POSTTRAUMATIC STRESS DISORDER (PTSD)

MELANIE J. MANN · 2026 · Case ID: A26028689

MIXED

Summary

The veteran, who served in the Marine Corps from February 2009 to February 2014, appeals the denial of service connection for anxiety, insomnia, degenerative arthritis of the lumbar spine, and right knee patellofemoral pain syndrome, as well as the grant of service connection for PTSD and tinnitus. The Board found credible evidence of an in-service stressor for PTSD, corroborated by a fellow service member, and gave the Veteran the benefit of the doubt, granting service connection for PTSD. The Board also granted service connection for tinnitus, finding the VA examiner's opinion inadequate for failing to consider the Veteran's lay testimony, threshold hearing shifts in service treatment records, and awards related to noise exposure. Service connection for anxiety was denied as it was subsumed within the PTSD diagnosis. For insomnia, degenerative arthritis of the lumbar spine, and right knee patellofemoral pain syndrome, the Board denied service connection, finding no in-service event or nexus, and that the evidence weighed against the claims, making the benefit of the doubt doctrine inapplicable. The claim for left elbow tendinitis was remanded for a new VA examination to address the Veteran's lay statements and the corroborating statements from a fellow service member regarding the in-service injury and ongoing symptoms.

Rationale

Credible supporting evidence of in-service stressor; Benefit of the doubt applied in Veteran's favor; VA examiner found PTSD symptoms met DSM-V criteria and related to service

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251211-614687

Full Decision Text

Citation Nr: A26028689
Decision Date: 03/31/26 Archive Date: 03/31/26

DOCKET NO. 251211-614687
DATE: March 31, 2026

ORDER

Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted.

Entitlement to service connection for anxiety is denied.

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for insomnia is denied.

Entitlement to service connection for degenerative arthritis of the lumbar spine is denied.

Entitlement to service connection for right knee patellofemoral pain syndrome is denied.

REMANDED

Entitlement to service connection for left elbow tendinitis is remanded.

FINDINGS OF FACT

1. There is credible supporting evidence that the Veteran experienced a stressor during service.

2. Resolving all reasonable doubt in the Veteran's favor, the Veteran's currently diagnosed PTSD is due to his in service stressor.

3. The Veteran's anxiety is subsumed with the Veteran's diagnosed PTSD.

4. Resolving all doubt in the Veteran's favor, his currently diagnosed tinnitus had its onset in service.

5. The Veteran's records do not reflect an in service event, injury, or disease related to insomnia.

6. The Veteran's diagnosed degenerative arthritis of the lumbar spine is not shown to be causally or etiologically related to any event, injury, or disease during service.

7. The Veteran's diagnosed right knee patellofemoral pain syndrome is not shown to be causally or etiologically related to any event, injury, or disease during service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for PTSD have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655.

2. The criteria for entitlement to service connection for anxiety have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655.

3. The criteria for entitlement to service connection for tinnitus have been met. 38?U.S.C. §§?1110, 5107; 38?C.F.R. §§?3.102, 3.303, 3.307, 3.309.

4. The criteria for entitlement to service connection for insomnia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655.

5. The criteria for entitlement to service connection for degenerative arthritis of the lumbar spine have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655.

6. The criteria for entitlement to service connection for right knee patellofemoral pain syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 2009 to February 2014, and was honored with multiple decorations for their service, including the Humanitarian Service Medal; Navy and Marine Corps Achievement Medal; Marine Corps Good Conduct Medal; National Defense Service Medal; Global War on Terrorism Expeditionary Medal; Global War on Terrorism Service Medal; Sea Service Deployment Ribbon; Sharpshooter Rifle Qualification Badge; and Sharpshooter Pistol Qualification Badge.

The matter comes before the Board on appeal from a rating decision issued in December 2024 by a Department of Veterans Affairs (VA) Regional Office.

In the December 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the November 2023 rating decision for PTSD and September 2023 rating decision for all other claims that were subsequently subject to a Higher Level Review by the agency of original jurisdiction (AOJ). 38 C.F.R. §?20.301.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.
cket. Therefore, the Board may only consider the evidence of record at the time of the November 2023 rating decision for PTSD and September 2023 rating decision for all other claims that were subsequently subject to a Higher Level Review by the agency of original jurisdiction (AOJ). 38 C.F.R. §?20.301.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.: see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110" refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability").

Establishing service connection for PTSD is separate from those for establishing service connection generally. 38 C.F.R. § 3.304(f); Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD generally requires: (1) medical evidence diagnosing the condition in accordance with applicable criteria; (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f).

Further, 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; 38 C.F.R. § 3.102.

1. Entitlement to service connection for PTSD.

2. Entitlement to service connection for anxiety.

The Veteran contends that he is entitled to service connection for his PTSD and anxiety.

In the December 2024 rating decision on appeal, the AOJ favorably found the Veteran was diagnosed with PTSD and anxiety. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). Thus, the Board finds that the first element of service connection is met for the Veteran's claims. At issue in this case is whether there was an in service event, injury, or disease, and if so whether the currently diagnosed condition was caused by the in service event, injury, or disease.

Regarding an in service event, injury, or disease, the Veteran states that he had multiple stressors in service that caused his PTSD and anxiety. This includes harassment and bullying by a Lance Corporal while working in the flightline shop in front of the entire shop as a new marine in August/September 2010; in July 2013 almost being sent out on a combat mission to deal with the escalating situation in Egypt; and in April 2013 while in the middle east suffering serious mechanical failure on their helicopter which almost resulted in a crash that could have resulted in them dying or being trapped in enemy territory. Of all the events, the April 2013 incident was noted to
caused by the in service event, injury, or disease.

Regarding an in service event, injury, or disease, the Veteran states that he had multiple stressors in service that caused his PTSD and anxiety. This includes harassment and bullying by a Lance Corporal while working in the flightline shop in front of the entire shop as a new marine in August/September 2010; in July 2013 almost being sent out on a combat mission to deal with the escalating situation in Egypt; and in April 2013 while in the middle east suffering serious mechanical failure on their helicopter which almost resulted in a crash that could have resulted in them dying or being trapped in enemy territory. Of all the events, the April 2013 incident was noted to have met Criteria A for PTSD in the June 2023 VA examination and was corroborated by lay statements from fellow service member B.S. in October 2023. As such, the Veteran has credible supporting evidence that the claimed in-service stressor occurred and meets the second element of service connection.

Regarding the nexus between the claimed conditions and in service stressor, the Veteran underwent a private opinion and VA opinion. In June 2023 the Veteran submitted a private opinion from private clinician F.B. who was the Veteran's long-term treating physician for his psychiatric disorders. The private clinician noted that the Veteran was not diagnosed with any of his current psychiatric disorders during his service and that he generally only received routine care at his VA annual medical appointments. However, it was noted that he had two emergency room visits while serving. The private clinician noted that after Veteran left the service, he was diagnosed with PTSD, anxiety, insomnia, and substance use disorders. Thus, the private clinician concluded that clinically the onset of the Veteran's symptoms and details from the Veteran's experiences suggest that he likely suffered from these disorders as a result of his military service.

In June 2023 the Veteran underwent a VA examination where the VA examiner diagnosed the Veteran with PTSD; alcohol use disorder is sustained remission; and opioid use disorder in sustained remission. The VA examiner noted the Veteran's onset of mental health symptoms followed his combat deployment and persisted, which have now met full DSM-V criteria for PTSD. The VA examiner found that the symptoms were related to trauma stressors experienced in service. Therefore, the VA examiner opined that the Veteran's diagnosed PTSD that was at least as likely as not incurred in or caused by PTSD during service. Additionally, the VA examiner found that the Veteran's claimed condition of anxiety was subsumed under diagnosis of PTSD and opiod/alcohol use disorder in remission. Thus, the Veteran's anxiety was not a separate condition.

Thus, the Board finds that the June 2023 VA examination applies valid medical analysis to the significant facts for this specific Veteran to reach their medical opinion. The VA examiner provided sufficient rationale given the Veteran's records and lay testimony. Thus, the Board affords significant probative weight to the June 2023 VA examination as it provides rationale for the conclusions reached and addressed the specifics of the Veteran's case in support thereof. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

While the June 2023 private opinion provides a favorable opinion as to the Veteran's diagnosis and their relationship to his service, the opinion provides insufficient rationale for the conclusions reached. As such, the private opinion is provided some probative weight. Id.

For the foregoing reasons, service connection for PTSD is warranted. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990). However, insofar as to the claim for service connection for anxiety, the Veteran's records support that such condition is subsumed of his PTSD and is thus not a separate condition to be service connected. Thus, service connection for anxiety is not warranted. Id.

3. Entitlement to service connection for tinnitus.

The Veteran contends that his currently diagnosed tinnitus had its onset in service.

Here, the VA examiner in the June 2023 VA examination noted the Veteran did not have a diagnosis of tinnitus. However, tinnitus is a condition that may be diagnosed by its unique and readily identifiable features since the presence of the disorder is not a determination "medical in nature," and is capable of lay observation. Barr v. Nicholson, 21?Vet. App.?303, 305 (2007). Additionally, the Veteran's duties associated with his military occupational specialty (MOS) as a Helicopter Crew Chief gave him a high probability of exposure to hazardous noises. Thus, the VA has conceded his hazardous noise exposure in service.

The June
contends that his currently diagnosed tinnitus had its onset in service.

The June 2023 VA examination noted that the Veteran did not have tinnitus as the Veteran's description of symptoms did not meet the Dauman and Tyler (1992) definition of tinnitus cited in the Tinnitus Handbook (Tyler). The VA examiner noted the Veteran reported transient ear noise that occurs in the general population without auditory damage or pathology. The VA examiner found that tinnitus is defined by occurring more than once per week for at least 5 minutes. Here however, the VA examiner found the Veteran reported tinnitus would occur 1-2 times per week for about 1 minute. As such, the VA examiner found this was transient ear noise that is not consistent with noise-induced tinnitus and was less likely than not related to military noise exposure. Thus, the VA examiner opined the etiology of tinnitus was not warranted when symptomatology and clinical exam findings do not indicate a diagnosis of recurrent tinnitus.

Here, however, the Board finds that the VA examiner failed to consider all of the Veteran's lay statements, as the Veteran had competently and credibly clarified that his tinnitus symptoms began in service due to his MOS and was constantly exposed to the loud engines. Further, the Board notes the Veteran is competent to describe his symptoms and experiences in and out of service. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Additionally, the sole basis for rejecting lay statements cannot be the fact that there are no corroborating records. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("the Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). Additionally, the Veteran's service treatment records (STRs) reflected threshold hearing shifts from the entrance examination to the exit examination, which were not addressed by the June 2023 VA examiner. Further, the Veteran's DD-214 reflected receipt of the Sharpshooter Rifle Qualification Badge and Sharpshooter Pistol Qualification Badge, but the examiner failed to address this, which directly related to the Veteran's tinnitus claim. Therefore, the June 2023 VA examiner clearly failed to consider the Veteran's lay testimony, ignored threshold hearing shifts noted in the Veteran's STRs, ignored the Veteran's award of the Sharpshooter Rifle Qualification Badge and Sharpshooter Pistol Qualification Badge, and only relied on the lack of complaints during and after service. Thus, the Board finds the June 2023 VA examination inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Furthermore, when a claim involves a diagnosis based on purely subjective complaints, the Board is within its province to weigh the Veteran's testimony and determine whether it supports a finding of service incurrence and continuous symptoms since service. Barr v. Nicholson, 21 Vet. App. 303 (2007). Resolving all doubt in the Veteran's favor, therefore, the Board finds that his current tinnitus had its onset in service. Accordingly, service connection for tinnitus is warranted. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990).

4. Entitlement to service connection for insomnia.

The Veteran contends that he is entitled to service connection for his diagnosed insomnia.

In the December 2024 rating decision on appeal, the AO
a finding of service incurrence and continuous symptoms since service. Barr v. Nicholson, 21 Vet. App. 303 (2007). Resolving all doubt in the Veteran's favor, therefore, the Board finds that his current tinnitus had its onset in service. Accordingly, service connection for tinnitus is warranted. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990).

4. Entitlement to service connection for insomnia.

The Veteran contends that he is entitled to service connection for his diagnosed insomnia.

In the December 2024 rating decision on appeal, the AOJ favorably found the Veteran was diagnosed with insomnia. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). Thus, the Board finds that the first element of service connection is met for the Veteran's claim. At issue in this case is whether there was an in service event, injury, or disease, and if so whether the currently diagnosed condition was caused by the in service event, injury, or disease.

Here, the Veteran's STRs are silent of any event, injury, or disease related to the Veteran's claimed insomnia. There are also no lay statements corroborating any in service issues with insomnia. It was not until years later that the Veteran was diagnosed with insomnia, long after service had concluded.

Additionally, the Board notes that the Veteran was not afforded a VA examination or opinion for the claimed insomnia. The duty to assist includes providing a medical examination or obtaining a medical opinion when necessary to decide on a claim, as defined by law. See 38 C.F.R. § 3.159(c)(4). Under 38 U.S.C. § 5103A(d), VA must provide a medical examination and/or obtain a medical opinion when there is: (1) competent evidence that the Veteran has a current disability (or persistent or recurrent symptoms of a disability); (2) evidence establishing that an event, injury or disease occurred in service; (3) an indication that the current disability or symptoms may be associated with service; and (4) there is not sufficient medical evidence to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. As stated above, in this case, the Veteran was not afforded a VA examination and no VA opinion was obtained with respect to the claimed condition. The Board, however, finds that no VA exam or opinion is necessary for the claim, as there is no evidence to show that the Veteran suffered from or had any symptoms of the claimed condition during service or within a year following service

For the foregoing reasons, service connection for insomnia is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the probative evidence is not in approximate balance and weighs against the Veteran's claim. Thus, the benefit of the doubt doctrine is not applicable in such regard, and his service connection claim must be denied. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990).

5. Entitlement to service connection for degenerative arthritis of the lumbar spine.

The Veteran contends that he is entitled to service connection for his degenerative arthritis of the lumbar spine.

In the December 2024 rating decision on appeal, the AOJ favorably found the Veteran was diagnosed with degenerative arthritis of the lumbar spine. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). Thus, the Board finds that the first element of service connection is met for the Veteran's claim. At issue in this case is whether there was an in service event, injury, or disease, and if so whether the currently diagnosed condition was caused by the in service event, injury, or disease.

Here, the Veteran's STRs are silent of any event, injury, or disease related to the Veteran's claimed degenerative arthritis of the lumbar spine. However, the Veteran stated that his degenerative arthritis of the lumbar spine had its onset in 2012 when he started experiencing lower back pain from frequently kneeling and hunching over in the UH-1N Helicopter while working
.F.R. § 3.104(c). Thus, the Board finds that the first element of service connection is met for the Veteran's claim. At issue in this case is whether there was an in service event, injury, or disease, and if so whether the currently diagnosed condition was caused by the in service event, injury, or disease.

Here, the Veteran's STRs are silent of any event, injury, or disease related to the Veteran's claimed degenerative arthritis of the lumbar spine. However, the Veteran stated that his degenerative arthritis of the lumbar spine had its onset in 2012 when he started experiencing lower back pain from frequently kneeling and hunching over in the UH-1N Helicopter while working as a crew chief, especially since the helicopter cabin was approximately 4 feet tall. The Veteran stated such lower back pain, pressure, stiffness, weakness, and fatigue just progressed and worsened since service. Such was corroborated by the Veteran's DD-214 and MOS in service. Thus, the Board concedes that the Veteran had an in service event, injury, or disease.

Regarding the nexus between the claimed conditions and in service event, injury, or disease, the Veteran underwent a VA examination in July 2023, wherein he was diagnosed with degenerative arthritis of the lumbar spine. While the VA examiner notes that in the Veteran's medical history from November 18, 2013, the Veteran indicated "no" for "recurrent back pain or any back problems," he also notes that treatment records show complaints of thoracic back pain. However, the VA examiner ultimately found that there were no medical records to objectively substantiate a chronic lower back condition pathology that would have persisted since the service. Thus, the VA examiner found that without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology and nexus had not been established. Therefore, the VA examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness.

Based on the aforementioned, the Board finds the July 2023 VA examiner adequately concluded that the Veteran's current diagnosis of degenerative arthritis of the lumbar spine is not related to his service, as the examiner specifically addressed the complaints of the Veteran and how the medical records did not support the Veterans claims. Thus, the Board finds the July 2023 VA examiner provided adequate rationale for the conclusion reached and addressed the specifics of the Veteran's case thereof. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

For the foregoing reasons, service connection for degenerative arthritis of the lumbar spine is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the probative evidence is not in approximate balance and weighs against the Veteran's claim. Thus, the benefit of the doubt doctrine is not applicable in such regard, and his service connection claim must be denied. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990).

6. Entitlement to service connection for right knee patellofemoral pain syndrome.

The Veteran contends that he is entitled to service connection for his right knee patellofemoral pain syndrome.

In the December 2024 rating decision on appeal, the AOJ favorably found the Veteran was diagnosed with right knee patellofemoral pain syndrome. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). Thus, the Board finds that the first element of service connection is met for the Veteran's claim. At issue in this case is whether there was an in service event, injury, or disease, and if so whether the currently diagnosed condition was caused by the in service event, injury, or disease.

Here, the Veteran's STRs are silent of any event, injury, or disease related to the Veteran's claimed degenerative arthritis of the lumbar spine. The Veteran claims that his right knee pain is the result of general wear and tear during his service. He states that the onset of symptoms began in 2014, within a year of his release from active duty. Since the onset of symptoms, the Veteran report that his symptoms have continued to worsen and include episodes of right knee lateral instability with prolonged walking for approximately 10 minutes or any high impact physical activities such as running or jogging and kneeling. The Board finds that the Veteran's reports regarding the cause of his right knee pain
the in service event, injury, or disease.

Regarding a nexus, the Veteran underwent a VA examination in July 2023 and was diagnosed with right knee patellofemoral pain syndrome. The VA examiner stated that the within the Veteran's Report of Medical history dated November 18, 2013, the Veteran reported "no" for "knee trouble (e.g. locking, giving out, pain, or ligament injury, etc)" and that there were no medical records to objectively substantiate a chronic right knee condition pathology that would have persisted on since service. The VA examiner found that without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. Thus, the VA examiner found a nexus has not been established. Therefore, the VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness.

Based on the aforementioned, the Board finds the July 2023 VA examiner adequately concluded that the Veteran's current right knee patellofemoral pain syndrome is not related to his service, as the examiner specifically addressed the complaints of the Veteran and how the medical records did not support the Veterans claims. Thus, the Board finds the July 2023 VA examiner provided adequate rationale for the conclusion reached and addressed the specifics of the Veteran's case thereof. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

For the foregoing reasons, service connection for right knee patellofemoral pain syndrome is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the probative evidence is not in approximate balance and weighs against the Veteran's claim. Thus, the benefit of the doubt doctrine is not applicable in such regard, and his service connection claim must be denied. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990).

REASONS FOR REMAND

Entitlement to service connection for left elbow tendinitis.

The Veteran contends that he is entitled to service connection for his left elbow tendinitis.

In the December 2024 rating decision on appeal, the AOJ favorably found the Veteran was diagnosed with left elbow tendinitis. As such, the question remaining is whether there was an in service event, injury, or disease, and if so whether the currently diagnosed condition was caused by the in service event, injury, or disease.

Regarding an in service event, injury, or disease, the Veteran's service treatment records were silent of an in service event, injury, or disease. However, the Veteran stated that his left elbow injury occurred in August 2010 when he fell off an obstacle course while trying to climb over a 6-foot wall and in the process of attempting to brace himself from the hard surface, he hyperextended his left upper extremity. This event was also corroborated by his fellow service member M.M. in a June 2023 lay statement. M.M. specifically stated that while they were going through PT evolution at an obstacle course in August 2010, M.M. saw the Veteran fall from an obstacle and land awkwardly on his left arm, place his hand down to brace for the impact, and hit his elbow very hard as he heard the pop and saw the Veteran wince in pain. M.M. stated that when they returned to the barracks, he saw that the Veteran's left elbow was visibly bruised and swollen. M.M. also observed the Veteran's elbow in the days following injury and stated that the swelling and bruising appeared worse, in that Veteran had was "black and blue about halfway up his forearm to
. in a June 2023 lay statement. M.M. specifically stated that while they were going through PT evolution at an obstacle course in August 2010, M.M. saw the Veteran fall from an obstacle and land awkwardly on his left arm, place his hand down to brace for the impact, and hit his elbow very hard as he heard the pop and saw the Veteran wince in pain. M.M. stated that when they returned to the barracks, he saw that the Veteran's left elbow was visibly bruised and swollen. M.M. also observed the Veteran's elbow in the days following injury and stated that the swelling and bruising appeared worse, in that Veteran had was "black and blue about halfway up his forearm to just under his shoulder." M.M. further stated the Veteran continued to complain of the pain from his left elbow after a couple months, especially on strenuous days that involved physical training. As such, the Board finds there was an in service event, injury, or disease in service.

Regarding a nexus, the Veteran underwent a VA examination in July 2023 and was diagnosed with left elbow tendinopathy. The VA examiner noted the August 2010 event in service. The VA examiner noted that within the Veteran's Report of Medical history dated November 18, 2013, the Veteran reported "no" for "painful shoulder, elbow, or wrist" and that there were no medical records to objectively substantiate a chronic left elbow condition pathology that would have persisted on since the service. Additionally, the VA examiner noted the relevant evidence showed emergency room treatment notes which revealed a chief complaint of falling on July 3, 2019, pain in the left elbow and tingling in left 4th and 5th finger. The VA examiner stated that without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. As such, the VA examiner found a nexus had not been established. Thus, the VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness.

Based on the foregoing, the Board finds the AOJ made a pre-decisional duty to assist error by failing to obtain an adequate VA opinion regarding the Veteran's claim for service connection for his left elbow condition. Although the Veteran was afforded a VA examination, the VA examiner failed to consider the Veteran's lay statements and the lay statements of fellow service member M.M. Specifically, the VA examiner relied on the lack of documentation of ongoing issues since service when the Veteran had lay statements from himself and another about such issues since in and out of service. Additionally, the VA examiner relied on a lack of documentation for the conclusions reached.

Therefore, the Board finds that the VA opinion is inadequate for adjudication and attempts must be made to obtain any outstanding records. As such, the AOJ made a pre-decisional duty to assist error by not obtaining an adequate VA opinion regarding service connection for the Veteran's left elbow tendinitis. Consequently, a remand is warranted to obtain the outstanding records and appropriate opinion to address all of the lay statements for the Veterans claim. See 38 U.S.C. § 5103A (d); McLendon v Nicholson, 20 Vet. App. 79, 81 (2006).

The matters are REMANDED for the following action:

1. Afford the Veteran with an appropriate VA opinion to determine the nature and etiology of the Veteran's diagnosed left elbow tendinitis. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. It is left to the discretion of the examiner to determine if an additional examination is necessary. Following a full review of the record:

(a.) The examiner should offer an opinion as to whether it is at least as likely as not that the Veteran's currently diagnosed left elbow tendinitis had its onset in or is otherwise related to his military service.

(b.) The examiner shall specifically address the Veteran's lay statements and the lay statements by fellow service member M.M. regarding the Veteran's experiences in and out of service, including the noted incidents in service, as well as their lay statements regarding his ongoing symptoms.

The examiner is advised that the lack of documentation is not dispositive on the question, and a nexus opinion cannot be based solely on the absence of documentation of in service findings or continuity of care thereafter.

(Continued on the next page)

Any opinions offered should be accompanied by the underlying reasons for the conclusions

Melanie J. Mann

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Hageman Gaina, Samantha L.

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

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