner stated that there were no findings, signs, or symptoms to support a diagnosis.

The Board notes that evidence of pain alone which results in functional impairment, even if there is no identified underlying diagnosis, can constitute a disability. Saunders v. Wilkie, 886 F.3d 1356 (2018). Resolving any reasonable doubt in favor of the Veteran and based on the above reports of functional impairment, the Board finds that the Veteran's bilateral ankle pain is adequate to constitute a current disability. Id.

As to bilateral plantar fasciitis, the file contains differing opinions as to the existence of the diagnosis. The November 2024 private examiner noted that the Veteran experiences daily pain at the plantar surface of his feet which intensifies with walking long periods. The examiner noted that a physical examination confirmed a diagnosis of bilateral plantar fasciitis. The February 2025 VA examiner noted the Veteran's report of foot pain when he is walking or standing that "feels like knives in his feet." The Veteran treats the condition with over the counter insoles and by wearing Hoka shoes. The VA examiner stated that there were no findings, signs or symptoms to support a diagnosis. As the evidence is in approximate balance regarding the present diagnosis of plantar fasciitis, the Board resolves any reasonable doubt in favor of the Veteran.

In light of the above, the first element of secondary service connection is satisfied for the above issues. Wallin, 11 Vet. App. at 512.

As to the second element of secondary service connection, the Board finds that the claimed primary or underlying disability is service connected. A November 2023 rating decision granted service connection for bilateral knee strain. Id.

The only remaining question is one of nexus.

In the 2024 private evaluation, the clinician opined that it is as likely as not that the Veteran's bilateral hip pain, bilateral ankle pain, and bilateral plantar fasciitis are directly and causally related to the constant and chronic compensation and adaptation to the weight shifting and altered gait caused by his injured knees. She added that these were permanent and progressive conditions.

The February 2025 VA examiner stated that she suspected that the Veteran's hip pain had considerable overlap with his back pain and it was not possible to give an objective rationale for knee strain leading to hip problems. The examiner did not provide opinions for the ankle or foot disorders, stating that there was no pathology to render a diagnosis.

Upon review, the Board finds that the positive evidence is at least in approximate balance with the negative evidence. Accordingly, resolving all reasonable doubt in the Veteran's favor, the final element of the Veteran's service connection claim is met for these claims and entitlement to service connection for bilateral hip strain, bilateral ankle pain, and bilateral plantar fasciitis on a secondary basis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th at 776.

REASONS FOR REMAND

1. Entitlement to service connection for allergic rhinitis

2. Entitlement to service connection for chronic sinusitis

3. Entitlement to service connection for chronic headaches

4. Entitlement to service connection for CFS

5. Entitlement to service connection for IBS

As the above issues are being remanded for the same reason, they will be addressed together for the purposes of this remand.

The Veteran contends that he developed allergic rhinitis, chronic sinusitis, chronic headaches, IBS, and CFS as a result of Gulf War Syndrome. See January 2025 VA Form 21-526EZ.

The evidence of record indicates that the Veteran had service in the Southwest Asia Theater of Operations during the applicable period and meets the definition of a Persian Gulf War veteran. See January 2025 Individual Longitudinal Exposure Record (ILER) which documents the Veteran's service in the Arabian Sea, the
to service connection for CFS

5. Entitlement to service connection for IBS

As the above issues are being remanded for the same reason, they will be addressed together for the purposes of this remand.

The Veteran contends that he developed allergic rhinitis, chronic sinusitis, chronic headaches, IBS, and CFS as a result of Gulf War Syndrome. See January 2025 VA Form 21-526EZ.

Review of the Veteran's service treatment records (STRs) and VA treatment records do not show that the Veteran has been evaluated or treated for the above conditions.

The Veteran provided a private evaluation from chiropractic physician M.T in support of his claims. Dr. M.T. stated that the Veteran reported suffering from allergic rhinitis, chronic sinusitis, chronic headaches, IBS, and CFS since his deployment to the Southwest Asia Theater of Military Operations and that these disorders were as likely as not directly and causally related to Gulf War Syndrome.

Unfortunately, this opinion evidence is insufficient to decide the claims, as Dr. M.T. did not adequately explain the medical basis for the above conclusions. See e.g. Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012) (medical opinions are adequate when they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion). Dr. M.T. did not, for example, cite any relevant diagnostic testing, clinical findings, or medical records as support for the diagnoses. For these reasons, the Board finds the opinions inadequate to substantiate the claim. See also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that conclusory, contradictory, or incomplete analysis is inadequate).

The Veteran attended VA examinations in February 2025. As to respiratory difficulties, the Veteran reported having chronic nasal symptoms since service (2019-2020) with current symptoms of sinus congestion, runny nose, blocked sinuses, snoring, and dry mouth, which interfere with sleep. He does not treat his sinus symptoms. As to chronic headaches, the Veteran reported suffering from four or more headaches a week since returning from deployment. The duration of his headaches is 30-40 minutes, depending on how quickly he takes medication. As to CFS, the Veteran reported having a constant feeling of tiredness and poor quality sleep which began in service (2020). As to IBS, the Veteran reported having symptoms of diarrhea which began in service (2020) after he returned from deployment and started eating normal food again. His current symptoms include "having loose stools after eating, which occurs on most days." He treats the symptoms with Pepto Bismol. See February 2025 VA examinations.

The VA examiner noted that the record was silent for complaints, investigation, diagnoses, or treatment for these disorders. The examiner's opinion for each of the claimed disabilities consisted of a statement that there are no findings, signs, or symptoms to support a diagnosis.

As each of the VA opinions is essentially a conclusory statement, the Board finds the February 2025 VA opinions insufficient for adjudicative purposes. For example, the examiner did not fully explain the various criteria used, how she applied the criteria to the reported symptoms, or her analysis generally. See Nieves-Rodriguez, 22 Vet. App. at 295, 302-04 (explaining that most of the probative value of a medical opinion comes from the discussion of its underlying reasoning or rationale). Additionally, the examination report does not reflect consideration of the Veteran's lay statements asserting possible symptoms of these disorders during and since active service. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007).

Failure to ensure that a VA examination or opinion is adequate is a pre-decisional duty-to-assist error requiring remand. 38 C.F.R. § 20.802 (a).

6. Entitlement to service connection for GERD

The Veteran contends that he developed GERD during active-duty service. Specifically, the Veteran attributes the disorder "to eating overly processed foods while on the ship." He stated that he began having symptoms of burning in his throat which he treated with Tums. Current symptoms remain the same. He finds it uncomfortable to
possible symptoms of these disorders during and since active service. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007).

Failure to ensure that a VA examination or opinion is adequate is a pre-decisional duty-to-assist error requiring remand. 38 C.F.R. § 20.802 (a).

6. Entitlement to service connection for GERD

The Veteran contends that he developed GERD during active-duty service. Specifically, the Veteran attributes the disorder "to eating overly processed foods while on the ship." He stated that he began having symptoms of burning in his throat which he treated with Tums. Current symptoms remain the same. He finds it uncomfortable to lay down and is careful about what he eats. The symptoms have improved with elevation of the head of the bed and continued use of Tums. See February 2025 VA examination.

The Veteran provided a November 2024 private evaluation from chiropractic physician M.T in support of his claim. Dr. M.T. stated that the Veteran's GERD is as likely as not directly and causally related to elements of his service-connected PTSD. As rationale, Dr. M.T. referenced a medical study which found that highly stressful jobs, such as being in the military, can lead to gastrointestinal problems. The researchers also found that those with GERD were more likely to have mental disorders. Unfortunately, this opinion evidence is insufficient to decide the claim, as Dr. M.T. did not discuss any facts pertaining to the Veteran's condition or individual circumstances. Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018). Aside from the Veteran being in the military, it is unclear what, if any, other factors of the Veteran's individual circumstances were considered by the examiner.

The Veteran attended a VA examination for GERD in February 2025. The examiner opined that the Veteran's GERD was less likely than not proximately due to or the result of his service-connected PTSD. The examiner cited an NIH website on the topic of GERD and posited that the Veteran's obesity was the more likely cause, as obesity is a listed risk factor for weakening of the lower esophageal sphincter, while PTSD is not.

The Board finds the February 2025 VA opinion insufficient to decide the claim as it focuses on general risk factors without considering other pertinent evidence, to include the Veteran's lay statements about the continuity and progression of relevant symptoms over time. An opinion without consideration of a claimant's competent lay statements is inadequate. See Miller v. Wilkie, 32 Vet. App. 249 (2020); Dalton, 21 Vet. App. at 23, 39-40.

Failure to ensure that a VA examination or opinion is adequate is a pre-decisional duty-to-assist error requiring remand. 38 C.F.R. § 20.802 (a).

7. Entitlement to service connection for residuals of a TBI

8. Entitlement to service connection for post traumatic residual pain and cramping of the left lower leg

As the above issues are claimed as resulting from the same in-service events, they will be addressed together for the purposes of this remand.

The Veteran contends that he suffers from residuals of a TBI, which include chronic headaches, unpredictable vertigo, and loss of memory, due to injury-related incidents in service. He also contends that he has residual pain with cramping in his lower left leg due to the same incidents. See January 2025 VA Form 21-526EZ and November 2024 private evaluation.

The Veteran's STRs document that the Veteran sustained multiple injuries from an unbelted rollover motor vehicle accident (MVA) in December 2017 which occurred while he was on leave. See July 2023 STR. Emergency room records note that the Veteran was lying on the back seat of a truck when the driver fell asleep and hit a curb. The driver overcorrected and the truck flipped over and rolled several times. The Veteran's left lower extremity went through one of the rear windows. The truck then came to a stop lying on its side with the Veteran's left leg and ankle trapped under the truck. At the hospital, the Veteran denied having a headache, however the clinician noted that the Veteran was bruised on the left orbit area. The Veteran complained of pain in his left wrist, left lower leg, and left ankle. The Veteran was provided with antibiotics, tramadol for pain, an ankle brace, and crutches. He was diagnosed with multiple abrasions, left facial contusions, and contusions of the left wrist, left lower leg, left ankle, and left foot. See JLV/MT
. The Veteran's left lower extremity went through one of the rear windows. The truck then came to a stop lying on its side with the Veteran's left leg and ankle trapped under the truck. At the hospital, the Veteran denied having a headache, however the clinician noted that the Veteran was bruised on the left orbit area. The Veteran complained of pain in his left wrist, left lower leg, and left ankle. The Veteran was provided with antibiotics, tramadol for pain, an ankle brace, and crutches. He was diagnosed with multiple abrasions, left facial contusions, and contusions of the left wrist, left lower leg, left ankle, and left foot. See JLV/MTF, hospital records of December 30, 2017.

The Veteran provided a lay statement describing additional injuries he sustained in July 2020 during an incident aboard ship while working as a midship line handler during rough seas. He and other sailors were injured when struck by a massive wave while they were working on the weather deck. The Veteran recalled being knocked off his feet and tossed around. He sustained injuries to his face and knees. See August 2023 statement. The Veteran also described holding on to the railing when his glasses and helmet came off, his face hit something hard, and he could hear an echo in his head. His lip was almost severed, and his nose was sliced open. His superiors wanted to medivac him to an aircraft carrier to get surgery, but the seas were too rough to do so safely. Instead, he received painful, poorly done stitches on board the ship. See November 2024 private psychological evaluation.

The Veteran provided a November 2024 private evaluation from chiropractic physician M.T in support of his claims. Dr. M.T. stated that she diagnosed the Veteran with a TBI which is directly and causally related to the injuries from the 2017 MVA event. Unfortunately, this opinion evidence is insufficient to decide the claim, as Dr. M.T. simply offered a conclusory statement and did not adequately explain the medical basis for the above determination. See e.g. Monzingo, 26 Vet. App. at 97, 105 . Dr. M.T. did not, for example, cite any relevant diagnostic testing, clinical findings, or medical records as support for the TBI diagnosis.

The Veteran attended VA examinations for TBI, headaches, vertigo, and memory loss, in February 2025.

As to TBI, the VA examiner noted the Veteran's report of blacking out during the 2017 MVA event. The Veteran recalled "concrete coming to glass and waking up with the truck lying on his leg." He recalled that he was awake and alert by the time the paramedics arrived. The Veteran stated that he reported headaches after the July 2020 incident at sea when he was injured by a wave that knocked him down. No action was taken in response to his complaint of headaches. The VA examiner concluded there was no evidence that either incident was reported as a TBI event. The examiner indicated on the report that the Veteran did not have and currently does not have a TBI as there are no findings, signs, or symptoms to support a diagnosis. See February 2025 VA TBI examination.

As to chronic headaches, the VA examiner noted the Veteran's report of experiencing headaches since the 2017 MVA event in service for which he sometime takes BC (aspirin) powders. Nevertheless, the examiner indicated on the report that the Veteran had no symptoms of headaches and stated there are no findings, signs, or symptoms to support a diagnosis. See February 2025 VA headache conditions examination.

As to the reported vertigo, the VA examiner noted the Veteran's report of dizziness and a feeling like he is off balance all the time which began after he started working at sea. The Veteran stated that he often has to have someone verify his work at his job because of his feeling that things were moving. The examiner indicated on the report that the Veteran had no symptoms of vertigo and stated there are no findings, signs, or symptoms to support a diagnosis. See February 2025 VA headache conditions examination.

As to the reported memory loss, the VA examiner, a psychologist, noted symptoms for VA purposes of mild memory loss and impairment of short and long term memory. The examiner noted that mental health medical records dated August 31, 2023, and September 9, 2023, indicated normal memory and intact cognitive functions. During the clinical interview, the Veteran reported that he forgets tasks but does not miss appointments. In response to the examiner's memory questions, the Veteran confirmed that he could remember the day, month and year
indicated on the report that the Veteran had no symptoms of vertigo and stated there are no findings, signs, or symptoms to support a diagnosis. See February 2025 VA headache conditions examination.

As to the reported memory loss, the VA examiner, a psychologist, noted symptoms for VA purposes of mild memory loss and impairment of short and long term memory. The examiner noted that mental health medical records dated August 31, 2023, and September 9, 2023, indicated normal memory and intact cognitive functions. During the clinical interview, the Veteran reported that he forgets tasks but does not miss appointments. In response to the examiner's memory questions, the Veteran confirmed that he could remember the day, month and year; the name of the current president; and the names of his siblings and parents. He was able to spell "world" backwards. The examiner opined that there was not sufficient information to make a diagnosis of a clinical level memory impairment.

Unfortunately, the Board finds the February 2025 VA opinions inadequate for adjudicative purposes, as the examiners appear to based their opinions on a lack of evidence in the record rather than an analysis of the Veteran's reported symptoms or lay statements. Reliance of the absence of evidence in the medical records, without more, is contrary to established case law. See e.g., Buchannan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding that the VA examiner's conclusion was improperly predicated on a lack of documentation in the medical record). See also Miller v. Wilkie, 32 Vet. App. 249 (2020); Dalton, 21 Vet. App. at 23, 39-40.

Failure to ensure that a VA examination or opinion is adequate is a pre-decisional duty-to-assist error requiring remand. 38 C.F.R. § 20.802 (a).

The Veteran also asserts that he has a current left lower leg disability due to the above events in service, particularly the 2017 MVA. The Veteran has reported experiencing intermittent sharp shooting pain down his shin and cramping of his left lower leg. He treats the condition with ice and Bio Freeze. See February 2025 VA examination.

The file contains differing opinions as to the existence of the diagnosis. The November 2024 private clinician diagnosed the Veteran with post traumatic residual pain and cramping of the left lower leg. Nothing was elicited as to functional impairment. The February 2025 VA examiner concluded that no other diagnosis could be provided separate from the currently service-connected knee strain. The examiner stated that there is no pathology to render a diagnosis.

As noted above, the United States Court of Appeals (Court) has held that pain alone may qualify as a disability for VA purposes, even without a specific underlying diagnosis, if it causes functional impairment and limits earning capacity. Saunders, 886 F.3d at 1356, 1368.

Therefore, in light of Saunders, a remand is necessary to obtain an addendum medical opinion as to whether the Veteran's current reported lower leg pain, separate from his diagnosed knee strain, results in functional impairment.

The failure to obtain a VA opinion addressing the factors outlined in Saunders constituted a pre-decisional duty-to-assist error requiring remand. 38 C.F.R. § 20.802 (a).

The matters are REMANDED for the following actions:

1. Arrange for the appropriate examinations from a different examiner to confirm the nature and likely etiology of the Veteran's claimed allergic rhinitis, chronic sinusitis, chronic headaches, IBS, and CFS. Any appropriate evaluations, testing, and studies deemed necessary by the examiner should be conducted, and the results included in the examination report. Thereafter, the examiner should provide responses to the following:

(a.) Does the Veteran have diagnosed allergic rhinitis, chronic sinusitis, chronic headaches, IBS, or CFS underlying his complaints for the respective conditions that are at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher) that are directly related to service?

(b.) Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's complaints of allergic rhinitis, chronic sinusitis, chronic headaches, IBS, or CFS constitute an undiagnosed illness?

(c.) Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's complaints of allergic rhinitis, chronic sinusitis, chronic headaches, IBS, or CFS constitute a medically unexplained chronic multi-symptom illness?

(d.) If chronic headaches are diagnosed
(the likelihood is at least approximately balanced or nearly equal, if not higher) that are directly related to service?

(d.) If chronic headaches are diagnosed and determined as not related to service, identify the etiology that is considered to be more likely and explain why that is so.

(e.) The examiner must provide a complete rationale for all opinions, supported by evidence and citing any records or medical literature relied upon. The examiner must consider relevant evidence of record, including lay testimony. If any of the above requested opinions cannot be made without resorting to speculation, the examiner must explain why.

2. Obtain a medical opinion as to the etiology of the Veteran's GERD. The claims file and a copy of this remand must be made available to and reviewed by the examiner. The need for another examination is left to the discretion of the examiner.

(a.) Based on a review of the entire record, the examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's GERD had its onset during service or is otherwise etiologically related to his service.

(b.) The examiner should also opine on whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's GERD is either (1) caused, or (2) aggravated by the Veteran's service connected PTSD. The examiner is reminded that causation and aggravation are separate legal concepts that must be addressed separately in the opinion.

(c.) The examiner must provide a complete rationale for all opinions, supported by evidence and citing any records or medical literature relied upon. The examiner must consider relevant evidence of record, including lay testimony. If any of the above requested opinions cannot be made without resorting to speculation, the examiner must explain why.

3. Schedule the Veteran for a VA TBI examination from an appropriate clinician, who has not already provided an opinion in this matter, regarding the nature and etiology of the Veteran's claimed TBI residuals. The claims file and a copy of this remand must be made available to and reviewed by the examiner. Any appropriate evaluations, testing, and studies deemed necessary by the examiner should be conducted, and the results included in the examination report. Thereafter, the examiner should address the following:

(a.) Does the Veteran have residual signs or symptoms of a TBI? Please explain your reasoning.

(b.) If so, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's current TBI symptoms are related to Veteran's service, to include the December 2017 MVA and the July 2020 incident at sea where he was knocked down by a wave and injured?

4. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his left lower leg pain. The claims file and a copy of this remand must be made available to and reviewed by the examiner. Any appropriate evaluations, testing, and studies deemed necessary by the examiner should be conducted, and the results included in the examination report. Thereafter, the examiner should address the following:

(a.) Please clarify the Veteran's diagnosis. Specifically, the examiner should indicate whether the Veteran has any diagnosable pathology associated with his reported symptoms of left lower leg pain that are separate and distinct from his already service-connected left knee disability.

(b.) If there is no diagnosable pathology for the left lower leg pain, the examiner must determine whether there is any objective evidence of symptoms of pain, which are unrelated to his service-connected knee disability, that result in functional impairment. Specifically, whether any symptom of pain unrelated to his service-connected knee disability impairs his ability to function under the ordinary conditions of daily life, including employment.

(c.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher
clarify the Veteran's diagnosis. Specifically, the examiner should indicate whether the Veteran has any diagnosable pathology associated with his reported symptoms of left lower leg pain that are separate and distinct from his already service-connected left knee disability.

(c.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any left lower leg pain disability or identified functional impairment had its onset in or is otherwise related to the Veteran's service, to include the December 2017 MVA and the July 2020 incident at sea where he was knocked down by a wave and injured?

(d.) The examiner must provide a complete rationale for all opinions, supported by evidence and citing any records or medical literature relied upon. The examiner must consider relevant evidence of record, including lay testimony. If any of the above requested opinions cannot be made without resorting to speculation, the examiner must explain why this is so.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Horan, Deborah E.

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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