HEARING LOSS

RAY BARTO SLABBEKORN, JR. · 2026 · Case ID: A26020220

MIXED

Summary

The Veteran, an Air Force Veteran who served from November 1987 to August 1991, appeals the denial of service connection for several conditions, including a jaw disorder, back disability, left ankle disability, bilateral hip disabilities, and bilateral knee disabilities. The Veteran also sought service connection for bilateral hearing loss, right ankle disability, irritable bowel syndrome (IBS) secondary to PTSD, hemorrhoids secondary to PTSD and IBS, and sleep apnea secondary to rhinitis and GERD. The Board reviewed evidence submitted before and after a March 2024 hearing, including the Veteran's testimony. The Board found that the Veteran's hearing loss was due to noise exposure in service, his right ankle disability was due to an in-service injury, his IBS was secondary to service-connected PTSD, his hemorrhoids were secondary to service-connected PTSD and IBS, and his sleep apnea was secondary to service-connected rhinitis and GERD. Consequently, service connection was granted for these conditions. However, the Board denied service connection for a jaw disorder post-wisdom teeth removal, a back disability, left ankle disability, bilateral hip disabilities, and bilateral knee disabilities, finding that the evidence did not establish a link to service or to the Veteran's service-connected right ankle disability. The Board noted that any evidence submitted outside the evidentiary window could be considered in a supplemental claim.

Rationale

Noise exposure in service; Hearing loss is a result of noise exposure

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200611-92429

Full Decision Text

Citation Nr: A26020220
Decision Date: 03/05/26 Archive Date: 03/05/26

DOCKET NO. 200611-92429
DATE: March 5, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is granted.

Entitlement to service connection for a right ankle disability is granted.

Entitlement to service connection for irritable bowel syndrome, secondary to service-connected posttraumatic stress disorder, is granted.

Entitlement to service connection for hemorrhoids, secondary to service-connected posttraumatic stress disorder (and now) service-connected irritable bowel syndrome, is granted.

Entitlement to service connection for sleep apnea, secondary to service-connected chronic rhinitis and gastroesophageal reflux disease, is granted.

Entitlement to service connection for a jaw disorder as a result of wisdom teeth removal in service is denied.

Entitlement to service connection for a back disability is denied.

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

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

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

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

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

FINDINGS OF FACT

1. New and relevant evidence has been received since an August 2019 rating decision denying service connection for sleep apnea, hemorrhoids, and irritable bowel syndrome.

2. New and relevant evidence has been received since an October 2019 rating decision denying service connection for a jaw disorder, post wisdom teeth removal, hearing loss, and disabilities of the back, bilateral ankles, hips, and knees.

3. The Veteran's hearing loss disability is a result of his noise exposure in service.

4. The Veteran has a right ankle disability as a result of injury in service.

5. The Veteran's irritable bowel syndrome is a result of his service-connected posttraumatic stress disorder.

6. The Veteran's hemorrhoids are the result of his service-connected posttraumatic stress disorder and (now) service-connected irritable bowel syndrome.

7. The Veteran's sleep apnea is a result of his service-connected rhinitis and gastroesophageal reflux disease.

8. The Veteran does not have a jaw disorder as a result of removal of wisdom teeth in service.

9. The Veteran does not have a back disability, left ankle disability, bilateral hip disability, or bilateral knee disability as a result of service or the (now) service-connected right ankle disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for bilateral hearing loss are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for entitlement to service connection for a right ankle disability are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for irritable bowel syndrome as secondary to service-connected posttraumatic stress disorder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for hemorrhoids as secondary to service-connected posttraumatic stress disorder and (now) service-connected irritable bowel syndrome are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for sleep apnea as secondary to service-connected rhinitis and gastroesophageal reflux disease are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for service connection for a jaw disorder secondary to wisdom teeth removal are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a back disability, to include as secondary to (now) service-connected right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303,
, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for service connection for a jaw disorder secondary to wisdom teeth removal are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a left ankle disability, to include as secondary to (now) service-connected right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

9. The criteria for service connection for a right hip disability, to include as secondary to (now) service-connected right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

10. The criteria for service connection for a left hip disability, to include as secondary to (now) service-connected right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

11. The criteria for service connection for a right knee disability, to include as secondary to (now) service-connected right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

12. The criteria for service connection for a left knee disability, to include as secondary to (now) service-connected right ankle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from November 1987 to August 1991.

On November 1, 2019, the Veteran submitted two VA Forms 20-0995, Decision Review Request: Supplemental Claims, and requested readjudication of service connection for sleep apnea, hemorrhoids, and irritable bowel syndrome secondary to posttraumatic stress disorder (PTSD) most recently addressed in an August 2019 rating decision; and service connection for a jaw disorder (post wisdom teeth removal), hearing loss, bilateral ankles, bilateral knees, bilateral hips, and back disability most recently addressed in an October 2019 rating decision.

In December 2019, the Regional Office (RO) issued the supplemental claim decision on appeal, which found that new and relevant evidence had not been received. In the June 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on March 1, 2024. This decision reflects the Board's consideration of the testimony, evidence, and information presented at the hearing, and a transcript of the hearing is in the Veteran's claims file.

As an appeal in which the Veteran requested, on the Notice of Disagreement, a Board hearing, the Board's decision is based on a review of the evidence of record at the time of the decision on the issues on appeal, evidence submitted by the Veteran or his representative at the hearing, to include testimony provided at the hearing, and evidence submitted by the Veteran or his representative within 90 days following the hearing. 38 C.F.R. § 20.302(a).

The relevant evidence that the Veteran submitted outside the evidentiary window was resubmitted after the Board hearing so that the Board could consider the evidence in this appeal. 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 claims, considering the new evidence in addition to the evidence previously considered.
and evidence submitted by the Veteran or his representative within 90 days following the hearing. 38 C.F.R. § 20.302(a).

The relevant evidence that the Veteran submitted outside the evidentiary window was resubmitted after the Board hearing so that the Board could consider the evidence in this appeal. 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 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 38 C.F.R. § 3.103 provides that a Veteran, upon request, is entitled to a hearing prior to VA's adjudication of an initial or supplemental claim. The Board observes that notice regarding the opportunity for a hearing at the RO was not provided in this case. In Bowen, the United States Court of Appeals for Veterans Claims found that there was no due process violation in the denial of the Veteran's requested hearing before the RO because the Veteran had subsequently been offered the opportunity to have a hearing before the Board. Bowen v. Shinseki, 25?Vet. App.?250, 253 (2012). Here, the Veteran was offered a choice of three dockets in the AMA framework to include the Board hearing docket. Although the issue in Bowen was not one of notice, the Board cannot discern a basis to find that the underlying holding and logic of Bowen would not lead to the same finding of a lack of prejudicial error under the procedure and facts of this case.

New and Relevant Evidence (NRE)

As noted in the introduction, in the December 2019 rating decision on appeal, the RO did not find that new and relevant evidence was received to readjudicate the service connection claims for bilateral hearing loss, hemorrhoids, irritable bowel syndrome, bilateral ankle disabilities, bilateral knee disabilities, bilateral hip disabilities, a back disability, sleep apnea, and jaw disability. Therefore, prior to considering these service connection claims on the merits, the Board must address the threshold issue of whether new and relevant evidence has been received based on the evidence of record at the time of the December 2019 rating decision (and evidence submitted at the time of the March 1, 2024 Board hearing or within 90 days of the hearing.)

Under the AMA, a claimant may continuously pursue a claim or issue by filing a supplemental claim following notice of a decision by an RO. 38 C.F.R. § 3.2500(c). If new and relevant evidence is presented or secured with respect to the supplemental claim, an RO will readjudicate the claim, taking into consideration all the evidence of record. 38 U.S.C. § 5108(a); 38 C.F.R. § 3.2501(d).

New evidence is evidence not previously part of the actual record before agency adjudicators. 38 C.F.R. § 3.2501(a)(1). Relevant evidence is information that tends to prove or disprove a matter at issue in a claim, including evidence that raises a theory of entitlement that was not previously addressed. 38 C.F.R. § 3.2501(a)(2). Readjudication of a claim is only warranted if new and relevant evidence has been received. 38 C.F.R. § 3.156(d). New and relevant evidence received before VA issues its decision on a supplemental claim will be considered as having been filed in connection with the claim. 38 C.F.R. § 3.2501(a)(2).

NRE for Sleep apnea, Hemorrhoids, and Irritable Bowel Syndrome

Reviewing the procedural background, the Veteran originally filed a service connection claim for sleep apnea, hemorrhoids, and irritable bowel syndrome in June 2019 claiming that the hemorrhoids and irritable bowel syndrome were associated with extended standing, running, and walking and started in service. He stated that the sleep apnea started after service in 2005 and did not elaborate on a theory of entitlement. See June 2019 VA Form 21-526EZ Fully Developed Claim.

The RO, in pertinent part, denied service connection for sleep apnea, hemorrhoids, and irritable bowel syndrome in August 2019 making no favorable findings. At the time of the August 2019 rating decision, the evidence included the service treatment records, which did not show any treatment for sleep apnea, hemorrhoids, or irritable bowel syndrome. The record also included a private treatment record showing
2019 claiming that the hemorrhoids and irritable bowel syndrome were associated with extended standing, running, and walking and started in service. He stated that the sleep apnea started after service in 2005 and did not elaborate on a theory of entitlement. See June 2019 VA Form 21-526EZ Fully Developed Claim.

The RO, in pertinent part, denied service connection for sleep apnea, hemorrhoids, and irritable bowel syndrome in August 2019 making no favorable findings. At the time of the August 2019 rating decision, the evidence included the service treatment records, which did not show any treatment for sleep apnea, hemorrhoids, or irritable bowel syndrome. The record also included a private treatment record showing complaints of abdominal pain, nausea, and heartburn in November 2013 with an assessment of reflux esophagitis.

In November 2019, the Veteran submitted a VA Form 20-0995 Supplemental Claim Application for sleep apnea, hemorrhoids and irritable bowel syndrome, this time claiming the disabilities as secondary to PTSD. With his November 2019 Supplemental Claim, the Veteran submitted some buddy statements from his wife noting snoring and hemorrhoids. The Veteran testified at a March 2024 Board hearing regarding the onset of his sleep apnea, hemorrhoids, and irritable bowel syndrome. Several days after his hearing, he also submitted a January 2024 private medical opinion finding that the sleep apnea, hemorrhoids, and irritable bowel syndrome were secondary to service-connected PTSD, gastroesophageal reflux disease (GERD), and allergic rhinitis. He also submitted a December 2021 private treatment record noting that the Veteran had lifelong issues with diarrhea for 20 to 30 years and was diagnosed with irritable bowel syndrome.

While the claim was pending, the RO granted service connection for PTSD, rhinitis, and GERD. See December 2019, March 2022, and June 2022 rating decisions.

This evidence is new as it was not previously before VA at the time of the August 2019 rating decision. The evidence also is relevant as it tends to prove the service connection claims for sleep apnea, hemorrhoids, and irritable bowel syndrome as it includes a favorable medical opinion relating the Veteran's disabilities to service-connected disabilities.

Therefore, the service connection claims for sleep apnea, hemorrhoids, and irritable bowel syndrome are considered reopened and the Board will proceed to adjudicate the claims on the merits.

NRE for Jaw Disorder (post wisdom teeth removal), Hearing Loss, Bilateral Ankles, Bilateral Knees, Bilateral Hips, and Back Disability

Reviewing the procedural background, the Veteran originally filed service connection claims for a jaw disorder (post wisdom teeth removal), hearing loss, disabilities of the bilateral ankles, "multi skeletal bilateral joint issues," and a back disability in June 2019. He claimed that he had headaches and jaw pain from wisdom teeth removal in service. He related his hearing loss to exposure to machine gun fire in service. He stated that the right and left ankle disabilities were from physical training and the joint issues were associated with extended standing, running, and walking. Finally, he noted that he had surgery for his back disability in 2005 secondary to joint issues. See June 2019 VA Form 21-526EZ Fully Developed Claim.

The RO, in pertinent part, denied service connection for a jaw disorder, post wisdom teeth removal, hearing loss, disabilities of the bilateral ankles, knees, and hips, and a back disability in August 2019. At the time the RO originally denied service connection for these disabilities, the evidence included the service treatment records, which showed the Veteran had his wisdom teeth removed, and sprained his right ankle in service. Service personnel records also showed that he was exposed to hazardous noise, and a July 2019 VA examination showed a diagnosis of hearing loss. However, the July 2019 VA examiner found that the hearing loss was not result of the hazardous noise in service based on there being no significant threshold shift between entry into service in 1987 and a post-active-duty Reserves audiogram in 1993. Post-service private treatment records also showed a back disability in July 2005, a right ankle sprain in October 2006, and complaints of knee pain in November 2013. Finally, a July 2019 VA examination report showed no diagnosis of a jaw disorder as a result of the wisdom teeth removal in service.

In September 2019, the Veteran submitted a VA Form 20-0995 Supplemental Claim Application for a jaw disorder, post wisdom teeth removal, hearing loss, disabilities of the bilateral ankles, knees, and hips, and a back disability. With his September 2019 Supplemental Claim, the Veteran submitted statements reiterating the same contentions that he had jaw pain from having his wisdom
1993. Post-service private treatment records also showed a back disability in July 2005, a right ankle sprain in October 2006, and complaints of knee pain in November 2013. Finally, a July 2019 VA examination report showed no diagnosis of a jaw disorder as a result of the wisdom teeth removal in service.

In September 2019, the Veteran submitted a VA Form 20-0995 Supplemental Claim Application for a jaw disorder, post wisdom teeth removal, hearing loss, disabilities of the bilateral ankles, knees, and hips, and a back disability. With his September 2019 Supplemental Claim, the Veteran submitted statements reiterating the same contentions that he had jaw pain from having his wisdom teeth removed in service, hearing loss from service, bilateral ankle disabilities from service, and hip, back, and knee disabilities secondary to his ankles.

The RO continued to deny service connection for a jaw disorder, post wisdom teeth removal, hearing loss, disabilities of the bilateral ankles, knees, and hips, and a back disability in an October 2019 rating decision. Although the RO did not explicitly find in the October 2019 rating decision that new and relevant evidence was received, since the RO adjudicated the claims on the merits, it implicitly found new and relevant evidence was received.

In November 2019, the Veteran submitted his most recent VA Form 20-0995 Supplemental Claim Application for a jaw disorder, post wisdom teeth removal, hearing loss, disabilities of the bilateral ankles, knees, and hips, and a back disability. With his November 2019 Supplemental Claim, he resubmitted a copy of the statement he had previously submitted in September 2019. He also submitted a copy of the July 2019 VA hearing loss examination report that was previously considered. In addition, he submitted private medical evidence showing complaints of bilateral ankle pain and edema in September 2019.

At the March 2024 Board hearing, the Veteran testified that he had jaw pain since his wisdom teeth were taken out and that a dentist had never told him he had a temporomandibular joint disorder. See Board hearing testimony, p. 18. He indicated that he sprained his ankle in service and that because of his right ankle he sprained his left ankle. Id. at 4. He also testified that when he sprained his left ankle after service, he also hurt his back in 2005. Id. He noted that regarding his hearing loss he was exposed to acoustic trauma in service as a military policeman from firing machine guns, and that he only wore foam ear plugs and heavy earmuffs. He recalled that after he got done with that training, he could not hear for at least a week or two. Id. at 8. He also stated that he had only been around gun firing twice after the military and wore hearing protection. Id. at 9.

Several days after the Board hearing, the Veteran resubmitted copies of the buddy statement from his wife regarding the ankles. He also submitted a new buddy statement from his daughter who observed him spraining his ankles many times.

Additionally, the Veteran submitted private treatment records dated in December 2020 noting he had complaints of ankle pain since injury in 1987 with re-injury over the years and currently had a diagnosis of primary arthritis in the ankles.

The hearing testimony and evidence submitted after the hearing is new as it was not previously before VA at the time of the October 2019 rating decision. The evidence also is relevant as it tends to prove or disprove the service connection claims for a jaw disorder, post wisdom teeth removal, hearing loss, disabilities of the bilateral ankles, knees, and hips, and a back disability as it includes testimony as to onset of the disabilities, and private medical evidence showing ongoing treatment and complaints of ankle pain.

Therefore, the service connection claims for a jaw disorder, post wisdom teeth removal, hearing loss, disabilities of the bilateral ankles, knees, and hips, and a back disability are considered reopened, and the Board will proceed to adjudicate the claims on the merits.

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. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as
disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

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

In addition, disability which is proximately due to, or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310.

When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102.

1. Service connection for bilateral hearing loss

The Veteran contends that he has hearing loss from noise exposure during his military service, particularly from machine gun fire during training exercises. See, e.g., June 2019 VA Form 21-626EZ, Fully Developed Claim.

On review of the evidence of record, the Veteran has a current diagnosis of bilateral sensorineural hearing loss as evidenced by a July 2019 VA examination report. Sensorineural hearing loss, as an organic disease of the nervous system, is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Thus, the presence of a current disability is established.

VA has conceded exposure to noise trauma in service, as the RO made a favorable finding in the August 2019 rating decision that the Veteran's military occupational specialty (MOS) as military police had a high probability of noise exposure. The Board is bound by this favorable finding absent clear and unmistakable error. See 38 C.F.R. § 3.104(c). The RO also granted service connection for tinnitus as a result of military service in the August 2019 rating decision.

Service treatment records show the Veteran complained of possible hearing loss in service. Service treatment records also show that the Veteran's hearing apparently worsened from entrance until an Air Force Reserves audiogram after active-duty service.

Specifically, the March 1987 entrance examination report shows the following audiometric findings:

HERTZ

500 1000 2000 3000 4000

RIGHT 0 0 5 0 0

LEFT 0 0 10 0 0

The Veteran declined a separation examination in August 1991.

However, a post-active-duty periodic examination during the Veteran's Reserves service included an audiometric evaluation. Specifically, the February 1993 audiometric findings showed the following:

HERTZ

500 1000 2000 3000 4000

RIGHT 5 5 10 5 10

LEFT 5 10 15 10 5

Therefore, the record shows the presence of a current hearing loss disability, in-service complaints of possible hearing loss with the Veteran's reports of in-service noise exposure, which VA has conceded, as well as service treatment records demonstrating some worsening in hearing acuity from the entrance examination until after active-duty service.

Thus, the determinative issue is whether the current hearing loss disability is a result of the noise exposure in service.

A VA examination was provided in July 2019. The examiner noted that the Veteran served in the Air Force in security policy and reported that he was exposed to loud noises
3000 4000

RIGHT 5 5 10 5 10

LEFT 5 10 15 10 5

Thus, the determinative issue is whether the current hearing loss disability is a result of the noise exposure in service.

A VA examination was provided in July 2019. The examiner noted that the Veteran served in the Air Force in security policy and reported that he was exposed to loud noises from guns, jets, and grenades. The examiner found that the Veteran's hearing loss was not at least as likely as not caused by or a result of an event in military service. The rationale provided was that there was no significant threshold shift when comparing the 1987 exam and the 1993 exam. The July 2019 VA medical opinion has some probative value, because even though the examiner does not clarify what "significant" threshold shift means, the opinion is based on an accurate medical history and provides an explanation that contains a clear conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

In weighing the July 2019 medical opinion with the remaining evidence of record, however, there is an approximate balance of the positive and negative evidence that does not satisfactorily prove or disprove the claim. Specifically, while the VA examiner found that the Veteran's hearing loss is not the result of his conceded acoustic trauma in service because there was no significant threshold shift, the service treatment audiogram records show that puretone thresholds shifted from 0 decibels in most of the frequencies in 1987 to 5 to 15 decibels in all of the frequencies in 1993. The examiner did not clarify what a "significant" shift is if it is not what was reflected on the Veteran's service treatment records. The record also does not demonstrate any other potential cause of the Veteran's hearing loss. The Veteran testified at the March 2024 Board hearing that he had only fired a gun twice after the military and that he wore hearing protection. See March 2024 Board hearing transcript, p. 9. There also is no record of any post-service noise exposure from his employment. An October 2019 VA PTSD examination report notes that the Veteran worked in an armored car, did shipping and receiving and sales, worked with Terminix, and also worked as a jailer in the county jail. None of these jobs, in and of themselves, demonstrate any extensive noise exposure. Thus, even though the examiner stated that it was not at least as likely as not that the Veteran's hearing loss was caused by military service, it appears that the VA examiner in July 2019 used a standard higher than "approximate balance" or "nearly equal." Specifically, the evidence shows the Veteran has conceded noise exposure, some decrease in hearing thresholds in service with complaints of possible hearing loss in service, and a current sensorineural hearing loss disability. Therefore, even though the opinion in July 2019 was negative, ultimately, the findings on the report seem instead to show that the evidence for and against the claim is nearly equal.

Hearing loss, as a chronic disease, can be established based on continued symptoms since service, notwithstanding the negative medical opinion. The Veteran did not have a hearing loss disability diagnosed in service, but he did complain of possible hearing loss in service. The February 1993 Reserves audiogram also does not show a diagnosis of hearing loss but shows some worsening in hearing. The Veteran has asserted that he has experienced hearing loss since exposure to machine gun fire in service, which he is competent to do. See, e.g., June 2019 VA Form 21-526EZ, Fully Developed Claim. In addition, the Veteran testified at the March 2024 Board hearing that he was exposed to acoustic trauma in service as a military policeman from firing machine guns, and that he only wore foam ear plugs and heavy earmuffs. See March 2024 Board hearing transcript, p. 8. He recalled that after he got done with that training, he could not hear for at least a week or two. Id.

While treatment records do not exist during the applicable presumptive period, other than the February 1993 Reserves audiogram (which is two years after active-duty service), the Board finds that the Veteran continued to experience the same symptoms of hearing loss since service. Additionally, the Veteran has not reported any post-service noise exposure other than firing a gun twice while wearing hearing protection.

Again, the Board acknowledges that the July 2019 VA medical opinion is not favorable
firing machine guns, and that he only wore foam ear plugs and heavy earmuffs. See March 2024 Board hearing transcript, p. 8. He recalled that after he got done with that training, he could not hear for at least a week or two. Id.

Again, the Board acknowledges that the July 2019 VA medical opinion is not favorable to the Veteran's claim but given that the examiner's rationale is unclear based on the findings in the report, this evidence is not enough to persuasively weigh against the Veteran's claim.

Upon review of the record, the Board finds the evidence to be approximately balanced as to whether the Veteran's current hearing loss is the result of noise exposure in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a bilateral hearing loss disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Service connection for right ankle disability

The Veteran seeks service connection for a right ankle disability, which he relates to physical training in service. See June 2019 VA Form 21-526EZ, Fully Developed Claim. He testified at the March 2024 Board hearing that he sprained his ankle pretty badly in service and that it never healed correctly and resulted in him continuing to sprain his ankle after service. See March 2024 Board hearing transcript, p. 4.

The Veteran has a current diagnosis of arthritis of the right ankle as evidenced by a December 2020 private treatment record. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331.

Service treatment records show the Veteran sprained his right ankle in February 1990. The Veteran had reportedly gone to the emergency room but there were no records of the treatment, but the Veteran said that x-rays were negative. He was given crutches and put on a limited profile.

Post-service, private treatment records show the Veteran continued to complain of right ankle pain and reinjury to the right ankle. In October 2006, the Veteran sprained his right ankle after stepping into a hole. X-rays were negative. A September 2019 private treatment record shows complaints of right ankle pain and edema. The Veteran reported spraining his ankles frequently and that he had gone to physical therapy but finally decided to get evaluated. X-rays were negative.

In December 2020, the Veteran was diagnosed with primary osteoarthritis of the right ankle. The report noted that the Veteran had ankle pain since injury in 1987 with reinjuries over the years. He now had persistent pain and swelling and stiffness.

On review of the evidence, the record shows that the Veteran injured his right ankle in service and was put on a limited profile with crutches. The record also shows the Veteran continued to experience right ankle pain since that injury in service with several reinjuries to the right ankle after service. Finally, the record shows a current diagnosis of arthritis of the ankle, which is a chronic disease. As the private clinician in December 2020 attributed the Veteran's symptoms to the Veteran's right ankle arthritis, continuity of symptomatology is established.

While the Veteran was never afforded a VA examination for his right ankle disability, given that he has submitted competent statements and testimony as to having experienced right ankle pain since injury to the ankle in service that never fully-healed, the service treatment records confirm that he injured his right ankle in service, and he has a current diagnosis of arthritis, which a private clinician has attributed to the continued symptoms, the evidence for and against the claim is relatively equally-balanced.

Upon review of the record, the Board finds the evidence to be approximately balanced as to whether the Veteran's current right ankle disability is the result of injury in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a right ankle disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Service connection for irritable bowel syndrome

The Veteran contends that he has irritable bowel syndrome as a result of his service-connected PTSD. See November 2019 VA Form 20-0995 Supplemental Claim. He also has stated that his irritable bowel syndrome started in service. See June 2019 VA Form 21-526EZ, Fully Developed Claim.; March 2024 Board hearing transcript
as to whether the Veteran's current right ankle disability is the result of injury in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a right ankle disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Service connection for irritable bowel syndrome

The service treatment records are negative for any findings pertaining to irritable bowel syndrome. However, the Veteran is service connected for PTSD. See December 2019 rating decision.

Post-service medical evidence includes a November 2013 private treatment record, which shows the Veteran had complaints of abdominal pain relieved with food and complaints of nausea. A December 2021 private treatment record also shows the Veteran had lifelong issues with diarrhea, a 20 to 30-year history, and had a diagnosis with irritable bowel syndrome.

As the Veteran has a current diagnosis of irritable bowel syndrome and is service connected for PTSD, the determinative issue is whether the current diagnosis is the result of his PTSD.

Several days after his Board hearing, the Veteran submitted a January 2024 private medical opinion from Dr. N., who found that it was at least as likely as not that the Veteran's intestinal condition, diagnosed as irritable bowel syndrome, was secondarily caused by his service-connected PTSD. Dr. N. noted that the Veteran had complained of a chronic intestinal condition marked by frequent diarrhea, diagnosed as irritable bowel syndrome, following years of complaints of loose stools made worse during periods of anxiety and stress. Dr. N. also indicated that medical literature showed many examples demonstrating a markedly elevated prevalence of irritable bowel syndrome amongst veterans suffering from PTSD.

The January 2024 private medical opinion is probative, because it is based on an accurate medical history and provides an explanation that contains a clear conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

There is no conflicting medical evidence of record as VA did not provide the Veteran with an examination addressing his irritable bowel syndrome.

Upon review of the record, the Board finds the evidence to be approximately balanced as to whether the Veteran's current irritable bowel syndrome is the result of his service-connected PTSD. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for irritable bowel syndrome is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4. Service connection for hemorrhoids

The Veteran contends that he has hemorrhoids as a result of his service-connected PTSD. See November 2019 VA Form 20-0995 Supplemental Claim. He also has stated that his hemorrhoids started in service but that he did not get treatment for them until after service. See June 2019 VA Form 21-526EZ, Fully Developed Claim.; March 2024 Board hearing transcript, p. 10. He recalled having surgery for his hemorrhoids in 1999. See Board hearing transcript, p. 11.

The Veteran submitted a January 2024 private medical opinion from Dr. N, who found that it was at least as likely as not that the Veteran's hemorrhoids were secondarily caused by his service-connected PTSD and irritable bowel syndrome. Dr. N. indicated that hemorrhoids were a common and well-understood consequence of frequent diarrhea. Thus, Dr. N. determined that the Veteran's irritable bowel syndrome made him at an increased risk for hemorrhoids. Dr. N. also noted that weight-gain caused by the Veteran's PTSD is a well-established cause of hemorrhoids. The January 2024 private medical opinion is probative, because it is based on an accurate medical history and provides an explanation that contains a clear conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

There is no conflicting medical evidence of record as VA did not provide the Veteran with an examination addressing his hemorrhoids.

Upon review of the record, the Board finds the evidence to be approximately balanced as to whether the Veteran's current hemorrhoids are the result of his service-connected PTSD and (now) service-connected irritable bowel syndrome. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hemorrhoids is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5
provides an explanation that contains a clear conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

There is no conflicting medical evidence of record as VA did not provide the Veteran with an examination addressing his hemorrhoids.

5. Service connection for sleep apnea

The Veteran contends that he has sleep apnea as a result of his service-connected PTSD. See November 2019 VA Form 20-0995 Supplemental Claim. He also testified that his sleep apnea started in service. See March 2024 Board hearing transcript, p. 16. He recalled his wife telling him he would snore loudly and appear to stop breathing while sleeping. Id. He stated that he finally got tested by VA in December 2020 and was given a continuous positive airway pressure machine. Id. at 17.

In addition to being service connected for PTSD, the Veteran also is service connected for rhinitis and GERD. See March 2022 and June 2022 rating decisions.

The Veteran submitted a January 2024 private medical opinion from Dr. N, who found that the Veteran had been diagnosed with mild obstructive sleep apnea in 2020 following years of complaints of worsening sleep disturbance in the context of weight gain. Dr. N. noted that the Veteran was service connected for chronic rhinitis, which resulted in at least mild obstruction of the nasal passages. Dr. N. also noted that the Veteran was service connected for GERD, which resulted in chronic regurgitation of stomach acids and symptoms of pyrosis. Dr. N. explained that obstructive sleep apnea is a condition that occurred when the soft tissues of the upper airways either collapsed, constricted, inflamed, or otherwise compromised the anatomical openings of the upper airway to the extent that they produced an obstruction to air flow during sleep. Dr. N. acknowledged that the most common cause of obstructive sleep apnea was obesity, but another recognized cause was nasal obstruction, which by contributing to mouth breathing and producing alterations in airflow velocity, can destabilize the upper airways and contribute to the further pathogenesis of this condition. Dr. N. found that it was at least as likely as not that the Veteran's obstructive sleep apnea had been secondarily caused by the soft-tissue inflammation in his airways from his long-standing service-connected GERD and his chronic nasal obstruction from his long-standing service-connected rhinitis. Dr. N. also noted that his service-connected PTSD disrupted his sleep and that intermediate weight gain also played a role.

On review, the record shows that the Veteran has a diagnosis of obstructive sleep apnea, he is service connected for rhinitis and GERD, and a probative medical opinion finds that the rhinitis and GERD contributed to the sleep apnea. There is no conflicting medical evidence of record as VA did not provide the Veteran with an examination addressing his sleep apnea.

Based on the record, the Board finds the evidence to be approximately balanced as to whether the Veteran's current sleep apnea is the result of his service-connected chronic rhinitis and service-connected GERD. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

6. Service connection for a jaw disorder, post wisdom teeth removal

The Veteran seeks service connection for a jaw disorder. He contends that he has headaches and jaw pain since having his wisdom teeth removed in service. See June 2019 VA Form 21-526EZ Fully Developed Claim. He testified at the March 2024 Board hearing that he had jaw pain since his wisdom teeth were taken out in service but that a dentist had never diagnosed him with temporomandibular joint dysfunction. See March 2024 Board hearing transcript, p. 18.

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

The Board concludes that the
a jaw disorder, post wisdom teeth removal

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

The Board concludes that the Veteran does not have a current diagnosis of a jaw disorder 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).

The service treatment records show that the Veteran had impacted molars #17 and 32 surgically removed in September 1988. Dental records show that he tolerated the procedure well and left the clinic in good condition. A follow-up September 1988 treatment record notes that healing was within normal limits. In July 1991, dental records show the Veteran had teeth #1 and 16 removed. August 1991 dental records show the Veteran had no complaints.

After service, a July 2019 VA examination report shows that the Veteran reported having his wisdom teeth extracted during military service and reported an occasional dull ache on both left and right jaws which was worse at night. The examiner noted that the Veteran did not recall any complications related to having his teeth extracted and no dental treatment following discharge in service in 1991 other than cleanings. On physical examination, the Veteran had anatomical loss of teeth #1, 4, 13, 16, 17, 28, and 32, but did not have any other physical disability related to this. Panographic/ intraoral imaging was provided and did not demonstrate loss of mandible or maxilla. There was no functional impact on the Veteran's ability to work. The examiner noted that the Veteran had teeth #17 and 32 extracted in September 1988 and teeth #1 and 16 extracted in July 1991. The examiner indicated that there were no objective or subjective findings of pain at the time of clinical examination, as the Veteran described the pain as a dull ache and not painful to touch. The examiner noted that there was no loss of range of motion or limitation in opening. The examiner further indicated that there were no significant intraoral or radiographic findings noted. The examiner reported that the sites where the third molars were extracted appeared within normal limits and there were no current findings that the examiner could associate with extraction of the third molars during military service.

The July 2019 VA examination report is probative, because it is based on an accurate medical history and provides an explanation that contains a clear conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board acknowledges that pain alone without an accompanying diagnosis can qualify as a disability if it reaches a level of functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). However, in this case, the July 2019 VA examiner found that there was no functional impairment regarding the Veteran's complaints of a dull ache in the jaw. Specifically, he did not have any limitations in range of motion or opening of the jaw and there was no impact on his ability to work.

While the Board has considered the Veteran's competent statements as to his symptoms of experiencing pain and headaches, weighing these symptoms with the July 2019 VA medical opinion, the evidence persuasively weighs against him having a current jaw disorder as a result of his wisdom teeth removal in service. Even though the Veteran is competent to state that he experiences pain in his jaw and headaches, he is not competent to attribute these symptoms to the removal of his wisdom teeth in service. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

The evidence thus reflects that the Veteran does not have a current jaw disorder as a result of the wisdom teeth removal in service. Since a current disability is a necessary element in establishing service connection, entitlement to service connection for a jaw disorder
in service. Even though the Veteran is competent to state that he experiences pain in his jaw and headaches, he is not competent to attribute these symptoms to the removal of his wisdom teeth in service. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

In reaching this conclusion, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38?U.S.C. §?5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran does not have a jaw disorder as a result of wisdom teeth removal in service. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

7. Service connection for a back disability

8. Service connection for a left ankle disability

9. Service connection for a right hip disability

10. Service connection for a left hip disability

11. Service connection for right knee disability

12. Service connection for a left knee disability

The Veteran seeks service connection for disabilities of the back, left ankle, bilateral hips, and bilateral knees. He originally claimed left ankle and general "multi skeletal" bilateral joint issues associated with physical training and extended standing, running, and walking. See June 2019 VA Form 21-526EZ Fully Developed Claim. He also claimed a back disability secondary to his joint disabilities. Id.

The Veteran later claimed that his hips, back, and knee disabilities were secondary to his ankles. See November 2019 VA Form 20-0995 Supplemental Claim. The Veteran testified at the March 2024 Board hearing that he sprained his right ankle pretty badly in service, which led to him favoring his right leg and caused him to sprain his left ankle. See March 2024 Board hearing transcript, p. 4. He further testified that he fell in 2005 spraining his ankle and ended up rupturing a disk in his back. Id. He also stated that he believed his knee and hip disabilities were directly related to his ankles and all stemmed from the right ankle injury in service. Id. at 4-5.

Initially, the Board notes that the RO did not obtain a VA medical examination with respect to the Veteran's claims. A medical examination or opinion is considered necessary when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see 38 U.S.C. § 5103A(d).

Step one of the McLendon test is met as the record shows competent evidence of current disabilities of the back, left ankle, bilateral hips, and bilateral knees. The record shows diagnoses of a back disability and left ankle disability. See, e.g., August 2005 private treatment record showing a lumbar disc herniation; and December 2020 private treatment record showing primary osteoarthritis of the left ankle. The Veteran's assertions of having symptoms of disabilities of the bilateral hips and bilateral knees also are competent evidence of symptoms of these
make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see 38 U.S.C. § 5103A(d).

Step one of the McLendon test is met as the record shows competent evidence of current disabilities of the back, left ankle, bilateral hips, and bilateral knees. The record shows diagnoses of a back disability and left ankle disability. See, e.g., August 2005 private treatment record showing a lumbar disc herniation; and December 2020 private treatment record showing primary osteoarthritis of the left ankle. The Veteran's assertions of having symptoms of disabilities of the bilateral hips and bilateral knees also are competent evidence of symptoms of these disorders, as a lay person is competent to observe these symptoms.

However, there is no evidence of any in-service incurrence of disabilities of the back, left ankle, bilateral hips, or bilateral knees. While the Veteran has stated that he started having these problems during physical training with extended standing, running, and walking, there is no record of any in-service treatment for the back, left ankle, bilateral hips, or bilateral knees.

In addition, none of the post-service medical evidence suggests an indication that the current back, left ankle, bilateral hips, and bilateral knee disability might be associated with the (now) service-connected right ankle disability.

Regarding the back, there is no indication that the Veteran's lumbar spine disability diagnosed in 2005 might be associated with his right ankle disability. Specifically, a July 2005 private magnetic resonance imaging (MRI) report shows a prominent central herniated nucleus pulposus at the L5-S1 level. An August 2005 private treatment record notes that the Veteran had back pain since January 2005 with no injury. His MRI showed that he had a large central/ paracentral right lumbar 5 disc herniation, which the clinician found to be the cause of his symptoms. In December 2020, a private treatment record shows the Veteran complained of low back pain for several years. The Veteran was assessed as having lumbago with sciatica of both left and right sides. The reason for the appointment was noted as trying to connect some of his past injuries to his VA disability. However, the clinician did not make any findings or suggest any relationship between the Veteran's lumbar spine disability and his right ankle disability.

Regarding the left ankle, post-service medical evidence shows complaints of pain and swelling in the left ankle and a diagnosis of osteoarthritis in December 2020, but none of the medical evidence indicates any association with the Veteran's right ankle. Specifically, a September 2019 private treatment record shows complaints of bilateral ankle pain left worse than right. The Veteran reported spraining his ankles frequently and had gone to physical therapy on and off through the years but decided to get formally checked. He reported that the previous day he had sprained his left foot when stepping off a ladder from the bottom step. On physical examination his left foot was swollen with bluish tinge noted. He was diagnosed with sprain of the left ankle and bilateral ankle joint pain. X-rays were negative. In December 2020, a private treatment record shows that the Veteran complained of ankle pain since injury in 1987 with reinjuries over the years and now had persistent pain and swelling and stiffness. It was noted that the Veteran had not been seen at their clinic since 2013. As noted, he was assessed as having primary osteoarthritis of the left ankle and foot.

While the Veteran's reason for the appointment included trying to connect some of his past injuries to his VA disability, the medical findings in the record did not suggest any indication that his right ankle disability might have contributed to his left ankle disability. Moreover, the Board deduces that the December 2020 clinician's note about injury to the ankle in 1987 was indicative of the Veteran's injury to his right ankle in service, as there is no record of treatment for the left ankle in the service treatment records.

With respect to the knees, none of the post-service medical evidence indicates any suggestion that the Veteran's right ankle disability might have contributed to his knee disabilities. Specifically, a November 2013 private treatment record shows complaints of knee pain. The Veteran was seen again for knee pain in December 2020. The December 2020 private treatment record previously referenced also noted that the Veteran attributed his knee pain to his previous ankle injuries, but the clinician noted that it was not something the clinic followed, as they had not seen him since 2013 when he came for knee pain. Again, the report noted the reason for the appointment was multiple sprains to his ankles and pain in the knees and back; and trying to connect some of his past injuries to his VA disability. However, the clinician made no medical findings suggesting that the
Veteran's right ankle disability might have contributed to his knee disabilities. Specifically, a November 2013 private treatment record shows complaints of knee pain. The Veteran was seen again for knee pain in December 2020. The December 2020 private treatment record previously referenced also noted that the Veteran attributed his knee pain to his previous ankle injuries, but the clinician noted that it was not something the clinic followed, as they had not seen him since 2013 when he came for knee pain. Again, the report noted the reason for the appointment was multiple sprains to his ankles and pain in the knees and back; and trying to connect some of his past injuries to his VA disability. However, the clinician made no medical findings suggesting that the right ankle disability might have contributed to the bilateral knee disabilities.

There are no relevant treatment records for the bilateral hips during the evidentiary window.

On review of the post-service medical evidence, while the Veteran has stated that he believes his right ankle caused disabilities in his back, left ankle, knees, and hips, none of the medical evidence indicates any suggestion that these disabilities might be associated with his right ankle disability. Even the December 2020 private clinician noted that the Veteran's reason for visiting was to connect his back and knee pain to his ankle disabilities but still did not make any medical findings suggesting such a relationship.

Therefore, there is no evidence establishing that an event, injury, or disease occurred in service, or an indication that any of these disabilities might be associated with the service-connected right ankle disability.

Given the lack of evidence of any in-service incurrence of disabilities of the back, left ankle, bilateral hips, and bilateral knees, there also is no indication that any current symptoms of these disorders may be associated with service. Moreover, there is no evidence that the Veteran's right ankle injury is connected, based on either causation or aggravation, to the back, left ankle, bilateral hip, or bilateral knee disabilities. Thus, the Board finds that while there is competent evidence of current disabilities or persistent symptoms of disabilities the back, left ankle, bilateral hips, and bilateral knees, steps two and three of the McLendon test are not met. The Board acknowledges that the standard in step three noting "an indication that the disability...may be associated with the veteran's service or with another service-connected disability" is a low bar. See McLendon, 20 Vet. App. at 81 (emphasis added). However, in this case, the evidence shows that this bar has not been met. Therefore, no VA examination is necessary in order to determine if any current back, left ankle, bilateral hip, or bilateral knee problems are the result of the Veteran's active-duty service or the (now) service-connected disability right ankle disability.

The record, as noted, also does not support his claims since the service treatment records are silent for any disabilities of the back, left ankle, bilateral hips, and bilateral knees and there is no evidence of any indication that any current symptoms of these disorders are the result of service or the service-connected right ankle disability. Therefore, the Board does not find that service connection for disabilities of the back, left ankle, bilateral hips, and bilateral knees is warranted.

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In reaching this conclusion, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38?U.S.C. §?5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran does not have current disabilities of the back, left ankle, bilateral hips, and bilateral knees as a result of his military service or the (now) service-connected right ankle disability. Thus, the benefit-of-the-doubt rule does not change the outcome on these issues.

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Sarah Richmond, 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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