HEARING LOSS

MICHELLE L. KANE · 2026 · Case ID: A26028791

MIXED

Summary

The Veteran served in the Air Force from May 1991 to April 2001 and again from February 2003 to August 2012, with additional service in the Air Force Reserves. The Veteran appealed the denial of service connection for bilateral hearing loss, left hand condition with degenerative joint disease, right knee disability, sebaceous cyst, residuals of a left ankle fracture, chronic sinusitis, laceration scars of the chin, and dermatitis. The Board denied service connection for all these conditions, finding that the evidence of record did not establish a current diagnosis or nexus to service. For hearing loss, left hand condition, right knee disability, and sebaceous cyst, the Board found no credible evidence or diagnosis. For the left ankle fracture residuals, the Board found the existing rating was sufficient. For chronic sinusitis and chin scars, the Board found the criteria for a compensable rating were not met. The dermatitis claim was dismissed as moot due to a subsequent grant of a higher evaluation. The Board remanded claims for recurrent tinnitus, left hip pain, and post-surgical right hip pain. The tinnitus claim was remanded for a VA opinion, as the private opinion failed to address conflicting service records showing no reported tinnitus. The hip pain claims were remanded for a VA opinion, as the private opinion linking them to the service-connected knee condition did not address the Veteran's denial of hip complaints in service.

Rationale

No current diagnosis of hearing loss; Evidence did not establish nexus to service

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6207

Docket No.

250220-527175

Full Decision Text

Citation Nr: A26028791
Decision Date: 03/31/26 Archive Date: 03/31/26

DOCKET NO. 250220-527175
DATE: March 31, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for a left hand condition, to include degenerative joint disease, is denied.

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

Entitlement to service connection for a sebaceous cyst is denied.

Entitlement to an evaluation in excess of 10 percent for service-connected residuals of a left ankle fracture is denied.

Entitlement to an initial compensable evaluation for service-connected chronic sinusitis is denied.

Entitlement to a compensable evaluation of service-connected laceration scars of the chin is denied.

Entitlement to a compensable evaluation for service-connected dermatitis is dismissed.

REMANDED

Entitlement to service connection for recurrent tinnitus is remanded.

Entitlement to service connection for left hip pain is remanded.

Entitlement to service connection for post-surgical right hip pain is remanded.

FINDINGS OF FACT

1. The most probative evidence of record does not show that the Veteran has a current diagnosis of hearing loss of either ear, according to VA standards.

2. The most probative evidence of record does not show that the Veteran has a current diagnosis of a left hand condition, to include degenerative joint disease.

3. The most probative evidence of record does not show that the Veteran has a current diagnosis of a right knee disability.

4. There is no credible evidence of an in-service sebaceous cyst.

5. The Veteran's service-connected residuals of a left ankle fracture are manifested by complaints of pain, plantar flexion of 35 degrees, and left ankle dorsiflexion of 20 degrees.

6. The Veteran's service-connected chronic sinusitis is manifested by congestion, difficulty breathing, facial pain, snoring, and sinus pressure.

7. The Veteran's service-connected laceration scars of the chin are no greater than 1.25 centimeters by 0.1 centimeters.

8. The Veteran's February 2025 appeal for an evaluation of 20 percent for service-connected dermatitis was satisfied in full by the April 2025 grant of a 30 percent evaluation, effective April 5, 2024, or the entire period of time on appeal.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for bilateral hearing loss have not been met. See 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385.

2. The criteria for entitlement to service connection for left hand condition, to include degenerative joint disease, have not been met. See 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

3. The criteria for entitlement to service connection for a right knee disability have not been met. See 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

4. The criteria for entitlement to service connection for a sebaceous cyst have not been met. See 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for entitlement to an evaluation in excess of 10 percent for service-connected residuals of a left ankle fracture have not been met. See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271.

6. The criteria for entitlement to an initial compensable evaluation for chronic sinusitis have not been met. 38 U.S.C. §§ 1155, 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6512.

7. The criteria for entitlement to a compens
See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271.

7. The criteria for entitlement to a compensable rating for service-connected laceration scars of the chin have not been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7800.

8. The criteria for dismissal of the appeal for a compensable evaluation for service-connected dermatitis have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1991 to April 2001, and from February 2003 to August 2012. The Veteran also served in the United States Air Force Reserves.

In August 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act of 2017 (the Appeals Modernization Act or AMA), Pub. Law 115-55, which created a new claims and appeals process for pursuing VA benefits.

In a January 27, 2025, rating decision, the Agency of Original Jurisdiction (AOJ) denied service connection for a left hand condition, to include degenerative joint disease. In a January 29, 2025, rating decision, the AOJ denied the remaining claims on appeal. On February 20, 2025, the Veteran appealed the denial of these claims. He requested the "Evidence Submission" lane, indicating that he did not want a Board hearing but that he had additional evidence that he would submit within the next 90 days. In an April 11, 2025, letter, the Board acknowledged the Veteran's appeal request and informed him that the appeal had been placed on the Evidence Submission docket.

Under the AMA, when a claimant seeks appellate review through the Board's Evidence Submission docket, the Board only may consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran with or within 90 days after his VA Form 10182 was submitted. 38 U.S.C. § 7113 (c); 38 C.F.R. § 20.303. Therefore, the Board may consider the evidence of record at the time of the January 27, 2025, and January 29, 2025, rating decisions, with regard to these respective claims, as well as any evidence submitted from February 20, 2025, to May 20, 2025. Notably, the Veteran has submitted no additional evidence since the January 2025 rating decisions.

A November 14, 2025, letter informed the Veteran that he had one year from the date of the notice of the decision on appeal, or 60 days from the date the Board received the VA Form 10182, to request a docket switch. On December 16, 2025, the Veteran submitted a statement, on which he waived his right to select a different Board review option. See Williams v. McDonough, 37 Vet. App. 305 (2024). Regardless, that one-year period has now passed, so the Board can proceed with this appeal.

The Board notes that additional VA examination reports and opinions were associated with the claims file after the January 2025 rating decisions. As these VA medical records were generated after the January 2025 rating decisions, the Board may not consider this new evidence. However, the Veteran may file a Supplemental Claim and submit or identify this evidence. 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. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board has thoroughly reviewed all evidence in the claims file. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim, and the Board's reasons for rejecting evidence favorable to the
after the January 2025 rating decisions. As these VA medical records were generated after the January 2025 rating decisions, the Board may not consider this new evidence. However, the Veteran may file a Supplemental Claim and submit or identify this evidence. 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. Specific instructions for filing a Supplemental Claim are included with this decision.

VA regulations provide that, "[u]pon request, a claimant is entitled to a hearing on any issue involved in a claim . . . before VA issues notice of a decision on an initial or supplemental claim." 38 C.F.R. § 3.103(d)(1). That regulation does not indicate that the claimant is entitled to pre-decisional notice of this optional hearing. In fact, 38 C.F.R. § 3.103(b)(1) provides that, following a decision, "[c]laimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief . . . [including] the right to a hearing on any issue involved in the claim as provided in paragraph (d) of this section ...." Read together with § 3.103(d), the only notice § 3.103(b) requires is that a claimant be provided notice of the right for a hearing with notification of the decision (by definition, a post-decisional notice). In November 2022, VA amended VA Form 21-526EZ and in May 2024 VA amended VA Form 20-0995 to inform claimants of the right to a hearing at any time during the claims process. The November 2024 claims in this appeal were filed on the November 2022 version of the VA Form 21-526EZ and the May 2024 version of the VA Form 20-0995. Therefore, the Board finds that the Veteran has been given proper notice with regard to his right to a hearing.

The Board notes that, in August 2022, the SFC Heath Robinson Honoring Our PACT Act, Pub. L. 117-168, 136 Stat. 1759 ("PACT Act") was passed. Under the PACT Act, VA is required to provide a disability examination and medical nexus opinion when a Veteran submits a compensation claim and has evidence of a disability and participation in a toxic exposure risk activity (TERA), but the evidence is not sufficient to establish service connection for the disability. See 38 U.S.C. § 1168 (a) (see PACT Act, Sec. 303). In this case, the Veteran participated in a TERA. As will be discussed below, there is no evidence of current diagnoses related to hearing loss of either ear, a right knee disability, or a left hand disability. Therefore, the requirement to obtain a TERA-specific examination and opinion does not apply to these claims.

The Veteran has not raised any other issues not addressed herein, to include regarding the duty to notify or the duty to assist, nor have any other issues been reasonably raised by the record.

Service Connection

Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303 (b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d).

To establish a right to compensation for a present disability, a claimant must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement. Shedden v. Principi, 381 F
C.F.R. § 3.303 (b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d).

The law provides for compensation for Persian Gulf Veterans who suffer from a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multi-symptom illness that became manifest during active duty in the Southwest Asia theater of operations or became manifest to a compensable degree within the prescribed presumptive period and by history, physical examination, and laboratory tests, cannot be attributed to any known clinical diagnosis. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. The Board notes that the Veteran qualifies as a Persian Gulf Veteran as he served on active military service in Southwest Asia. See July 2024 VA Memorandum; 38 U.S.C. § 1117 (West 2014); 38 C.F.R. § 3.317 (2024).

1. Entitlement to service connection for bilateral hearing loss is denied.

The Veteran is seeking service connection for bilateral hearing loss.

The threshold requirement for service connection is competent evidence of the existence of the claimed disability at some point during the course of the appeal or in proximity to the claim. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary); see also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

With respect to hearing loss, VA has specifically defined what is meant by a "disability" for the purposes of service connection. See 38 C.F.R. § 3.385. "[I]mpaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when 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."

The Veteran underwent a VA audiological examination in January 2025, at which the Veteran's hearing was noted within normal limits bilaterally according to VA standards. Specifically, none of the auditory thresholds in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz were noted at 40 decibels or greater; auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz were not noted at 26 decibels or greater; and the speech recognition scores using the Maryland CNC Test were at least 94 percent bilaterally.

The Veteran submitted a September 2024 private Report of Consultation and Examination from Dr. A.N., D.C., in which the provider linked hearing loss to the Veteran's service. This report included audiogram results in a graph format. The United States Court of Appeals for Veterans Claims (Court) has held that interpretation of a graphical audiogram is a finding of fact, to be made by the Board in the first instance. Kelly v. Brown, 7 Vet. App. 471 (1995). If the Board is unable to interpret the graphical audiogram due to unclear results or several possible interpretations, then the Board must remand the results for translation by an appropriate specialist. Savage v. Shinseki, 24 Vet. App
2024 private Report of Consultation and Examination from Dr. A.N., D.C., in which the provider linked hearing loss to the Veteran's service. This report included audiogram results in a graph format. The United States Court of Appeals for Veterans Claims (Court) has held that interpretation of a graphical audiogram is a finding of fact, to be made by the Board in the first instance. Kelly v. Brown, 7 Vet. App. 471 (1995). If the Board is unable to interpret the graphical audiogram due to unclear results or several possible interpretations, then the Board must remand the results for translation by an appropriate specialist. Savage v. Shinseki, 24 Vet. App. 259, 270 (2011); see Kelly, 7 Vet. App. at 471.

In this case, the Board is able to interpret the graphical audiogram and notes that the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz were not recorded at 40 decibels or greater in either ear. Furthermore, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz were not recorded at 26 decibels or greater for either ear. Speech recognition scores were not recorded using the Maryland CNC test. As such, the VA criteria for hearing loss were not demonstrated in this audiogram

The claims file contains no other medical evidence reflecting that the Veteran currently meets the criteria for hearing loss of either ear according to VA standards. In the absence of valid puretone tests and Maryland CNC word scores, a current hearing loss disability in either ear for VA purposes cannot be established, and service connection must be denied. 38 C.F.R. § 3.385. Therefore, while the Board recognizes the Veteran's sincere belief in his claim, the competent medical evidence of record does not show that the Veteran has current hearing loss of either ear, according to VA standards.

The Board has considered the Veteran's contention that he has hearing loss related to his service. However, he is not competent to diagnose himself with hearing loss according to VA standards or to provide a link between such a diagnosis and active service, as he has no medical knowledge, training, or expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As such, his statements to that effect are accorded with little probative value.

In summary, for the reasons stated above, the Board finds that the preponderance of the evidence is against the claim for service connection for hearing loss of either ear due to a lack of a current diagnosis, and the benefit-of-the-doubt rule is not for application.

2. Entitlement to service connection for a left hand condition, to include degenerative joint disease, is denied.

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

The Veteran is seeking service connection for a right knee disability and a left hand condition, to include degenerative joint disease.

Upon review of the claims file, the Board finds that there is no medical evidence or record showing that the Veteran has a current diagnosis related to a right knee disability or a left hand condition throughout the period of time on appeal.

In a September 2024 private Report of Consultation and Examination from Dr. A.N., D.C., the provider noted that the Veteran suffered progressive pain and dysfunction of the right knee and diagnosed the Veteran with right knee pain. The provider also diagnosed the Veteran with left wrist and hand pain. No specific disabilities related to the right knee or the left hand or wrist were identified.

In a January 2025 VA knee examination, the examiner noted that no functional loss or impairment of the right knee was reported. In a January 2025 VA hand and fingers examination, the Veteran's left hand was noted as normal, and no disability was diagnosed. There is no other medical evidence of record documenting a right knee or left hand disability.

The Court has held that the requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 312 (2007). A claimant may be granted service connection even though the disability resolves prior to the Secretary's adjudication of the claim. Id.

In this case, no medical evidence of record has reflected the existence of these claimed disabilities at the time the claims for VA disability compensation were filed in 2024 or during the pendency of the claims.

In the absence of proof of related current disability, there
right knee or left hand disability.

In the absence of proof of related current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. Therefore, as there is no probative evidence reflecting that the Veteran has current diagnoses of a right knee disability or a left hand disability, service connection cannot be granted for these claimed disabilities.

The Board notes that the Veteran is competent to report symptoms such as pain. Historically, symptoms such as pain, without a diagnosed or identifiable underlying malady, were not sufficient to establish a current disability for VA compensation purposes. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999) (Sanchez-Benitez I). However, in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the United States Court of Appeals for the Federal Circuit rejected such a theory, holding that pain can constitute a current disability under 38 U.S.C. § 1110, so long as it results in functional impairment of earning capacity.

Here, the Veteran has not established that he has right knee or left hand pain that results in a functional impairment which limits his earning capacity in any way. There is simply no medical evidence in the record documenting such. While the provider noted in the September 2024 private Report of Consultation and Examination that the Veteran suffered from right knee pain and dysfunction and left hand and wrist pain, it does not appear that his claimed conditions have required him to seek treatment on any regular basis, nor does he indicate that he has lost work opportunities or that his earning capacity has been impaired as a result of these claimed conditions. Consequently, the Board finds that the Veteran has not alleged any specific complaints that would qualify as a current disability for VA purposes under Sanchez-Benitez I and Saunders.

With regard to granting service connection on a presumptive basis under 38 C.F.R. § 3.317, the Board notes that the Veteran complained of knee pain in the September 2024 private Report of Consultation and Examination. However, the Veteran specifically reported no functional loss or impairment at the January 2025 VA examination. Therefore, service connection cannot be granted as due to an undiagnosed illness on a presumptive basis under 38 C.F.R. § 3.317, given the inconsistency in the record as to whether the Veteran has any related impairment or symptoms.

With regard to the Veteran's claimed left hand disability, the Board notes that a March 2012 service treatment record revealed that the Veteran had a left hand sprain, and a July 2012 VA examination report noted that the Veteran had a resolved right hand strain. Therefore, service connection cannot be granted as due to an undiagnosed illness on a presumptive basis under 38 C.F.R. § 3.317, as the evidence clearly showed that the Veteran had a prior history of a left hand injury, even if he does not currently have a diagnosed disability.

The Board has considered the Veteran's assertion that he should be granted service connection for his claimed right knee and left hand disabilities. However, the Board finds that the Veteran is not competent to diagnose himself with a right knee or a left hand disability during the period of time on appeal, as he has no medical education, training, or expertise. Jandreau, supra. As such, the Veteran's opinion is afforded little weight in that regard.

In summary, for the reasons stated above, the Board finds that the preponderance of the evidence is against the claims for service connection for a right knee disability and a left hand disability, and the benefit-of-the-doubt rule is not for application.

4. Entitlement to service connection for a sebaceous cyst is denied.

In his November 25, 2024, VA Form 21-526EZ, the Veteran indicated that he was seeking service connection for sebaceous cyst residual scarring. In support of his claim, the Veteran submitted a September 2024 private Report of Consultation and Examination from Dr. A.N., D.C., in which the provider noted that the Veteran developed a sebaceous cyst that had be surgically removed while at Dover Air Force Base. The provider noted that the cyst was between the scapulae, and a deep 1-inch-long scar remains. The provider linked this condition to his active duty service.

The Board concludes the service treatment records do not support this history. An April 2008 service treatment record noted a lump in/on the skin, without identifying the location, and the Veteran was referred to dermatology. The June 2008 dermatology notes show a biopsy on the right nasal bridge, determined to be basal cell carcinoma. Therefore, the "lump" shown in his medical history in records dated after 2008 was a reference to this treatment. There is no indication of a sebaceous cyst in the scapulae in the service records. In February 2011, the Veteran was again referred to dermatology from Dover AFB, where he underwent a thorough "upper body" physical examination that identified various skin issues, but not a sebaceous cyst anywhere on the body, nor any indication a surgical procedure was needed to remove a cyst. In March 2012, so just prior to his separation from active duty, he underwent an examination during which he denied any skin problems.

Despite the Veteran's comment to the private provider that he had a sebaceous cyst removed during service, that history is not credible and is directly refuted by the service treatment records. He was seen by dermatology during service, but those records, including those examinations, do not show he was diagnosed with a sebaceous cyst that was then removed. That history is also not credible in light of his VA claims history and initial VA examination. Prior to separating from service, the Veteran filed VA compensation claims, to include for skin conditions. He did not mention a sebaceous cyst. Since he was claiming skin conditions, the fact he did not claim a sebaceous cyst with removal weighs heavily against his statements now, as it is reasonable to expect he would have claimed all skin conditions that occurred during service. Moreover, he had a VA skin examination in 2012 in connection with his initial claims. He did not report a prior sebaceous cyst/removal to the VA examiner. Since this exam was being performed in connection with his compensation claims, it is reasonable to expect he would have told the examiner all the skin conditions he was treated for during service, so the fact he did not mention a sebaceous cyst weighs against his current allegations.

As there is no credible evidence of an in-service sebaceous cyst, the September 2024 private examiner's opinion was based on an inaccurate history and has no probative value. The Board finds that the preponderance of the evidence is against the claim for service connection for a sebaceous cyst, and the benefit-of-the-doubt rule is not for application.

Increased Rating

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1. Where the Veteran timely appealed the rating initially assigned for the service-connected disability within one year of the notice of the establishment of service connection for it, VA must consider whether the Veteran is entitled to "staged" ratings to compensate him or her for times since filing his or her claim when his or her disability may have been more severe than at other times during the course of his or her appeal. See Fenderson v. West, 12 Vet. App. 119 (1999). But where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in such cases, when the factual findings show distinct time periods during which a claimant exhibits symptoms of the disability at issue and such symptoms warrant different evaluations, staged evaluations may also be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007).

When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996).

In reviewing the Veteran's appeal for an increased rating, the Board has not overlooked the holding of the Court in Rice v. Shinseki, 22 Vet. App. 447 (2009) [holding that claims for higher evaluations also include a claim for entitlement to unemployability (TDIU) when the appellant claims he or she is unable to work due to a service-connected disability]. However, as the Veteran has not asserted and the evidence of record does not suggest that he is unemployable as a result of his service-connected disabilities on appeal, the Board finds that this issue should not be construed as being on appeal at this time. See Rice, 22 Vet. App. 447, citing Comer v. Peake, 552 F.3d 1362 (Fed. Cir. 2009).

Period on Appeal

On April 5, 2024, the Veteran submitted a VA Form 21-0966, Intent to File a Claim. On November 25, 2024, the Veteran submitted a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, requesting increased ratings for his service-connected disabilities on appeal. Therefore, the relevant rating period begins April 5, 2024, the date the Veteran submitted his Intent to File a Claim. With the exception of sinusitis, as the initial rating is on appeal, the Board will generally review evidence from the one year "look back period" preceding the submission of the claim to see if worsening was shown. See 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

1. Entitlement to an evaluation in excess of 10 percent for service-connected residuals of a left ankle fracture is denied.

In the January 29, 2025, rating decision on appeal, the Regional Office (RO) increased the evaluation assigned to the Veteran's service-connected residuals of a left ankle fracture to 10 percent, effective April 5, 2024, under Diagnostic Code 5271. The Veteran is seeking a higher evaluation.

Diagnostic Code 5271 contemplates disability of the ankle manifested by limitation of motion. Normal range of motion of the ankle includes plantar flexion from 0 degrees to 45 degrees and dorsiflexion (extension) from 0 degrees to 20 degrees. 38 C.F.R. § 4.71a, Plate II.

Under
residuals of a left ankle fracture is denied.

Under Diagnostic Code 5271, a 10 percent rating is assigned when limitation of motion is moderate (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion), and a 20 percent rating is assigned when limitation of motion is marked (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). 38 C.F.R. § 4.71a.

With regard to granting an evaluation in excess of 10 percent under Diagnostic Code 5271, the Board acknowledges that the January 2025 VA examination revealed left ankle plantar flexion at 35 degrees and left ankle dorsiflexion at 20 degrees. No additional limitation was noted upon repetitive testing. In a September 2024 private Report of Consultation and Examination from Dr. A.N., D.C., the provider noted that the Veteran's dorsiflexion and plantar flexion were mildly decreased. The claims file contains no other medical evidence of record documenting more severe limitation of motion during the appeal period.

Therefore, as there is no medical evidence of record reflecting that the Veteran's left ankle demonstrates dorsiflexion to less than 5 degrees dorsiflexion or plantar flexion to less than 10 degrees, an increased rating is not warranted under Diagnostic Code 5271.

The Board has reviewed alternative diagnostic codes under which the Veteran could receive increased ratings for his service-connected left ankle disability. However, the Board finds them to be inapplicable in this case. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270-5274. Specifically, the Veteran's service-connected left ankle disability does not manifest with ankylosis of the ankle (Diagnostic Code 5270), ankylosis of the subastragalar or tarsal joint (Diagnostic Code 5272), malunion of os calcis or astragalus (Diagnostic Code 5273), or astragalectomy (Diagnostic Code 5274). As such, increased or separate evaluations are not available for this disability under these diagnostic codes.

The Board has considered the holding of the Court in Chavis v. McDonough, 34 Vet. App. 1 (2021), that ankylosis can be demonstrated by functional equivalent. In this case, the Board finds that the evidence of record demonstrates no such left ankle impairment consistent with the functional equivalent of ankylosis, even considering the Veteran's subjective complaints. See January 2025 VA examination report. Even when pain and subjective symptoms were considered, the Veteran's left ankle disability did not manifest with impairment consistent with the functional equivalent of ankylosis. He has not alleged functional impairment comparable to that experienced by an individual with immobility of the ankle. His symptoms are fully contemplated by the assigned schedular rating. The DeLuca concepts of functional loss, painful motion, etc. are still used to apply the rating criteria found in the diagnostic codes. Thompson v. McDonald, 815 F.3d 781 (Fed. Cir. 2016) and Mitchell v. Shinseki, 25 Vet. App. 32, 36 (2011). The Thompson court explained: "Section 4.40 also makes clear that functional loss may be due to pain and that pain may render a part seriously disabled. When evaluating a disability, § 4.40 provides a broad canvas. However, whatever the background, an applicant for disability benefits is rated based on the criteria set forth in § 4.71a." Thompson, 815 F.3d at 786.

In sum, while the medical evidence of record has indicated that the Veteran's disability affects his mobility, the evidence does not reflect that this limitation is equivalent to ankylosis or that the Veteran does not retain some range of motion. Therefore, the Board finds there is no evidence in the record reflecting that the Veteran's service-connected disability manifests with ankylosis of the left ankle or with the functional equivalent of ankylosis. An
disabled. When evaluating a disability, § 4.40 provides a broad canvas. However, whatever the background, an applicant for disability benefits is rated based on the criteria set forth in § 4.71a." Thompson, 815 F.3d at 786.

In sum, while the medical evidence of record has indicated that the Veteran's disability affects his mobility, the evidence does not reflect that this limitation is equivalent to ankylosis or that the Veteran does not retain some range of motion. Therefore, the Board finds there is no evidence in the record reflecting that the Veteran's service-connected disability manifests with ankylosis of the left ankle or with the functional equivalent of ankylosis. An increased evaluation is not warranted under the diagnostic criteria for rating ankle disabilities on the basis of ankylosis.

With respect to the possibility of assigning a higher rating for any period of time on appeal under 38 C.F.R. §§ 4.40 and 4.45, there is no indication in the medical evidence of record, to include the January 2025 VA ankle examination report, that any subjective complaints, such as pain, fatigue, incoordination, or weakness, result in additional limitation of function so as to meet the criteria for a higher evaluation than has already been assigned or for any separate evaluations for any period of time on appeal. As such, an increased rating is not warranted under 38 C.F.R. §§ 4.40 and 4.45 or DeLuca.

In summary, the Board finds that the Veteran's service-connected residuals of a left ankle fracture does not warrant an evaluation in excess of 10 percent, effective April 5, 2024.

Additionally, as noted above, the Board will generally review evidence from the one year "look back period" preceding the submission of the claim to see if worsening was shown. See 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). In this case, there is no pertinent evidence submitted within the one-year look back period prior to the April 5, 2024, claim. As such, an increased rating could not be assigned prior to April 5, 2024, on that basis.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

2. Entitlement to an initial compensable evaluation for service-connected chronic sinusitis is denied.

In a January 2025 rating decision, the AOJ granted service connection for chronic sinusitis and assigned a noncompensable evaluation, effective April 5, 2024, under Diagnostic Code 6512. The Veteran is seeking a higher evaluation.

Under the General Rating Formula for Sinusitis, a noncompensable disability rating is warranted for sinusitis detected by X-ray only. A 10 percent disability rating is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent disability rating is warranted for three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent disability rating is warranted following radical surgery with chronic osteomyelitis, or for near constant sinusitis characterized by headaches, pain, and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. Pursuant to the Note for the General Formula, an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97, Diagnostic Code 6512.

Upon review of all evidence of record, the Board finds that a compensable rating for chronic sinusitis is not warranted under Diagnostic Code 6512. Specifically, there is no evidence reflecting that the Veteran had incapacitating episodes of sinusitis requiring antibiotic treatment for at least four weeks, or at least three non-incapacitating episodes of sinusitis per year characterized by headaches, pain, and purulent discharge or crusting. In a September 2024 private Report of Consultation and Examination, Dr. A.N., D.C. noted the Veteran's complaints of congestion of the maxillary sinuses with difficulty breathing and facial pain. At a January 2025 VA examination, the Veteran reported that his current symptoms included snoring, sinus pressure, and congestion. The Veteran reported episodes of sinusitis but none in the past several years. He denied taking medications for this sinusitis. The Veteran did not report having any incapacitating episodes of sinusitis. The Board notes that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician under 38 C.F.R. § 4.97, and there is no evidence that the Veteran's sinusitis required bed rest. The Veteran also did not report having non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge or crusting.

In short, the Board has reviewed the medical evidence and it does not indicate that the Veteran had one or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three or more non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting, to warrant the next highest rating of 10 percent under 38 C.F.R. § 4.97, Diagnostic Code 6512. Moreover, the evidence does not show that the Veteran had radical surgery with chronic osteomyelitis, or near constant chronic sinusitis. As such, an increased rating is not warranted under Diagnostic Code 6512.

The Board has reviewed alternative diagnostic codes under which the Veteran could receive increased ratings for his service-connected chronic sinusitis. However, the Board finds that the General Rating Formula for Sinusitis is the most appropriate method for evaluating the Veteran's symptoms related to his sinusitis.

3. Entitlement to a compensable evaluation of service-connected laceration scars of the chin is denied.

The Veteran's service-connected laceration scars of the chin are assigned a noncompensable evaluation under Diagnostic Code 7800. The Veteran is seeking a higher evaluation.

Diagnostic Code 7800 applies to scar(s) or other disfigurement of the head, face, or neck. 38 C.F.R. § 4.118, Diagnostic Code 7800. Under Diagnostic Code 7800, a 10 percent rating is assigned for burn scar(s) of the head, face, or neck, scar(s) of the head, face, or neck due to other causes, or other disfigurement of the head, face, or neck with one characteristic of disfigurement. A 30 percent rating is assigned for such scars with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with two or three characteristics of disfigurement. A 50 percent rating is assigned for such scars with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of
other disfigurement of the head, face, or neck with one characteristic of disfigurement. A 30 percent rating is assigned for such scars with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with two or three characteristics of disfigurement. A 50 percent rating is assigned for such scars with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of disfigurement. An 80 percent rating is assigned for such scars with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with six or more characteristics of disfigurement. 38 C.F.R. § 4.118, Diagnostic Code 7800 (2024).

Note (1) provides the eight characteristics of disfigurement, for purposes of evaluation under § 4.118, are: (1) scar five or more inches (13 or more cm. in length); (2) scar at least one-quarter inch (0.6 cm.) wide at widest part; (3) surface contour of scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.); (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches; (7) underlying soft tissue missing in an area exceeding six square inches; (8) skin indurated and inflexible in an area exceeding six square inches. 38 C.F.R. § 4.118, Diagnostic Code 7800, Note (1).

Note (2) reflects that tissue loss of the auricle should be rated under Diagnostic Code 6207 (loss of auricle).

Note (3) provided that consideration should be given to unretouched color photographs when evaluating under these criteria.

Note (4) provides that disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, should be separately evaluated under the appropriate diagnostic code(s), and § 4.25 should be applied to combine the evaluation(s) with the evaluation assigned under this diagnostic code.

Note (5) to Diagnostic Code 7800 provides that the characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation.

Upon review of the file, the Board finds no evidence of record supporting an increased compensable evaluation under Diagnostic Code 7800. Specifically, the evidence of record, to include the January 2025 VA examination report, does not reflect that Veteran's service-connected laceration scars of the chin manifests with visible or palpable tissue loss and either gross distortion or asymmetry of at least one feature or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with one or more characteristics of disfigurement. The Veteran underwent a pertinent VA examination in January 2025, at which he was noted as having one scar on his chin that was 1.25 centimeters by 0.1 centimeters. The examiner noted that there was no elevation, depression, or adherence to underlying tissue. There is no medical evidence demonstrating otherwise. As such, a compensable evaluation is not available under Diagnostic Code 7800.

The Board has considered whether the Veteran's service-connected scars would warrant a separate or increased rating under any other diagnostic code. In this case, Diagnostic Codes 7801 and 7802 are not applicable, as they pertain to scars other than the head, face, or neck. The Board has reviewed the remaining diagnostic codes relating to diseases of the skin but finds Diagnostic Codes 7800 is the most appropriate diagnostic code to apply in this case, and an increased evaluation is not available for the Veteran's complaints under any other relevant diagnostic codes.

In summary, for the reasons and bases set forth above, the Board concludes that the preponderance of the evidence does not support the Veteran's claim for an increased rating. The benefit of the doubt rule enunciated in 38 U.S.C. § 510
increased rating under any other diagnostic code. In this case, Diagnostic Codes 7801 and 7802 are not applicable, as they pertain to scars other than the head, face, or neck. The Board has reviewed the remaining diagnostic codes relating to diseases of the skin but finds Diagnostic Codes 7800 is the most appropriate diagnostic code to apply in this case, and an increased evaluation is not available for the Veteran's complaints under any other relevant diagnostic codes.

4. Entitlement to a compensable evaluation for service-connected dermatitis is dismissed.

In a January 29, 2025, rating decision, the AOJ continued a noncompensable evaluation for service-connected dermatitis (also claimed as eczema). On the February 20, 2025, VA Form 10182, the Veteran appealed the evaluation continued in the January 2025 rating decision and indicated that he believed that a 20 percent evaluation should be assigned.

While the Board cannot consider evidence post-dating the decision on appeal, it can consider the legal effect of subsequent decisions on the appealed issue. Here, in an April 15, 2025, rating decision, the AOJ recharacterized the Veteran's disability as dermatitis with basal cell carcinoma on right nasal area and hyperhidrosis (also claimed as eczema) and assigned a 30 percent evaluation, effective April 5, 2024. On a June 2, 2025, VA Form 10182, the Veteran appealed the evaluation assigned in the April 2025 rating decision and indicated that he believed that a 60 percent evaluation should be assigned.

Notably, the January 2025 and April 2025 rating decisions both addressed increased rating claims for the same service-connected disability dating back to the April 5, 2024, Intent to File a Claim. The Veteran's February 20, 2025, appeal for a compensable evaluation under docket number 250220-527175 specifically indicated that that the Veteran was seeking a 20 percent evaluation. The Veteran's June 2, 2025, appeal for an evaluation in excess of 30 percent for his service-connected disability was addressed by the Board in a March 2026 decision under docket number 250602-551881.

Therefore, as the Veteran's service-connected disability has already been assigned an evaluation in excess of the 20 percent evaluation he was seeking in the February 20, 2025, appeal, for the entire period of time on appeal or dating back to the April 5, 2024, Intent to File a Claim, the Board finds that the benefit that the Veteran was seeking in the February 20, 2025, appeal has been satisfied while the present appeal was pending. Therefore, the Board no longer has jurisdiction over the Veteran's claim for a compensable evaluation for the service-connected disability on appeal. His appeal as to this issue is rendered moot by the subsequent grant of the 30 percent evaluation, effective April 5, 2024, for this disability, which more than satisfied his request for a 20 percent evaluation in his February 2025 VA Form 10182. As there remains no case or controversy to resolve with regard to this issue, the appeal is dismissed. 38 U.S.C. § 7105(d)(5).

In dismissing this claim,
Veteran was seeking in the February 20, 2025, appeal has been satisfied while the present appeal was pending. Therefore, the Board no longer has jurisdiction over the Veteran's claim for a compensable evaluation for the service-connected disability on appeal. His appeal as to this issue is rendered moot by the subsequent grant of the 30 percent evaluation, effective April 5, 2024, for this disability, which more than satisfied his request for a 20 percent evaluation in his February 2025 VA Form 10182. As there remains no case or controversy to resolve with regard to this issue, the appeal is dismissed. 38 U.S.C. § 7105(d)(5).

In dismissing this claim, it is noted that the Board cannot dismiss an increased rating appeal for a disability for which an increased rating has already been granted without consideration of the effective date consequences of such a grant. See Johnson v. Collins, 38 Vet. App. 151 (2025) (finding an appeal moot "only if it is impossible to grant any effectual relief whatsoever."). In this case, the Veteran sought a 20 percent evaluation in his February 2025 VA Form 10182. Subsequently, the RO satisfied his request by granting a 30 percent evaluation to this disability, effective April 5, 2024, the entire appeal period. To the extent, that the Veteran indicated in his June 2, 2025, appeal that he wished to be assigned a 60 percent disability for this disability, the Board notes that that request was addressed in a separate March 2026 Board determination under docket number 250602-551881. Notably, the appeal period for that appeal stream also dated back to April 5, 2024.

For the reasons above, there is no longer any specific determination with which the Veteran disagreed on his February 2025 appeal before the Board that could result in any additional benefit to the Veteran. Therefore, dismissal of the claim is warranted. 38 U.S.C. § 7105 (d).

REASONS FOR REMAND

1. Entitlement to service connection for recurrent tinnitus is remanded.

The Veteran is seeking entitlement to service connection for recurrent tinnitus.

In a September 2024 private Report of Consultation and Examination, Dr. A.N. D.C. concluded that it is as likely as not that the Veteran's tinnitus is directly and causally related to the acoustic trauma from aircraft engines, flight line, and generators.

In January 2025, the Veteran underwent a VA examination, at which he reported tinnitus with an onset of about 2004. The examiner determined that his tinnitus was not at least as likely as not caused by or a result of military noise exposure. The examiner noted that the Veteran was somewhat unsure of the date of onset of tinnitus, but his best estimate was that the onset of tinnitus was about 2004. The claims file refutes the Veteran's claim with 21 hearing examinations in service and no complaints of tinnitus. The Veteran specifically denied tinnitus at February 1999 and February 2000 hearing conservation examinations. The Veteran denied tinnitus at August 2003, December 2005, July 2005, February 2006, and March 2008 examinations. Tinnitus was not marked on the July 2012 VA general examination. The first report of tinnitus was from the September 2024 private consultation in preparation for his disability filing, 12 years post active duty. Therefore, it is less likely than not that the Veteran's current tinnitus is a result of active duty military noise exposure.

The Board does not find the September 2024 private opinion sufficient to grant the claim at this time. Specifically, the September 2024 private opinion failed to discuss the Veteran's history regarding his denial of or failure to report tinnitus on several occasions throughout service and at the July 2012 VA examination. However, as no opinion was obtained regarding the Veteran's claimed tinnitus and his in-service TERAs, the Board finds that a VA opinion must be obtained on this matter in accordance with the provisions of 38 U.S.C. § 1168 (a). If the claim continues to be denied and the Veteran again appeals to the Board, the full probative weight to be assigned the September 2024 private opinion will be addressed in a subsequent decision on the merits.

2. Entitlement to service connection for left hip pain is remanded.

3. Entitlement to service connection for post-surgical right hip pain is remanded.

The Veteran is seeking service connection for bilateral hip pain. Specifically, in his November 25, 2024, VA Form 21-526EZ, the Veteran reported that he had bilateral hip pain secondary
, the Board finds that a VA opinion must be obtained on this matter in accordance with the provisions of 38 U.S.C. § 1168 (a). If the claim continues to be denied and the Veteran again appeals to the Board, the full probative weight to be assigned the September 2024 private opinion will be addressed in a subsequent decision on the merits.

2. Entitlement to service connection for left hip pain is remanded.

3. Entitlement to service connection for post-surgical right hip pain is remanded.

In support of his claim, the Veteran submitted a September 2024 private Report of Consultation and Examination, in which Dr. A.N., D.C. linked the Veteran's right and left hip disabilities to his left knee disability. Specifically, the provider concluded that the Veteran developed bilateral hip pain as a result of an altered gait due to his left knee disability. The Veteran reported that he has been advised that he needs a total left hip joint replacement. The provider noted that the Veteran underwent a total right hip replacement in 2021.

As the provider failed to provide specific current diagnoses for the Veteran's claimed disabilities other than pain, and failed to discuss the Veteran's medical history in any detail, the Board finds this opinion is not sufficient to grant service connection for these claimed disabilities at this time. However, as the September 2024 private opinion suggests that the Veteran suffers at minimum hip pain and at most some sort of hip disability that has required or will require a total hip replacement that could be related to a service-connected left knee disability, the Board finds that these issues must be remanded in order to schedule the Veteran for a VA examination and to obtain etiological opinions on these matters. If the claims continue to be denied and the Veteran again appeals to the Board, the full probative weight to be assigned the September 2024 private opinion will be addressed in a subsequent decision on the merits.

In this regard, the Board notes that, in VA's sub-regulatory guidance, an exception applies to the provisions of 38 U.S.C. § 1168 (a) for claims based on physical trauma. VBA Letter 20-24-06, Exception to TERA Examination and Medical Opinion Requirement at page 12 (June 12, 2024). Therefore, the Board has no basis under the PACT Act upon which to order a medical examination/opinion related to the Veteran's hip pain, as there is no indication that this disability could be directly related to service due to anything other than physical trauma.

The matters are REMANDED for the following action:

1. Obtain a VA medical opinion addressing the etiology of the Veteran's claimed tinnitus. Upon review of the claims file, the examiner should opine as to whether it is at least as likely as not that the Veteran's tinnitus is related in any way to any conceded in-service TERAs.

The examiner must address the synergistic, combined effect of all of the Veteran's TERAs.

The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. If the examiner determines that additional examination is needed to respond to the questions above, such should be provided.

2. Schedule the Veteran for a VA examination for his claimed left and right hip disabilities. Upon examination of the Veteran and review of the claims file, the examiner should respond to the following:

" Diagnose the Veteran with all current disabilities related to both hips.

" If the Veteran has a related diagnosis of either hip, opine as to whether it is at least as likely as not that the Veteran's diagnosed hip disabilities began during, or were caused by, his service.

" If the Veteran has a related diagnosis of either hip, opine as to whether it is at least as likely as not that the Veteran's diagnosed hip disabilities were caused or aggravated by his service-connected left knee disability. See September 2024 opinion, received 11/25/24; January 2025 VA examination.

" If no diagnosis is rendered related to either hip, opine as to whether the Veteran's symptoms related to his hips are at least as likely as not at attributable to an undiagnosed illness or a diagnosable but MUCMI, in that either the etiology or pathophysiology is unknown or inconclusive.

The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached.

MICHELLE L. KANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L. Durham, Counsel

The Board's decision in this case is binding

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