Case A26015185

DUSTIN L. WARE · 2026 · Case ID: A26015185

MIXED

Summary

The veteran served from July 1982 to July 1985 and again from February 1991 to April 1991. The veteran appealed the denial of service connection for neck pain, diabetes mellitus type II (DM II), and eye issues. The Board denied service connection for neck pain, finding no current diagnosis or mention in service treatment records or post-service records. For DM II, the Board noted a concession of toxic exposure risk activity (TERA) due to the veteran's MOS, but found no in-service complaints, treatment, or diagnosis. Post-service records showed DM II manifested years after service, and the VA examiner opined it was less likely than not caused by TERA, finding no medical literature supporting a link. The Board found the veteran incompetent to opine on the etiology of DM II, thus his lay assertions carried low probative weight, and the benefit of the doubt doctrine was not applicable. For eye issues, the Board noted the veteran claimed they were due to DM II. While the VA examiner diagnosed diabetic retinopathy, cataracts, and herpes simplex keratitis, the examiner opined these were less likely than not caused by TERA, attributing cataracts to age and retinopathy to DM II, not exposure. The Board found no competent medical or lay evidence linking the eye issues to service, and the veteran's own suggestion of a link to non-service-connected DM II weighed against direct service connection. The Board denied service connection for all three conditions. The Board remanded claims for increased ratings for osteochondritis dissecans of the right knee and osteochondritis of the left knee, finding the VA examination inadequate for failing to address flare-ups and functional loss, and noting inconsistencies in the examiner's findings. The Board also remanded claims for service connection for erectile dysfunction (ED), hypertension (HTN), and obstructive sleep apnea (OSA), finding the VA examiner's opinions inadequate for failing to address whether service-connected PTSD or its medications aggravated these conditions.

Rationale

No current diagnosis of neck pain or neck condition.; No mention in service treatment records.; No mention in post-service treatment records.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250219-518187

Full Decision Text

Citation Nr: A26015185
Decision Date: 02/19/26 Archive Date: 02/19/26

DOCKET NO. 250219-518187
DATE: February 19, 2026

ORDER

Entitlement to service connection for neck pain is denied.

Entitlement to service connection for diabetes mellitus type II (DM II) is denied.

Entitlement to service connection for eye issues is denied.

REMANDED

Entitlement to a disability rating in excess of 20 percent for osteochondritis dissecans of the right knee is remanded.

Entitlement to a disability evaluation in excess of 10 percent for osteochondritis of the left knee is remanded.

Entitlement to service connection for erectile dysfunction (ED) is remanded.

Entitlement to service connection for hypertension (HTN) is remanded.

Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

FINDINGS OF FACT

1. The Veteran does not have a current diagnosis of neck pain or for a neck condition.

2. The weight of the evidence is against a finding that the Veteran's DM II had its onset in service or is causally or etiologically related to an in-service event, injury, or disease.

3. The weight of the evidence is against a finding that the Veteran's eye issues had their onset in service or are causally or etiologically related to an in-service event, injury, or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for neck pain have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for DM II have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for eye issues have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1982 to July 1985 and February 1991 to April 1991.

In February 2025, the Board of Veterans' Appeals (Board) received a VA Form 10182, Decision Review Request: Board Appeal electing the Direct Review docket to review a January 2025 Higher Level Review (HLR) decision by the Department of Veterans Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ). 38 C.F.R. § 3.2500(a). Therefore, the Board may only consider the evidence of record at the time of the September 2024 and July 2024 initial rating decisions. 38?C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decisions, which were subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board notes that it has thoroughly reviewed the evidence of record in conjunction with this case. However, the Board has limited its discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish
to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Service connection may also be established on a secondary basis for a disability which is due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be caused by or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Ward v. Wilkie, 31 Vet. App. 233 (2019) (aggravation may be found when there is any incremental increase in disability or impairment of earning capacity, regardless of permanence).

Further, pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease, however remote, are service connected, unless clearly attributable to intercurrent causes. Entitlement to service connection based on chronicity pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C.A. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). HTN and DM are on the list of chronic diseases.

In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994).

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a Veteran's disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A Veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson
whether a Veteran's disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A Veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 3030 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377.

If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995).

After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104. When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (reasonable doubt to be resolved in Veteran's favor); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (the benefit-of-the-doubt rule applies if the competing evidence is in approximate balance).

1. Entitlement to service connection for neck pain

The Veteran contends his neck pain was caused by his military service. See March 2024 VA Form 21-526EZ, Fully Developed Claim.

As to the first element of service connection, a disability must be present at the time a claim for VA disability compensation is filed or during or contemporaneous to the pendency of the appeal. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Here, the record does not establish a current diagnosis of neck pain or any neck condition at any time over the course of the Veteran's claim.

A review of the Veteran's service treatment records (STRs) does not reflect any mention of neck pain or a neck condition. Furthermore, the Veteran's post-service treatment records do not reflect any treatment for, complaints, or diagnoses pertaining to neck pain or a neck condition.

As there is no current diagnosis of neck pain or neck condition at any time during the pendency of the appeal, the medical evidence does not support service connection for the claim and there is no doubt to be otherwise resolved.

2. Entitlement to service connection for DM II

The Veteran contends his DM II is due to his exposure from being a materials storage and handling specialist. See March 2024 VA Form 21-526EZ, Fully Developed Claim.

In the January 2025 HLR rating decision, the AOJ made the favorable findings that the Veteran had been diagnosed with DM II and participation in a toxic exposure risk activity (TERA) was conceded based upon the Veteran's military occupational specialty (MOS) as a material storage and handling specialist.

The Veteran's service treatment records (STRs) do not show complaints, treatment, or diagnosis related to DM II.

The Veteran's post-service treatment records reflect he was first diagnosed with DM when he was hospitalized in August 1999 due to uncontrolled DM. See August 1999 Columbus VAOPC note. The records reflect the Veteran has been treated for DM II ever since.

The Veteran offers no lay statements that he suffered from DM while in service or soon thereafter.

In April 2024, the Veteran was afforded a VA examination for DM. The examiner diagnosed the Veteran with DM II. The Veteran reported his condition began in 2005. The examiner opined the Veteran's DM was less likely than not caused by the indicated TERA, after considering the total potential exposures through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran. The examiner noted reviewing the Veteran's entire medical and non-medical record and found there was no medical or scientific evidence available that provided any indication of a relationship between the development of DM and the Veteran's TERA.

There is no competent and credible evidence of record linking the Veteran's DM to his service. The Veteran is deemed competent to report on his observable events during service. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Whether his DM is related to his service, or any incidents therein falls outside the realm of common knowledge of this Veteran. Determining the etiology of his DM requires medical inquiry into biological processes, anatomical relationships, and physiological functioning.

Such internal physical processes are not readily observable and are not within the competence of the Veteran, who, in this case, has not been shown by the evidence of record to have the training, experience, or skills needed to provide a competent etiology opinion.

As the Veteran is not competent to provide a nexus to his service, his lay assertions carry a low probative weight.

The Board finds that service connection is not warranted for DM II either presumptively or on a direct basis. The evidence fails to show that the Veteran meets the criteria for service connection under 38 C.F.R. § 3.309(e).

Also, there is no probative evidence showing that his DM is related to a disease, injury, or incident in service and/or continuity of symptomology under 38 C.F.R. § 3.303(b). Instead, the record shows that his DM II manifested many years after service, which is probative evidence against a finding of continuity of symptoms.

Lastly, direct service connection is not warranted, because there is no competent nexus to service.

Accordingly, the medical evidence of record is against finding that the Veteran's DM was incurred in service or in any way related to his active service period. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

3. Entitlement to service connection for eye issues

The Veteran contends his eye issues are due to his DM II. See March 2024 VA Form 21-526EZ, Fully Developed Claim.

In the January 2025 HLR rating decision, the AOJ made the favorable findings that the Veteran had been diagnosed with non-proliferative diabetic retinopathy, nuclear sclerotic cataracts, and herpes simplex keratitis, and participation in TERA was conceded based on the Veteran's MOS.

A review of the Veteran's STRs showed there were no complaints or treatments relating to any respiratory conditions or symptoms.

A review of the Veteran's post-service treatment records reflect he was followed closely for diabetic retinopathy. In July 2007, mild nonproliferative diabetic retinopathy was noted in the Veteran's left eye. See generally July 2003 to July 2007 Columbus VAOPC notes. Further, it was not until April 2015 that the Veteran was diagnosed with cataracts. See April 2015 Columbus VAOPC note.

In August 2024, the Veteran was afforded a VA examination for eye conditions. The examiner diagnosed the Veteran with non-proliferative diabetic retinopathy in the right eye, nuclear sclerotic cataracts bilaterally, and herpes simplex keratitis in the right eye. The examiner found diabetic retinopathy was first noted around November 2009, as were the cataracts. The examiner found the herpetic keratitis was first noted that day during the examination. The examiner opined the Veteran's eye conditions were less likely than not caused by the indicated TERA, after considering the total potential exposures through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran. The examiner found the cataracts were mild and age-related and the diabetic retinopathy was very mild and caused by DM, not any exposure. Further, the examiner found the ptosis developed in 2021 was either age-related or idiopathic; but found it was not from an environmental exposure from nearly 30 years ago. Lastly, the examiner noted the herpetic keratitis was a viral infection that had just developed.

After a thorough and holistic analysis of the evidence of record, the Board concludes there is no competent medical or lay evidence that satisfies the nexus element of the direct service connection claim. Davidson v. Shinseki, 581 F.3d 1313, 1315-1316 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The Veteran has not provided any evidence that his eye issues are causally related to his active-duty service. In fact, the Veteran suggests that they are related to his non-service-connected DM II.

In denying the Veteran's claim of entitlement to service connection for eye issues, the Board has considered the benefit of the doubt doctrine, however, as the evidence of record persuasively shows that his eye issues are not due to or otherwise related to his active-duty service, it is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (reasonable doubt to be resolved in Veteran's favor); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (the benefit-of-the-doubt rule applies if the competing evidence is in approximate balance).

REASONS FOR REMAND

1. Entitlement to a disability rating in excess of 20 percent for osteochondritis dissecans of the right knee is remanded.

2. Entitlement to a disability evaluation in excess of 10 percent for osteochondritis of the left knee is remanded.

The Veteran contends his left and right knee have worsened and he is entitled to an increased disability rating for each. See March 2024 VA Form 21-526EZ, Fully Developed Claim.

In April 2024, the Veteran was provided with a knee and lower leg VA examination. However, the Board finds the April 2024 VA examination is inadequate for rating purposes, as it did not comply with the requirements of Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court determined that it was not sufficient for an examiner to provide that a requested opinion regarding whether the Veteran had additional functional loss during flare-ups or after repeated use over time for musculoskeletal disabilities pursuant to DeLuca, was not possible without resorting to speculation based on the fact that the examination was not performed during a flare-up or after repetitive use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court found that an examiner must do all that reasonably should be done to become informed before concluding that a requested opinion cannot be provided without resorting to speculation. For an examination not conducted during a flare-up or after repeated use over time to comply with DeLuca, the examiner must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the Veteran, and offer an opinion based on an estimate derived from information procured from relevant sources, including the lay statements of the veteran. Sharp at 34-35.

In this case, the VA examiner did not address a range of motion (ROM) or estimated ROM after repeated use over time. Additionally, the Veteran reported instability and sharp pains. He stated he had to wear braces and has limited mobility. The examiner diagnosed the Veteran with bilateral knee instability. However,
an examination not conducted during a flare-up or after repeated use over time to comply with DeLuca, the examiner must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the Veteran, and offer an opinion based on an estimate derived from information procured from relevant sources, including the lay statements of the veteran. Sharp at 34-35.

In this case, the VA examiner did not address a range of motion (ROM) or estimated ROM after repeated use over time. Additionally, the Veteran reported instability and sharp pains. He stated he had to wear braces and has limited mobility. The examiner diagnosed the Veteran with bilateral knee instability. However, contrarily the examiner found there was no recurrent subluxation or persistent instability bilaterally, that the Veteran did not use any assistive devices, and that there was no functional impact. All of which clearly contradicts the Veteran's statements and the examiner's own diagnosis.

Thus, based on the holding in Sharp and the inconsistencies in the opinion, a remand is required to correct a pre-decisional duty to assist error and to obtain a new VA examination for the Veteran's bilateral knee conditions.

3. Entitlement to service connection for ED is remanded.

4. Entitlement to service connection for HTN is remanded.

5. Entitlement to service connection for OSA is remanded.

The Veteran contends his ED, HTN, and OSA are a result of his service-connected post-traumatic stress disorder (PTSD), and/or due to the medication he is taking for his PTSD. See March 2024 VA Form 21-526EZ, Fully Developed Claim and May 2025 Appellate Brief.

In the January 2025 HLR rating decision, the RO made the favorable findings that the Veteran was diagnosed with ED, HTN, and OSA and the Veteran was service connected for PTSD. Thus, the first and second Wallin elements for secondary service connection have been met.

Therefore, the question before the Board is whether the Veteran's ED, HTN, or OSA were due to or the result of, or is aggravated by, the Veteran's PTSD.

Here, the record reflects the Veteran was given VA examinations for ED, HTN, and OSA in April 2024. In all three examinations, the examiner opined the Veteran's ED, HTN, and OSA were less likely as not due to or the result of the Veteran's service-connected PTSD.

Specifically, in the ED opinion, the examiner found the Veteran's ED was at least as likely as not due to or the result of the Veteran's non-service-connected DM II. The examiner noted that medical literature showed erection problems, were common in men with diabetes. Especially those with DM II. High blood sugar over a long period of time can damage the nerves and blood vessels. This damage causes problems with getting or keeping an erection firm enough for sex.

In the HTN opinion, the examiner stated that medical literature showed for most adults, there was no identifiable cause of high blood pressure. The examiner found the Veteran's condition began from stress. There was no literature that showed a connection between HTN and the development of PTSD, therefore, a nexus could not be established.

Lastly, in the OSA opinion, the examiner found no literature supported a causal link between OSA and PTSD. The examiner noted that medical literature showed OSA and PTSD were often co-morbid with implications for disease severity and treatment outcomes. OSA prevalence was higher in PTSD sufferers than in the general population, with a likely bidirectional effect of the two illnesses.

The Board finds the April 2024 VA opinions on ED, HTN and OSA are inadequate as they failed to address whether the Veteran's service-connected PTSD could have aggravated the Veteran's ED, HTN, or OSA. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (the Court vacated a Board decision where a VA examiner did not specifically opine as to whether a disability was aggravated by a service-connected disability.) Thus, a remand is warranted to correct this pre-decisional duty to assist error.

The matters are REMANDED for the following actions:

1. Schedule the Veteran for a VA examination by an appropriately qualified clinician to assess the severity of his service-connected bilateral knee conditions.

The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner must attempt to elicit information from the Veteran regarding the frequency, duration, characteristics, precipitating and alleviating factors, and severity of
to whether a disability was aggravated by a service-connected disability.) Thus, a remand is warranted to correct this pre-decisional duty to assist error.

The matters are REMANDED for the following actions:

1. Schedule the Veteran for a VA examination by an appropriately qualified clinician to assess the severity of his service-connected bilateral knee conditions.

The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner must attempt to elicit information from the Veteran regarding the frequency, duration, characteristics, precipitating and alleviating factors, and severity of any flare-ups, and the degree of and/or extent of functional loss during flare-ups and/or after repeated use.

Based on the Veteran's lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use.

If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training.

All findings should be fully documented in the examination report.

2. Obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's ED, OSA, and HTN.

The entire claims file must be made available to the examiner for review.

The examiner is asked to address:

(a.) Whether the Veteran's ED has been aggravated by his service-connected PTSD, including the medication he has been prescribed.

(b.) Whether the Veteran's OSA has been aggravated by his service-connected PTSD, including the medication he has been prescribed.

(c.) Whether the Veteran's HTN has been aggravated by his service-connected PTSD, including the medication he has been prescribed.

The examiner is reminded that causation and aggravation are separate and distinct concepts and require separate rationales. The examiner should provide specific evidence of record to support any conclusions, such as references from this Veteran's relevant medical history and/or medical literature. In formulating any opinion, the examiner must address the Veteran's contentions.

The clinician must provide a rationale to support the opinion.

The reviewing clinician is advised that the Veteran is competent to report his symptoms and history, such as the onset of the symptoms. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection.

If an opinion cannot be provided without resorting to speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question.

DUSTIN L. WARE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Simons

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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