ANXIETY DISORDER

T. V. CASEY · 2026 · Case ID: A26001609

MIXED

Summary

The veteran, who served in the Navy from July 1959 to May 1960, appeals the denial of service connection for several conditions, including TBI, migraines, back, hip, knee, and ankle disabilities. The Board granted service connection for unspecified anxiety disorder, finding a current diagnosis, in-service complaints of tension and depression, and a favorable VA medical opinion linking the condition to an in-service stressor. The Board denied service connection for TBI and migraines, finding the veteran's assertion of an in-service head injury not credible due to inconsistencies with service treatment records and the veteran's own post-service statements. The Board also denied service connection for back, hip, knee, and ankle disabilities, finding a lack of current disability or nexus to service, and that the evidence weighed against the claims. The Board remanded claims for asthma and erectile dysfunction due to duty to assist errors and incomplete medical opinions. The asthma remand requires an opinion on pre-existing conditions and aggravation by service, including toxic exposure risk activities (TERAs). The erectile dysfunction remand requires obtaining private treatment records and an addendum opinion on nexus to service and TERAs.

Rationale

Current disability established; In-service complaints noted in STRs; Favorable VA medical opinion on nexus

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241203-493763

Full Decision Text

Citation Nr: A26001609
Decision Date: 01/07/26 Archive Date: 01/07/26

DOCKET NO. 241203-493763
DATE: January 7, 2026

ORDER

Entitlement to service connection for unspecified anxiety disorder is granted.

Entitlement to service connection for a traumatic brain injury (TBI) is denied.

Entitlement to service connection for migraines, to include as secondary to the claimed TBI, is denied.

Entitlement to service connection for a back disability is denied.

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

Entitlement to service connection for left hip disability is denied.

Entitlement to service connection for right knee disability is denied.

Entitlement to service connection for left knee disability is denied.

Entitlement to service connection for right ankle disability is denied.

Entitlement to service connection for left ankle disability is denied.

REMANDED

Entitlement to service connection for asthma is remanded.

Entitlement to service connection for erectile dysfunction is remanded.

FINDINGS OF FACT

1. The Veteran's unspecified anxiety disorder is related to service.

2. The evidence persuasively weighs against a finding that the Veteran incurred a TBI or migraine condition in service.

3. The evidence persuasively weighs against a finding that the Veteran's back disability is related to service.

4. The evidence persuasively weighs against a finding that the Veteran has had a right or left hip disability at any time during or approximate to the pendency of the claim.

5. The evidence persuasively weighs against a finding that the Veteran's knee arthritis had its onset during active duty service or manifested within one year of separation from service, or that any right or left knee disability is related to service.

6. The evidence persuasively weighs against a finding that the Veteran has had a right or left ankle disability at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for his unspecified anxiety disorder have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

3. The criteria for entitlement to service connection for migraines have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for entitlement to service connection for a back disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for a right hip disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

7. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

8. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

9. The criteria for entitlement to service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Navy from July 1959 to May 1960. He had additional periods of service in the Navy Reserve.

The matter comes before the Board of Veterans' Appeals (Board
right ankle disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Navy from July 1959 to May 1960. He had additional periods of service in the Navy Reserve.

The matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2024 rating decision by a Department of Veterans Affairs (VA) Regional Office, which is the agency of original jurisdiction (AOJ).

In the December 3, 2024, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the November 2024 rating decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.

If evidence was submitted either (1) during the period after the AOJ issued the rating decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. However, because the Board is remanding the claims of asthma and erectile dysfunction, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider with regards to the neurological and musculoskeletal claims, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

As a final preliminary matter, the Board notes that it has recharacterized the Veteran's claims for back and knee disabilities more broadly in order to clarify the nature of the benefit sought and ensure complete consideration of the claim. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009).

As a final preliminary matter, the Board notes that it sent the Veteran, with copy to his representative, multiple correspondences relevant to his appeal in March 2025.

First, the Board sent a letter acknowledging his request in the December 2024 VA Form 10182 for an extension of time to submit evidence, indicating that there is no legal authority under the Appeals Modernization Act (AMA) to grant an extension request, and providing information regarding the alternative dockets and lanes available for review.

Second, the Board sent a letter indicating that the deadline of November 21, 2025, for allowing claimants to switch dockets under the AMA pursuant to 38 C.F.R. § 20.202(c)(2) had not yet lapsed, and that unless the Veteran filed a waiver, the Board would wait until the deadline lapsed to adjudicate the claim. As no response was received, the Board has waited until the deadline lapsed and will proceed to adjudicate the claim. See Williams v. McDonough, 37?Vet. App.?305 (2024).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury.
be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 U.S.C. §§ 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a).

The Board notes at the outset that it will remand the claim of service connection for erectile dysfunction to obtain private medical treatment records related to a genitourinary condition. However, as these records are not relevant to neurological or musculoskeletal claims, the Board does not find that there is a pre-decisional duty to assist error with regard to those claims or that remand of those claims is warranted. See Golz v. Shinseki, 590 F.3d 1317, 1322 (Fed. Cir. 2010) (clarifying that the duty to assist in obtaining records extends only to relevant records)

1. Entitlement to service connection for unspecified anxiety disorder is granted.

The Board finds that the first element of service connection, the existence of a current disability, is satisfied. The September 2024 VA examination shows a diagnosis of unspecified anxiety disorder. The AOJ also made a favorable finding to that effect in the November 2024 rating decision. The Board notes that favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board. 38 C.F.R. § 3.104(c).

The Board next finds that the second element of service connection is satisfied, as the Veteran's service treatment records (STRs) show that he complained of tension and feelings of depression in October 1959 and that he engaged in therapy through November 1959. The clinician noted that "although patient was well motivated, no relief of symptoms resulted because of deep-seated personality problems. Patient stated that he was advised by Dispensary physician that he should be surveyed out of the service for asthma. He has decided to do so and therapy was terminated."

Additional records subsequent to service show that the Veteran reported incidents of social isolation and racial harassment in service. Specifically, the Veteran stated in a March 2024 VA Form 21-0781 (Statement in Support of Claim for PTSD) that he endured isolation, racial harassment, and hazing, which was greatly upsetting and triggered nightmares. He reported in a March 2024 VA treatment record that he has a long history of alcohol abuse that began in service as a result of racial harassment and social isolation. He made similar reports in the September 2024 VA examination. The Board finds these reports competent and credible.

Therefore, the remaining question before the Board is whether there is a nexus between the current disability and service. The September 2024 VA medical opinion is for service connection. The examiner stated that the "Veteran is being diagnosed with Unspecified Anxiety Disorder. His diagnosis is at least as likely a result of his in-stressor related event." The Board finds this opinion adequate and highly probative as to the nexus element. Thus, the Board finds that the third element of service connection is satisfied.

In sum, service connection for unspecified anxiety disorder is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Entitlement to service connection for a TBI is denied.

3. Entitlement to service connection for migraines, to include as secondary to the claimed TBI, is denied.

The Veteran asserted in the March 2024 VA Form 21-526EZ (Fully Developed Claim) that his "TBI to include migraines" are due to a "fall from top bunk" in 1959. The Board finds, for the reasons set out below, that this assertion is not credible and, therefore, that service connection is not warranted.

VA treatment records dated May 2024 and June 2024 show that the Veteran presented to the emergency department complaining of a head injury and headache, among other related symptoms, as a result of being struck on the back of the head with a golf ball in May 2024, causing him to lose consciousness for 5 to 10 seconds; this was assessed as a very mild TBI. Prior
March 2024 VA Form 21-526EZ (Fully Developed Claim) that his "TBI to include migraines" are due to a "fall from top bunk" in 1959. The Board finds, for the reasons set out below, that this assertion is not credible and, therefore, that service connection is not warranted.

VA treatment records dated May 2024 and June 2024 show that the Veteran presented to the emergency department complaining of a head injury and headache, among other related symptoms, as a result of being struck on the back of the head with a golf ball in May 2024, causing him to lose consciousness for 5 to 10 seconds; this was assessed as a very mild TBI. Prior medical history was shown to include other medical conditions but not a prior TBI or headache conditions. The clinician expressly noted that: "Vet denies any other head injuries in his past."

The Veteran's STRs do not contain any record of complaints, treatment, or diagnosis of a TBI or headaches during service. The service records do not show or otherwise suggest an incident involving a fall from a top bunk during service.

A January 1960 STR (Board Medical Survey) shows that his past history was essentially negative and that his physical examination was unremarkable, other than the asthma for which he was medically discharged.

The Board affords significant probative value to the Veteran's express denial of any head injury prior to the one that occurred in June 2024, or decades after separation from service, as set out in the VA treatment records, because he made the statement to a medical professional for purpose of diagnosis and treatment. See Fed. R. Evid. 803(4) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care).

The Board also affords significant probative value to the lack of documentation in the STRs of any TBI or headaches resulting from a fall from the top bunk. There is no indication that the service records are incomplete, and any pertinent reports of physical injuries would have been recorded. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (stating that VA may use silence in the STRs as evidence contradictory to a veteran's assertions if the STRs appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred) (Lance, J., concurring); see also Fed. R. Evid. 803(7) (indicating that the absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded). The Board emphasizes that the STRs, including the January 1960 STR, are highly probative both as to the Veteran's subjective reports and their objective findings. They were generated contemporaneously with in-service evaluations with a view towards ascertaining the Veteran's then-state of physical and mental fitness and are akin to statements of diagnosis or treatment. See Fed. R. Evid. 803(4).

The Board does not intend to imply that the Veteran has any intent to deceive with his statements regarding the claimed in-service injury but rather finds that such inconsistencies are typical of memory and the passage of time. See Seng v. Holder, 584 F.3d 13, 19 (1st Cir. 2009) (noting that, notwithstanding a declarant's intent to speak the truth, the witness's statement may lack credibility because of faulty memory).

Accordingly, the Board finds that the Veteran's reports regarding a TBI and migraines following an in-service fall from a top bunk are not credible and they are not afforded probative weight. Thus, although the VA treatment records show that the first element of service connection is satisfied, the Board finds that the second element is not. In order to grant an award, all legal requirements must be satisfied.

The Board acknowledges that AOJ's duty to assist with respect to obtaining records and VA examinations. 38 C.F.R. § 3.159.

First, the Board acknowledges that the VA treatment records reference private medical treatment for urgent care or trauma assessment from the Wellstar Kennestone Hospital. Although review of the claims file does not show that the AOJ attempted to obtain any outstanding records of this treatment, the Board does not find that this constitutes a pre-decisional duty to assist error or that a remand is warranted.

In Golz v. Shinseki, 590 F.3d 1317 (Fed. Cir. 2010), the Federal Circuit defines VA's duty to obtain "relevant" records holding that "[r]elevant records for the purpose of § 5103A are those records that relate to the injury for which the claimant is seeking benefits and have a reasonable possibility of helping to substantiate the veteran's claim." Id. at 1321. The Golz Court noted that VA need not obtain records in every case in order to rule out their relevance and stated that such decision would be akin to a determination that all medical records must be obtained. Id. at 1323. Similarly, it is not the case that a record's relevance can always be determined without reviewing the record itself. "The legal standard for relevance requires VA to examine the information it has related to medical records and if there exists a reasonable possibility that the records could help the veteran substantiate his claim for benefits, the duty to assist requires VA to obtain the records. [. . .] In close or uncertain cases, the VA should be guided by the principles underlying this uniquely pro-claimant system. [. . .] As long as a reasonable possibility exists that the records are relevant to the veteran's claim, VA is required to assist the veteran in obtaining the identified records. At the same time, we acknowledge that Congress has placed reasonable limits on VA's duty to assist. The relevancy limitation allows VA to focus its efforts on obtaining documents that have a reasonable possibility of assisting claimants in substantiating their claims for benefits." Id.?

Here, the AOJ would simply have been obtaining records in order to decisively exclude their relevance. The outstanding private medical treatment records pertain to treatment for a TBI that occurred in June 2024, more than 60 years following separation from service and the alleged incident. Furthermore, the VA treatment records associated with the claims file contain clinical findings regarding his prior medical history, including the Veteran's express denial of a prior head injury. Therefore, this is not a close or uncertain case. There is no reasonable possibility that attempts to obtain any additional records would help in substantiating the Veteran's claim.

Second, the Board acknowledges that the AOJ did not obtain a VA examination. However, the Board does not find that this constitutes a pre-decisional duty to assist error a remand is warranted to obtain one. Although the record at the time of the rating decision shows competent evidence of a current disability, it does not show that the claimed event or injury occurred in service, as set out in detail above, or contain an indication that such disability may be associated with service. As such, the obligation to obtain an examination was not triggered. See McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The Federal Circuit has held that "[i]n the absence of any medical evidence, [a veteran's] own conclusory statements regarding causation were insufficient to establish the necessary nexus between his in-service [disability] and his present ailments." Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). Conclusory, generalized statements are not enough to entitle a veteran to an examination under 38 USC 5103A(d)(2)(B), "[s]ince all veterans could make such a statement, this theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations as a matter of course in virtually every veteran's disability case. If Congress had intended that requirement, presumably it would have explicitly so provided." Id.

Here, the only record evidence regarding any indication that the claimed disability may be associated with service is the Veteran's bare statement in the March 2024 VA Form 21-526EZ, as set out above.

Although lay testimony is competent to establish the presence of observable symptomatology, such as headache sensation, here the Veteran has not made specific assertions regarding any observed symptoms, their onset, or their progression, or even the nature or extent of the injury. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); Pierce v. Principi, 18 Vet. App. 440 (2004). Rather, this March 2024 statement relays only the bare fact of the asserted fall. Thus, the only evidence in support of a link is the Veteran's conclus
service is the Veteran's bare statement in the March 2024 VA Form 21-526EZ, as set out above.

Although lay testimony is competent to establish the presence of observable symptomatology, such as headache sensation, here the Veteran has not made specific assertions regarding any observed symptoms, their onset, or their progression, or even the nature or extent of the injury. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); Pierce v. Principi, 18 Vet. App. 440 (2004). Rather, this March 2024 statement relays only the bare fact of the asserted fall. Thus, the only evidence in support of a link is the Veteran's conclusory assertion that his current disabilities are related to his period of service. The bare assertion of a link is insufficient to meet even the low burden triggering VA's duty to assist in providing an examination and medical opinion.

The Board also observes that the Veteran's DD Form 214 shows that his military occupational specialty (MOS) was dental officer and that he reported, in the September 2024 VA examination for PTSD, having worked as a dentist for six decades, which shows that he possesses medical training. To the extent that this March 2024 statement may be considered medical rather than lay evidence, the Board finds that the Veteran is not competent to provide a diagnosis of a TBI or a nexus opinion regarding etiology of a TBI. The issue is medically complex, and he does not have the requisite specialized knowledge, training, or credentials to make such a determination.

The VA Adjudication Procedures Manual (M21-1) provides guidance regarding TBIs. Although the M21-1 is not binding on the Board, the Board must address relevant provisions of the M21-1 and conduct an independent analysis before determining whether the provisions may be relied upon as a factor to support its decision. Overton v. Wilkie, 30 Vet. App. 257 (2018); DAV v. Sec'y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017). The Board finds the M21-1 provisions highly instructive in the present case, particularly in light of the absence of any other legal authority on this matter, and the Board accepts them as appropriate guidance. M21-1, Section IV.i.3.A.1.i., "Qualification Requirements of Examiners - Psychological Examinations" provides that "the initial diagnosis of TBI must be made by one of the following specialists: physiatrists; psychiatrists; neurosurgeons; or neurologists." (emphasis in original).

Here, the Veteran is not shown to have such specialized medical training. Accordingly, he is not competent to provide an initial diagnosis of a TBI in service. He is not competent to opine on etiology of an initial TBI. To the extent that his March 2024 statement may be interpreted as a medical nexus opinion, arguendo, based on a liberal and sympathic reading of the filing, the Board finds that it did not include a rationale, and is therefore conclusory, inadequate, and not probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) ("To have probative value, a medical examination report submitted to the Board of Veterans' Appeals must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.")

Additionally, M21-1, Sections V.iii.12.B.1.a, "Definition: TBI," and V.iii.12.B.1.b, "TBI Events," provide that "The term traumatic brain injury (TBI) means the physical, cognitive, and/or behavioral/emotional residual disability resulting from an event of external force causing an injury to the brain. The TBI event is a traumatically induced structural injury and/or physiological disruption of brain function resulting from an external force indicated by at least one of the following clinical signs immediately following the event: any period of loss of consciousness or decreased consciousness; any loss of memory for events immediately before or after the injury; any alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.); neurological deficits, whether or not transient, or intracranial lesion." (emphasis in original).

The VA Medical Electronic Performance Support System (MEPSS) provides that TBI "is defined as a structural injury and/or physiological disruption of brain function from an external force that is indicated by new onset or worsening of at least one of the following clinical signs: Any period of loss of or a decrease in level of consciousness; Any loss of memory for events immediately before or after the injury; Any alteration in mental state at the time of the injury
or decreased consciousness; any loss of memory for events immediately before or after the injury; any alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.); neurological deficits, whether or not transient, or intracranial lesion." (emphasis in original).

The VA Medical Electronic Performance Support System (MEPSS) provides that TBI "is defined as a structural injury and/or physiological disruption of brain function from an external force that is indicated by new onset or worsening of at least one of the following clinical signs: Any period of loss of or a decrease in level of consciousness; Any loss of memory for events immediately before or after the injury; Any alteration in mental state at the time of the injury (such as confusion, disorientation, slowed thinking, etc.); Neurological deficits that may or may not be transient (such as weakness, loss of balance, change in vision, praxis, paresis/paralysis, sensory loss, aphasia); Intracranial lesion (direct injury to brain tissue)." See MEPSS, "8045 - Residuals of Traumatic Brain Injury (TBI)," available at https://mepss.vbatraining.org/Medical%20Issues/Neurological/ codes/8045.stml (last visited Dec. 11, 2025).

Here, although the March 2024 statement specified the external force, or the fall from the top bunk, and implied a resulting impact to the head, the Veteran did not provide any further details or indications regarding any impact on consciousness, memory, mental state, neurological function, or intracranial lesion. The STRs of record also did not show the presence of any such symptomatology, but rather, indicated a normal medical history and unremarkable physical examination in the year following the asserted fall. Moreover, the Veteran expressly denied any head injury prior to the one incurred in June 2024, or decades following separation from service, in a VA treatment record. Accordingly, to the extent that the Veteran's assertion may be deemed a medical nexus opinion, the Board finds that it is contradicted by the other medical evidence of record.

Overall, the Board finds that the Veteran's March 2024 statement, whether it is considered lay or medical evidence, is too conclusory and generalized to trigger the Board's duty to obtain a VA examination. To the extent that this statement may be interpreted as a medical opinion, it is not probative, as it is conclusory and contrary to the other evidence of record.

In sum, the Board finds that evidence of record persuasively weighs against finding that the Veteran incurred a TBI following an in-service head injury. Accordingly, the second and third elements of service connection are not satisfied. As the Veteran has not asserted, nor has the record reasonably raised, any alternative theories of entitlement for either the TBI or any headache disability, no further analysis of this matter is warranted.

As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

4. Entitlement to service connection for a back disability is denied.

The Board finds that the first element of service connection, the existence of a current disability, is satisfied. The August 2024 VA examination showed a diagnosis of lumbosacral strain and scoliosis. The November 2024 rating decision made a favorable finding to this effect. The Board notes that favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board. 38 C.F.R. § 3.104(c).

Turning to the second element, the Veteran's STRs do not contain any record of complaints, treatment, or diagnosis of a back disability during service. During the pendency of the present claim, the Veteran made several statements regarding the claimed in-service event. In the March 2024 VA Form 21-526EZ, he indicated that the onset of the disability was in 1960. In the August 2024 VA examination, he indicated that he injured his back while playing golf 20 years ago, and that the onset of the condition was in 2004.

The Board observes that the Veteran did not make any specific statements or assertions regarding any in-service event or injury beyond the general assertion regarding a year of onset, as set out above, in the application form. Moreover, the only asserted back injury of record was noted to have occurred approximately 40 years after separation from service. Accordingly, the Board finds that the second element of service connection is not satisfied.

Turning to the nexus element of the claim, the VA examiner opined against service connection, reasoning that the record
the onset of the disability was in 1960. In the August 2024 VA examination, he indicated that he injured his back while playing golf 20 years ago, and that the onset of the condition was in 2004.

Turning to the nexus element of the claim, the VA examiner opined against service connection, reasoning that the record evidence does not support an association with service. The Board finds that the VA medical opinion is probative and dispositive of the matter. It was offered by a qualified professional with the necessary education, training?and experience, who also had the added benefit of having interacted with and observed the Veteran. Neither the Veteran nor his representative have specifically challenged the medical findings in the VA examination. Moreover, the findings are not expressly contradicted by any lay or medical evidence of record. Neither the Veteran nor his representative have presented or identified any medical opinion or treatment record that supports the presence of a nexus to service. See Colvin v. Derwinski,?1?Vet. App.?171, 175?(1991) (VA may only consider independent medical evidence to support its findings and?is?not permitted to base decisions on its own unsubstantiated medical conclusions).

The Board acknowledges the Veteran's statement in the December 2024 VA Form 10182 that the "provider not compliant did not evaluate effective (sic)." To the extent that this may be interpreted as a challenge to the VA examination or medical opinion, the Veteran did not make any specific assertions beyond this general statement.

The Board also acknowledges the Veteran's statements of record and the assertion that the Veteran's claimed back disability is related to service, as well as the Veteran's occupational background as a dentist. To the extent that medical nexus opinion may be inferred from a liberal and sympathetic reading of the pleadings, he has not provided any supporting rationale, and therefore, it is not afforded any probative weight. Thus, the VA medical opinion is not contradicted by any contrary probative medical opinion. See Nieves-Rodriguez, 22?Vet. App.?295. Accordingly, the nexus element of the claim is not satisfied.

Thus, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a back disability is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

5. Entitlement to service connection for a right hip disability is denied.

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

The threshold requirement for substantiating a claim of service connection is that there must be competent evidence of the disability for which service connection is sought. In the absence of proof of a current disability, there is no valid claim for service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

The term "disability" for VA purposes?refers to the functional impairment of earning capacity, not the underlying cause of said disability. See Saunders v. Wilkie, 886 F.3d 1356 (2018). "To establish the presence of a disability pursuant to Saunders, there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level to affect earning capacity, which may include showing manifestations of a similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person." See Wait v. Wilkie, 33?Vet. App.?8, 16 (2020).

Here, it is not shown by competent evidence that the Veteran was found to have a diagnosis or functional impairment of earning capacity related to the claimed right and left hip disabilities. Accordingly, the threshold requirement is not met.

Specifically, the Veteran underwent a VA examination in August 2024 that did not show a diagnosis related to the claimed hip disabilities, did not show that the Veteran reported any current symptoms, did not document any symptoms upon physical evaluation, and noted no functional impact. The examiner also specifically opined that there were no subjective or objective findings to support a diagnosis at this time.

Review of the VA treatment records associated with the file did not show any treatment for any hip conditions. In the March
8, 16 (2020).

Review of the VA treatment records associated with the file did not show any treatment for any hip conditions. In the March 2024 VA Form 21-526EZ, the Veteran merely indicated that the onset of the disability was in 1960 without providing further details regarding onset or progression of symptoms, to include their nature or any functional impact.

The Board finds that the August 2024 VA examination is probative and dispositive of the matter. It was offered by a qualified professional with the necessary education, training?and experience, who also had the added benefit of having interacted with and observed the Veteran. Moreover, the VA examination findings are not expressly contradicted by any lay or medical evidence of record. Neither the Veteran nor his representative have presented or identified any medical opinion or treatment record that supports the presence of a diagnosis or functional impairment of earning capacity. Neither the Veteran nor his representative have specifically challenged the medical findings in the VA examination, beyond the general assertion in the December 2024 VA Form 10182, which is insufficient. Furthermore, to the extent that the Veteran's March 2024 statement may be interpreted as a medical opinion, in light of his background as a dentist, the Board does not find afford it any probative value, as he has not provided any supporting rationale.

The Board finds that the Veteran does not have a current disability related to the claim and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Therefore, the first element of service connection, the existence of a current disability, is not satisfied.

Thus, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for right or left hip disabilities is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

7. Entitlement to service connection for a right knee disability is denied.

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

Service connection on a presumptive basis for certain chronic diseases, including arthritis, may be established under 38 C.F.R. § 3.303(b) by evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307, (ii) present manifestations of the same chronic disease, and (iii) evidence of continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Although establishing service connection generally requires evidence of a nexus between the claimed in-service disease or injury and the present disability, 38?C.F.R. § 3.303(b) relaxes the nexus requirement for veterans suffering from certain chronic diseases via two alternative methods of establishing service connection: chronicity and continuity of symptomatology. The latter, continuity of symptomatology, can be shown when there is evidence that a now chronic condition was "noted" during service and there has been continuous symptoms of that condition since service. See Walker, 708 F.3d at 1339; Savage v. Gober, 10?Vet. App.?488, 495-97 (1997); Wilson v. Derwinski, 2?Vet. App.?16 (1991). If the nexus element is satisfied under 38 CFR 3.303(b) based on chronicity or continuity, then a medical opinion is not necessary to establish service connection. See Walker, 708 F.3d at 1336, Savage, 10?Vet. App.?at 495-97.

The Board finds that the first element of service connection, the existence of a current disability, is satisfied. The August 2024 VA examination showed a diagnosis of bilateral knee strain and right knee degenerative arthritis and right suprapatellar knee joint effusion. The November 2024 rating decision made a
(1997); Wilson v. Derwinski, 2?Vet. App.?16 (1991). If the nexus element is satisfied under 38 CFR 3.303(b) based on chronicity or continuity, then a medical opinion is not necessary to establish service connection. See Walker, 708 F.3d at 1336, Savage, 10?Vet. App.?at 495-97.

As the presence of both chronic and non-chronic diagnoses is shown, the Board will analyze theories of entitlement based on both direct and presumptive service connection.

Turning to the second element of the claim, the Veteran's STRs do not contain any record of complaints, treatment, or diagnosis of a knee disability during service. During the pendency of the present claim, the Veteran made several statements regarding the claimed in-service event. In the March 2024 VA Form 21-526EZ, he indicated that the onset of the disability was in 1960. In the August 2024 VA examination, he indicated that he began having bilateral knee pain 3 years ago in 2021, that it was of unknown origin, and he denied having a knee condition in service.

The Board observes that the Veteran did not make any specific statements or assertions regarding any in-service event or injury beyond the general assertion regarding a year of onset, as set out above, in the application form. Moreover, the only asserted onset of knee pain was noted to have occurred approximately 60 years after separation from service. The Veteran also expressly denied a knee condition in service. Accordingly, the Board finds that the second element of service connection is not satisfied.

Turning to the nexus element of the claim, the VA examiner opined against service connection, reasoning that the record evidence does not support an association with service. The Board finds that the VA medical opinion is probative and dispositive of the matter. It was offered by a qualified professional with the necessary education, training?and experience, who also had the added benefit of having interacted with and observed the Veteran. Neither the Veteran nor his representative have specifically challenged the medical findings in the VA examination beyond the general assertion in the December 2024 VA Form 10182, which is insufficient. Neither the Veteran nor his representative have presented or identified any medical opinion or treatment record that supports the presence of a nexus to service. See Colvin,?1?Vet. App. at 175. Furthermore, to the extent that the Veteran's March 2024 statement may be interpreted as a medical opinion, in light of his background as a dentist, the Board does not find afford it any probative value, as he has not provided any supporting rationale.

With regards to presumptive service connection for the diagnosed arthritis, the Board emphasizes that the STRs did not show any complaints or treatment related to the knees; that the Veteran was not diagnosed with arthritis until decades after separation from service; and that the Veteran reported that the onset of pain occurred in 2021, or decades after separation from service. Accordingly, the Board finds that the weight of the evidence is against service connection on a presumptive basis, to include on the basis of chronicity or continuity of symptomatology.

Thus, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for right and left knee disabilities is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

9. Entitlement to service connection for a right ankle disability is denied.

10. Entitlement to service connection for a left ankle disability is denied.

Here, it is not shown by competent evidence that the Veteran was found to have a diagnosis or functional impairment of earning capacity related to the claimed right and left ankle disabilities. Accordingly, the threshold requirement is not met.

Specifically, the Veteran underwent a VA examination in August 2024 that did not show a diagnosis related to the claimed ankle disabilities, did not show that the Veteran reported any current symptoms, did not document any symptoms upon physical evaluation, and noted no functional impact. The examiner also specifically opined that there were no subjective or objective findings to support a diagnosis at this time.

Review of the VA treatment records associated with the file did not show any treatment for any ankle conditions. In the March 2024 VA Form 21-526EZ
it is not shown by competent evidence that the Veteran was found to have a diagnosis or functional impairment of earning capacity related to the claimed right and left ankle disabilities. Accordingly, the threshold requirement is not met.

Review of the VA treatment records associated with the file did not show any treatment for any ankle conditions. In the March 2024 VA Form 21-526EZ, the Veteran merely indicated that the onset of the disability was in 1960 without providing further details regarding onset or progression of symptoms, to include their nature or any functional impact.

The Board finds that the August 2024 VA examination is probative and dispositive of the matter. It was offered by a qualified professional with the necessary education, training?and experience, who also had the added benefit of having interacted with and observed the Veteran. Moreover, the VA examination findings are not expressly contradicted by any lay or medical evidence of record. Neither the Veteran nor his representative have presented or identified any medical opinion or treatment record that supports the presence of a diagnosis or functional impairment of earning capacity. Neither the Veteran nor his representative have specifically challenged the medical findings in the VA examination, beyond the general assertion in the December 2024 VA Form 10182, which is insufficient. Furthermore, to the extent that the Veteran's March 2024 statement may be interpreted as a medical opinion, in light of his background as a dentist, the Board does not afford it any probative value, as he has not provided any supporting rationale.

The Board finds that the Veteran does not have a current disability related to the claim and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294 ; McClain, 21 Vet. App. at 321. Therefore, the first element of service connection, the existence of a current disability, is not satisfied.

Thus, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for right or left ankle disabilities is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

The Board finds that a remand is warranted in order to correct a duty to assist errors that occurred prior to the November 2024 rating decision on appeal. 38 C.F.R. § 20.802.

The Board notes that remands are interlocutory in nature and that it is not making any findings herein regarding the credibility of any lay statements.

1. Entitlement to service connection for asthma is remanded.

In August 2024, the AOJ obtained a VA examination and medical opinion, which is against direct service connection. However, this medical opinion is incomplete or not wholly adequate as it does not address a theory of entitlement based on a pre-existing condition. Here, multiple records indicate that the Veteran's asthma was present since childhood, prior to his enlistment in service. The case must be returned for an addendum opinion. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (holding that once VA undertakes an examination, it must provide an adequate one); see also 38 C.F.R. § 3.304.

2. Entitlement to service connection for erectile dysfunction is remanded.

In August 2024, the AOJ obtained a VA examination and medical opinion, which is against service connection. However, this medical opinion is incomplete or not wholly adequate as it does not address a theory of entitlement based on the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act). The case must be returned for an addendum opinion. See Barr, 21 Vet. App. 303; see also 38 U.S.C. § 1168.

Additionally, the Veteran reported to the VA examiner having undergone a prostatectomy at a private hospital following a prostate cancer diagnosis 25 years prior. However, it is not evident upon review of the claims file that the AOJ attempted to obtain any outstanding private medical treatment records related to genitourinary treatment.

The matters are REMANDED for the following action:

1. Ask the Veteran to complete a VA Form 21-4142 (Authorization for Release of Information) and VA Form 21-4142a (General Release for Medical Provider
ACT Act). The case must be returned for an addendum opinion. See Barr, 21 Vet. App. 303; see also 38 U.S.C. § 1168.

The matters are REMANDED for the following action:

1. Ask the Veteran to complete a VA Form 21-4142 (Authorization for Release of Information) and VA Form 21-4142a (General Release for Medical Provider Information to the VA) to obtain any outstanding private/non-VA medical treatment records for the Veteran's claimed erectile dysfunction. Any inability to obtain these records should be documented pursuant to 38 C.F.R. § 3.159(e).

2. Obtain an addendum opinion on the nature and etiology of the Veteran's asthma from the VA examiner who performed the August 2024 examination or another appropriate medical professional if the examiner is unavailable. A new examination of the Veteran is only necessary if deemed so by the examiner. The examiner is asked to opine regarding the following:

(a) Did asthma clearly and unmistakably (undebatable) preexist the Veteran's service?

(b) If so, was it clearly and unmistakably not aggravated by service?

(c) If asthma either did not clearly and unmistakably preexist service or was not clearly and unmistakably not aggravated by service, is it approximately at least as likely as not related to service, including the Veteran's toxic exposure risk activities (TERAs)?

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3. Obtain an addendum opinion on the nature and etiology of the Veteran's erectile dysfunction from the VA examiner who performed the August 2024 examination or another appropriate medical professional if the examiner is unavailable. A new examination of the Veteran is only necessary if deemed so by the examiner. The examiner is asked to opine whether the Veteran's erectile dysfunction is approximately at least as likely as not related to service, including the Veteran's TERAs?

T. V. Casey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. M., Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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