ULCERATIVE COLITIS

E. I. VELEZ · 2026 · Case ID: A26024766

MIXED

Summary

The veteran, who served in the U.S. Navy as a midshipman from July 1997 to May 2001 and on active duty from May 2001 to July 2006, appeals the denial of service connection for human papillomavirus (HPV) and bilateral hearing loss, and seeks an increased rating for ulcerative colitis. The Board granted a 60 percent rating for ulcerative colitis, finding the veteran's symptoms, including frequent diarrhea, abdominal pain, and anemia, met the criteria for that rating, despite some discrepancies in the VA examination findings. Service connection for HPV was denied due to a lack of evidence of a current disability or symptoms, and the Board found a VA examination unnecessary as the record did not indicate a current condition. Bilateral hearing loss was denied because the audiometric testing did not meet VA criteria for a disability, despite the veteran's subjective complaints. Service connection for right and left knee disabilities was granted, finding the veteran's current bilateral patellofemoral pain syndrome began in service and persisted, despite an inadequate VA opinion that initially denied service connection. Service connection for a right ring finger fracture was granted, as the injury occurred during the veteran's time at the Naval Academy, which the Board considered active duty, and the VA examiner's opinion to the contrary was based on an incorrect understanding of duty periods. The issues of left hip, right hip, and right ankle disabilities were remanded for adequate medical opinions addressing the nexus to service, as the prior VA opinions were found inadequate due to incomplete medical histories or lack of reasoned rationale. Entitlement to TDIU was also remanded due to inadequate development by the agency of original jurisdiction.

Rationale

Private treatment records show treatment with prednisone for flare-ups, symptoms of pain, bleeding, and diarrhea.; Veteran reported 3-10 bowel movements per day during flare-ups, and was unable to leave the bathroom.; Private provider noted anemia based on bloodwork, which the Board found persuasive despite VA exam not finding anemia.

Service Branch

NAVY

Special Benefit

TDIU

Docket No.

210405-151286

Full Decision Text

Citation Nr: A26024766
Decision Date: 03/19/26 Archive Date: 03/19/26

DOCKET NO. 210405-151286
DATE: March 19, 2026

ORDER

Entitlement to a 60 percent rating for ulcerative colitis is granted.

Entitlement to service connection for human papillomavirus (HPV) is denied.

Entitlement to service connection for a bilateral hearing loss disability is denied.

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

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

Entitlement to service connection for broken right ring finger is granted.

REMANDED

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

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

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

Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

FINDINGS OF FACT

1. During the review period, the Veteran's ulcerative colitis has been characterized by treatment with oral agents including immunosuppressants, abdominal pain, up to ten episodes per day of diarrhea, and anemia.

2. The evidence of record persuasively weighs against finding that the Veteran has had HPV, or any symptoms or residuals of HPV, at any time during or approximate to the pendency of the claim.

3. The Veteran does not have a current bilateral hearing loss disability for VA purposes.

4. The Veteran's right and left knee disabilities began in service and have continued since service.

5. The Veteran's right ring finger fracture was caused by an injury while she was a midshipman at the United States Naval Academy.

CONCLUSIONS OF LAW

1. The criteria for a 60 percent rating, but no higher, for ulcerative colitis have been met. 38 U.S.C. §§ 1155, 5107 (2024); 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.114, Diagnostic Code 7346 (2025).

2. The criteria for service connection for HPV have not been met. 38 U.S.C. §§ 1110, 5107 (2024); 38 C.F.R. §§ 3.102, 3.303 (2025).

3. The criteria for service connection for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1155, 5107 (2024); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100 (2025).

4. The criteria for service connection for a right knee disability have been met. 38 U.S.C. §§ 1110, 5107 (2024); 38 C.F.R. §§ 3.102, 3.303 (2025).

5. The criteria for service connection for a left knee disability have been met. 38 U.S.C. §§ 1110, 5107 (2024); 38 C.F.R. §§ 3.102, 3.303 (2025).

6. The criteria for service connection for broken right ring finger have been met. 38 U.S.C. §§ 1110, 5107 (2024); 38 C.F.R. §§ 3.6(b)(4), 3.102, 3.303 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran was a midshipman at the United States Naval Academy from July 1997 to May 2001 and served on active duty from May 2001 to July 2006. This matter came before the Board of Veterans' Appeals (Board) on appeal from an April 2020 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the April 5, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on February 3, 2025. Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following
2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on February 3, 2025. Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

The Board notes that at the February 2025 Board hearing, the Veteran chose to limit her testimony to the issue of an increased rating for ulcerative colitis. The Veteran's attorney confirmed on the record that the Veteran did not wish to present testimony regarding the service connection issues on appeal and that she wanted the Board to issue a decision regarding those issues based on the evidence of record. The Board therefore finds that the Veteran has been provided with the requested opportunity for a hearing regarding all of the issues on 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 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.

However, because the Board is remanding the issues of service connection for left and right hip and right ankle disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those issues. 38 C.F.R. § 3.103(c)(2)(ii).

When evidence of unemployability is submitted during the course of an appeal from an assigned disability rating, a claim for entitlement to a total disability rating based on individual unemployability (TDIU) will be considered to have been raised by the record as "part and parcel" of the underlying claim. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Here, the February 2020 VA ulcerative colitis examination found that the Veteran's disability affected her ability to work, specifically noting that she had to be near a restroom due to multiple episodes of bloody stool. The Board therefore finds that the issue of entitlement to TDIU was raised by the record prior to the decision on appeal.

1. Entitlement to a compensable rating for ulcerative colitis

The Veteran contends that she is entitled to a higher rating for ulcerative colitis, which is rated as noncompensable. The Board concludes that a 60 percent rating, but no higher, is warranted.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Individual disabilities are assigned separate diagnostic codes. See U.S.C. §1155; 38 C.F.R. § 4.1. When there is a question as to which of two evaluations applies, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for the rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id.

When the evidence is in approximate balance in the veteran's favor or nearly equal 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; see also Gilbert v. Derwinski, 1 Vet.
of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

When the evidence is in approximate balance in the veteran's favor or nearly equal 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

During the review period, the Veteran's ulcerative colitis is rated under Diagnostic Code (DC) 7323. The DC directs that ulcerative colitis be rated as Crohn's disease or undifferentiated form of inflammatory bowel disease (DC 7326).

Under DC 7326, a 10 percent rating is warranted for minimal to mild symptomatic inflammatory bowel disease that is managed with oral or topical agents (other than immunosuppressants or other biologic agents); and is characterized by recurrent abdominal pain with three or less daily episodes of diarrhea and no signs of systemic toxicity.

A 30 percent rating is warranted for mild to moderate inflammatory bowel disease that is managed with oral and topical agents (other than immunosuppressants or other biologic agents); and is characterized by recurrent abdominal pain with three or less daily episodes of diarrhea and minimal signs of toxicity such as fever, tachycardia, or anemia.

A 60 percent rating is warranted for moderate inflammatory bowel disease that is managed on an outpatient basis with immunosuppressants or other biologic agents; and is characterized by recurrent abdominal pain, four to five daily episodes of diarrhea; and intermittent signs of toxicity such as fever, tachycardia, or anemia.

A 100 percent rating is warranted for severe inflammatory bowel disease that is unresponsive to treatment; and requires hospitalization at least once per year; and results in either an inability to work or is characterized by recurrent abdominal pain associated with at least two of the following: (1) six or more episodes per day of diarrhea, (2) six or more episodes per day of rectal bleeding, (3) recurrent episodes of rectal incontinence, or (4) recurrent abdominal distension. 38 C.FR. § 4.114, DCs 7323, 7326.

The Veteran's private treatment records show treatment for ulcerative colitis, including a prescription for prednisone. July 2018 private treatment records from a follow up appointment after a flare up noted that she was prescribed prednisone to treat the flare up, which had involved bleeding and pain. March 2020 private treatment records show that the Veteran was complaining of a flare with two to three bowel movements per day, fatigue, and pain. The records show that the Veteran had been treated with Apriso daily, and that the provider prescribed a course of prednisone to treat the flare up.

The Veteran submitted a January 2020 disability benefits questionnaire from her private provider. The provider reported that the Veteran's ulcerative colitis was well controlled with oral medication, noting treatment with Apriso. The provider found symptoms of diarrhea, distension, anemia, and nausea. Regarding the finding of anemia, the provider noted CBC results showing hemoglobin of 13.6.

A February 2020 VA examination diagnosed ulcerative colitis and noted the Veteran's reports of sudden urges, pain and bleeding. The examiner found a need for medication, specifically noting the use of mesalamine and prednisone. The examiner found bloody diarrhea but did not find anemia based on February 2020 bloodwork.

The Board finds that the private and VA examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran's statements, in-person examinations and the examiners' observations, the Board finds them entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

At the February 2025 Board hearing, the Veteran reported that during the review period she had symptoms of daily abdominal cramping/pain, rectal bleeding, bloating, and urgency, as well as between three and ten bouts of diarrhea. She specifically reported that her base level of severity involves three bowel movements with loose stool
examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran's statements, in-person examinations and the examiners' observations, the Board finds them entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

At the February 2025 Board hearing, the Veteran reported that during the review period she had symptoms of daily abdominal cramping/pain, rectal bleeding, bloating, and urgency, as well as between three and ten bouts of diarrhea. She specifically reported that her base level of severity involves three bowel movements with loose stool per day, and that during flare ups she has at least six per day and was unable to leave the bathroom. She also reported that she had been on medication since 2003 and that she was prescribed prednisone to treat her ulcerative colitis flare ups.

The Veteran submitted an April 2025 statement reporting that on her worst days she did not get out of bed except to go to the bathroom between six and ten times. She stated that her bowel movements were never normal.

The Veteran is competent to report lay-observable symptoms such as pain, bleeding and diarrhea, as well as their frequency. Moreover, the undersigned has had the opportunity to observe the Veteran and finds her to be credible. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). The Board therefore assigns her statements significant probative weight.

Again, the Veteran's ulcerative colitis is currently rated as noncompensable. Upon review of the above, the Board finds that the Veteran's ulcerative colitis more nearly approximates the severity of a 60 percent rating.

The evidence shows that during the review period the Veteran was treated with immunosuppressants along with other oral agents. Private treatment records document that her ulcerative colitis flare ups are treated with prednisone, a corticosteroid. The VA examination also specifically found treatment both with mesalamine and prednisone. The evidence also shows that the Veteran had symptoms of abdominal pain and frequent diarrhea. The Veteran has submitted competent statements that she has three episodes of diarrhea on a normal day, and six to ten episodes per day during flare ups. While the record shows varying frequencies, the Board will rate the Veteran on the highest level of disability shown during the period and finds that she has over six bowel movements during flare ups, consistent with a 60 percent rating under the DC. Finally, the private examination found that the Veteran had anemia. The criteria for a 60 percent rating are therefore met.

The Board acknowledges that the VA examination did not find anemia. However, as the Veteran's private treatment provider found anemia based on bloodwork during the review period, the evidence is at least in approximate balance and supports a finding that the Veteran had anemia due to her ulcerative colitis.

The Board has also considered whether a rating above 60 percent is warranted. However, the evidence does not show, and the Veteran does not contend, that her ulcerative colitis requires hospitalization at least once per year. A 100 percent rating is therefore not warranted under the DC.

Because ulcerative colitis is specifically listed in the rating schedule, it may not be rated by analogy under a different DC. Copeland v. McDonald, 27 Vet. App. 333, 337 (2015). Therefore, no other diagnostic codes are potentially applicable which might afford a higher rating on an alternative basis.

The evidence shows that the criteria for a 60 percent rating for ulcerative colitis are met, but is persuasively against a rating in excess of 60 percent and is not in approximate balance or nearly equal in the Veteran's favor in that regard. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, a 60 percent rating, but no higher, is granted.

Service Connection

Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West,
Veteran's favor in that regard. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, a 60 percent rating, but no higher, is granted.

Service Connection

Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a).

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

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006).

When the evidence is in approximate balance in a veteran's favor or nearly equal 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Entitlement to service connection for HPV

The Veteran contends that she is entitled to service connection for HPV. The Board concludes that the evidence does not show that the Veteran has a current HPV disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

October 1999 service treatment records show treatment for a plantar wart. March 2004 service treatment records show that the Veteran denied a history of sexually transmitted diseases, including genital warts. July 2005 and May 2006 service treatment records show that the Veteran denied a history of sexually transmitted diseases.

Private treatment records are silent for complaints, diagnosis or treatment related to HPV.

The Veteran submitted a January 2020 VA Form 526EZ claiming compensation benefits for HPV. The Veteran stated that it was incurred in service in 2004. The Veteran did not report any specific symptoms or functional impairment related to HPV or any facilities where she receives treatment for her claimed disability. While the Veteran listed HPV on the claim form, this was a claim for benefits and did not constitute evidence of a current disability.

The record is negative for any evidence, other than the Veteran's own generalized assertion that she is entitled to service connection for HPV, of a current HPV disability. Again, to establish service connection the evidence must show not only an event in service, but a current disability. While service treatment records show a plantar wart in 1999, the Veteran filed her claim almost 20 years later in January 2020. The Veteran did not present any lay or medical evidence of symptoms or diagnosis of HPV or its residuals during the current period or recent to the filing of the claim. The Board therefore finds that the probative evidence of record is not in approximate balance in favor of the Veteran and is against finding that she has had an HPV disability at any time during or recent to the pendency of the current claim.

In so finding, the Board notes the Federal Circuit's holding in Saunders v. Wilkie, which stated that even in the absence of a presently diagnosed condition, pain can cause functional impairment, and that in that situation, "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However,
period or recent to the filing of the claim. The Board therefore finds that the probative evidence of record is not in approximate balance in favor of the Veteran and is against finding that she has had an HPV disability at any time during or recent to the pendency of the current claim.

In so finding, the Board notes the Federal Circuit's holding in Saunders v. Wilkie, which stated that even in the absence of a presently diagnosed condition, pain can cause functional impairment, and that in that situation, "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However, in addition to the lack of a diagnosed disability, the record does not contain a statement from the Veteran regarding symptoms or functional impairment, any other competent evidence containing an indication of symptomology resulting in functional impairment.

The Board acknowledges that a VA examination was not obtained for this issue but finds that an examination is not required to make a final adjudication. VA has a duty to provide an examination or obtain a medical opinion on an issue of service connection when the record, 1) contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, 2) indicates that the disability or signs and symptoms of a disability may be associated with active service, and 3) the record does not contain sufficient information to decide the issue. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In this case, although the Veteran contends service connection is warranted for HPV, there is no indication (or specific assertion) that the Veteran has had a disability related to HPV at any time during or recent to the filing of the claim. As there is no competent evidence that the Veteran has a current disability, to include signs or symptoms of such disability, the standards of McLendon are not met in this case and a VA examination is not required.

The Board has also considered whether a VA examination was required pursuant to 38 U.S.C. § 1168(a). Pursuant to the PACT Act, unless an exception applies, VA is required to provide an examination when a veteran submits a claim for service connection and has, 1) evidence of a disability, 2) participation in a toxic exposure risk activity (TERA) in service; and 3) the evidence is not sufficient to grant service connection. The requirement for an examination does not apply if the Secretary determines there is no indication of an associated between the disability claimed by a veteran and the TERA for which a veteran submitted evidence. 38 U.S.C. § 1186(b). The Secretary has determined that the exception applies for non-presumptive claims based on physical trauma, mental disorders, conditions determined to have no positive association with herbicide agent exposure, and claims for disabilities that manifested during service or with an etiology not associated with toxic exposure.

Here, the Veteran has claimed service connection for a HPV disability. However, as explained above, the record does not contain evidence of a current disability. A VA examination pursuant to 38 U.S.C. § 1168(a) was therefore not required.

The Board finds that the probative evidence of record does not support the conclusion that the Veteran has had an HPV infection or a disability related to HPV or its residuals during or recent to the pendency of the claim. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303.

2. Entitlement to service connection for a bilateral hearing loss disability

The Veteran contends that she is entitled to service connection for a bilateral hearing loss disability. The Board concludes that the competent evidence indicates that the Veteran does not have a current bilateral hearing loss disability for VA purposes and service connection is therefore not warranted.

Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a).

For VA purposes, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000,
warranted.

Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a).

For VA purposes, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

Private treatment records are silent for audiometric testing or treatment for a hearing loss disability.

At the February 2020 VA audiological examination for compensation purposes, puretone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 15 15 20 15 10

LEFT 15 20 25 30 25

The average puretone threshold was 15 decibels in the right ear and 25 decibels in the left ear. Speech audiometry conducted with the Maryland CNC test revealed speech recognition ability of 96 percent in the right ear and 98 percent in the left ear. The examiner noted the Veteran's reports that she had a hard time hearing with background noise around.

At the outset, the Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the report is based on the Veteran's statements, in-person examinations and the examiners' observations, the Board finds it entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

As noted above, in order to be considered a disability for VA purposes, hearing loss must be shown to meet certain audiometric criteria. In this case, the evidence does not support the conclusion that those criteria have been met. The VA examination showed that the required auditory thresholds were not met as neither ear had an auditory threshold of 40 or greater at any frequency, and did not have three frequencies at 26 or greater. There is also no indication that the Veteran's speech recognition score in either ear ever fell below 94 percent. The Board therefore finds that the Veteran's hearing impairment does not meet the criteria to be considered a disability for VA purposes.

The Veteran is competent to report her difficulty hearing. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 310 (2007); and 38 C.F.R. § 3.159 (a)(2) (2017). Nevertheless, as a layperson, without the appropriate medical training and expertise, her statements are not competent evidence to provide a probative opinion on a medical matter, especially the severity of her bilateral hearing loss disability in terms of the applicable criteria. Rather, this necessarily requires appropriate medical findings regarding the extent and nature of his bilateral hearing loss, including audiometric testing for puretone thresholds.

The Board therefore finds that the competent evidence of record indicates that the Veteran's bilateral hearing loss does not meet the criteria to be considered a disability for VA purposes. Service connection is therefore not warranted. 38 C.F.R. §§ 3.303, 3.385.

3. Entitlement to service connection for a right knee disability

4. Entitlement to service connection for a left knee disability

The Veteran contends that her current right and left knee disabilities began in service and have continued since service. The Board concludes that the Veteran has a current disability of bilateral patellofemoral pain syndrome that began during active service and that service connection is therefore warranted. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d).

The April 2020 rating decision made a favorable finding of current disabilities
§§ 3.303, 3.385.

3. Entitlement to service connection for a right knee disability

4. Entitlement to service connection for a left knee disability

The April 2020 rating decision made a favorable finding of current disabilities in the right and left knee. Under the AMA, the Board is bound by this favorable finding in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104 (c). There being no clear and unmistakable error in the finding, the question before the Board is limited to whether there is a nexus to service.

Service treatment records document multiple reports of knee pain. March 2002 service treatment records show that the Veteran reported right knee pain that had been present for two to three weeks. The provider assessed a right knee pain problem and opined that she might have chondromalacia. A June 2004 medical history report documented reports of painful knees. While the separation medical examination report did not find abnormalities in the lower extremities, the May 2006 separation medical history report shows that the Veteran specifically reported knee pain since 2001. The Veteran also endorsed painful joints.

A February 2020 VA examination diagnosed bilateral patellofemoral pain syndrome, and the examiner noted the Veteran's reports that it began in 2002 with symptoms of pain and limited mobility. The examiner provided a February 2020 opinion that the knee disabilities were not due to service. As a rationale, the examiner acknowledged that service treatment records showed complaints of knee pain from 2001 to 2006, but that as it was not reported at separation it was not chronic. This opinion is inadequate as it is based on an inaccurate fact. As noted above, the Veteran specifically reported bilateral knee pain in her separation medical history report. As the opinion is based on an inaccurate medical history, the Board assigns it no probative weight. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993).

The Board therefore finds that the competent evidence of record indicates that the Veteran's conceded right and left knee disabilities were incurred during service and have continued since service. Service treatment records document knee complaints throughout the Veteran's period of active duty, including in the separation medical history report. The Veteran reported at the VA examination that her symptoms of pain and limited mobility had been present since service. As the VA opinion has been found to be inadequate, the Veteran's statements are the only probative evidence regarding whether the current knee disability began in service. As noted above, the Veteran reported consistent bilateral knee symptoms beginning in service and persisting since that time.

Thus, resolving all doubt in favor of the Veteran, there is simply no basis upon which the Board can dissociate the current disability from the manifestations during service. The Board therefore finds that the Veteran's right and left knee disabilities began in service and have continued since service. Service connection for the conceded right and left knee disabilities is therefore warranted. 38 C.F.R. § 3.303(d).

5. Entitlement to service connection for broken right ring finger

The Veteran contends that her right ring finger fracture was due to service. The Board concludes that the Veteran has a current diagnosis of right finger fracture with residuals of pain that is related to a documented in-service fracture. Service connection is therefore warranted.

The April 2020 rating decision made a favorable finding of a current diagnosis of right finger fracture. Under the AMA, the Board is bound by this favorable finding in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104 (c). There being no clear and unmistakable error in the finding, the question before the Board is limited to whether the conceded disability is due to service.

The Veteran was a midshipman at the United States Naval Academy from July 1997 to May 2001. She then served on active duty in the United States Navy from May 2001 to July 2006.

In addition to full-time duty in the Armed Forces, active duty includes Service at any time as a cadet at the United States Military, Air Force, or Coast Guard Academy, or as a midshipman at the United States Naval Academy. 38 C.F.R. § 3.
C.F.R. § 3.104 (c). There being no clear and unmistakable error in the finding, the question before the Board is limited to whether the conceded disability is due to service.

The Veteran was a midshipman at the United States Naval Academy from July 1997 to May 2001. She then served on active duty in the United States Navy from May 2001 to July 2006.

August 1998 service treatment records show that the Veteran injured her right fourth digit while playing basketball. A right-hand x-ray report shows a fracture on the right fourth finger.

A February 2020 VA examination diagnosed right finger fracture and found current symptoms of pain on flexion and extension of the finger along with a functional impact of pain with grasping. In a February 2020 opinion, the examiner found that the fracture was not due to service. As a rationale, the examiner stated that the Veteran's active-duty period was from May 2001 to July 2006, and the injury was not from that period but during the Veteran's time at the Naval Academy.

The Board finds that the February 2020 opinion is inadequate as it is based on an incorrect understanding of duty periods. As noted above, service as a midshipman at the United States Naval Academy is considered full-time duty for VA purposes. The Board therefore assigns the opinion that the fracture was not due to service no probative weight as it is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). However, the factual finding that the fracture was due to the documented injury at the Naval Academy is unaffected by the examiner's misunderstanding regarding duty periods, and the Board therefore assigns that finding significant probative weight.

The Board therefore finds that the competent evidence of record indicates that the Veteran's conceded right finger fracture disability was due to the documented right finger fracture during the Veteran's time at the Naval Academy. The VA examiner specifically found that the disability was due to that injury. Service connection is therefore warranted. 38 C.F.R. §§ 3.6(b)(4), 3.303(a).

REASONS FOR REMAND

1. Entitlement to service connection for a left hip disability

2. Entitlement to service connection for a right hip disability

The issues of entitlement to service connection for left and right hip disabilities are remanded to correct a duty to assist error that occurred prior to the April 2020 rating decision on appeal. The AOJ obtained a February 2020 medical opinion prior to the rating decision on appeal. However, this medical opinion does not provide an adequate rationale regarding whether the Veteran's conceded bilateral hip disability has a nexus to service.

A February 2020 VA examination diagnosed bilateral trochanteric pain syndrome and left hip femoral acetabular impingement. In a February 2020 opinion, the examiner noted that service treatment records showed a complaint of left hip pain during an infection that was resolved with antibiotics. Without further explanation, the examiner simply stated that it was less likely than not that the Veteran incurred a chronic hip disability during service. The Board finds this opinion inadequate as it did not provide a reasoned medical explanation connecting the noted fact of the Veteran's in-service left hip treatment with its conclusion. The examiner did not explain why the conclusion followed from the factual statement. The opinion is therefore inadequate, and remand for a new opinion is required. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

3. Entitlement to service connection for a right ankle disability

The issue of entitlement to service connection for a right ankle disability is remanded to correct a duty to assist error that occurred prior to the April 2020 rating decision on appeal. The AOJ obtained a February 2020 medical opinion prior to the rating decision on appeal. However, this medical opinion does not provide an adequate rationale regarding whether the Veteran's right ankle disability has a nexus to service.

A February 2020 VA examination diagnosed right ankle tendonitis. The examiner noted the Veteran's reports that it began after an injury in July 1997, and that it was easily sprained. A February 2020 opinion then found that the current right ankle disability was not due to service As a rationale, the examiner stated that service records showed a November 1998 right ankle inversion that was diagnosed as a sprain. The examiner then stated that sprains typically resolved within days with conservative treatment and it was less likely than not the veteran incurred a chronic right ankle condition during service. The Board finds that this opinion is inadequate as it relied on an incomplete medical history. In addition to the November 1998 sprain noted by the examiner, service treatment records also show that the Veteran was diagnosed with a right ankle sprain in July 1997, as she reported at the examination. As the examiner failed to consider the evidence of the multiple documented right ankle sprains in service, the opinion is inadequate and the Board finds that remand for a new opinion is required.

4. Entitlement to a TDIU

The issue of entitlement to TDIU is remanded to correct a duty to assist error that occurred prior to the April 2020 rating decision on appeal. As discussed above, the issue of entitlement to TDIU was raised by the record prior to the decision on appeal. However, the Board's review indicates that the AOJ did not conduct required development regarding entitlement to TDIU, including obtaining a VA Form 8940.

As a result, the record does not currently contain the information needed to adjudicate the issue of entitlement to TDIU. The Veteran reported at the February 2024 Board hearing that she had not worked since 2011 for a combination of reasons, including her ulcerative colitis. She also stated that she had worked at nuclear power plants and GE, but the nature of her past employment as well as her earnings history is not clear from the record. The private treatment records in the file list her occupation as a stay-at-home mom and do not indicate that the Veteran has been unable to work. A remand is therefore required to allow VA to conduct the required development and ensure compliance with the duty to assist.

The matters are REMANDED for the following action:

1. Conduct appropriate development regarding the issue of entitlement to TDIU, including contacting the Veteran and asking her to complete a VA Form 8940.

2. Obtain a VA opinion from an appropriate provider, to determine the etiology of the current left and right hip disabilities. The examiner should review the file and provide a complete rationale for all opinions expressed. An in-person examination is not required unless the provider deems it necessary.

The opinion should address it is as likely as not (ie, the evidence is in approximate balance or nearly equal in the Veteran's favor) that the current left and right hip disabilities are related to the Veteran's active service. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms.

3. Obtain a VA opinion from an appropriate provider, to determine the etiology of the current right ankle disability. The examiner should review the file and provide a complete rationale for all opinions expressed. An in-person examination is not required unless the provider deems it necessary.

The opinion should address it is as likely as not (ie, the evidence is in approximate balance or nearly equal in the Veteran's favor) that the current right ankle disability is related to the Veteran's active service, to include the documented July 1997 and November 1998 right ankle strains shown in the service treatment records. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms.

E. I. VELEZ

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Arnold, 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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