THORACOLUMBAR OR LUMBAR SPINE LIMITATION OF MOTION

Summary

The Veteran served in the U.S. military from July 1990 to September 2005, with service periods including time in the Southwest Asia theatre of operations. The Veteran sought service connection for multiple conditions, including OSA, ED, headaches, sinusitis, vertigo, neck disability, bilateral upper extremity radiculopathy, voiding dysfunction, back disability, bilateral hip pain, bilateral wrist pain, pseudo folliculitis barbae, and right ear hearing loss. The Board granted service connection for OSA, ED, headaches, sinusitis, vertigo, neck disability, bilateral upper extremity radiculopathy, voiding dysfunction, and back disability. Service connection was denied for pseudo folliculitis barbae, bilateral hip pain, bilateral wrist pain, and right ear hearing loss. The Board found the criteria for service connection were met for the granted conditions, noting that ED, headaches, OSA, and vertigo were secondary to service-connected PTSD, while chronic sinusitis was granted presumptively due to toxic exposure risk activity (TERA) in Southwest Asia. The neck disability and bilateral upper extremity radiculopathy were granted based on onset during service. The denied conditions were not granted due to a lack of indication of diagnosis or functional impairment close in proximity to or during the pendency of the claim, or in the case of right ear hearing loss, a lack of indication of disability for VA purposes.

Rationale

Criteria for service connection met; Worsened by service-connected right knee strain

Full Decision Text

Citation Nr: A26029227
Decision Date: 03/31/26	Archive Date: 03/31/26

DOCKET NO. 251119-607611
DATE: March 31, 2026

ORDER

Service connection for a lower back disability is granted.

Service connection for erectile dysfunction (ED) is granted.

Service connection for headaches is granted.

Service connection for obstructive sleep apnea (OSA) is granted.

Service connection for chronic sinusitis is granted.

Service connection for vertigo is granted.

Service connection for a neck disability is granted.

Service connection for right upper extremity radiculopathy is granted.

Service connection for left upper extremity radiculopathy is granted.

Service connection for voiding dysfunction is granted.

Service connection for pseudo folliculitis barbae is denied.

Service connection for right wrist pain is denied.

Service connection for left wrist pain is denied.

Service connection for right hip pain is denied.

Service connection for left hip pain is denied.

Service connection for right ear hearing loss is denied.

FINDINGS OF FACT

1. The Veteran is diagnosed with lumbar sprain which is worsened by the service connected right knee strain.

2. The Veteran is diagnosed with ED which is worsened by the service-connected PTSD.

3. The Veteran is diagnosed with tension headaches which are worsened by the service-connected PTSD. 

4. The Veteran is diagnosed with OSA which is worsened by the service-connected PTSD. 

5.  The Veteran is diagnosed with chronic sinusitis due to his participation in a toxic exposure risk activity (TERA) during the Veteran's service in South West Asia (SWA).

6. The Veteran is diagnosed with vertigo which had its onset during service.

7.  The Veteran is diagnosed with a neck disability which had its onset during the Veteran's combat service.

8.  The Veteran is diagnosed with right upper extremity radiculopathy that had its onset during service. 

9.  The Veteran is diagnosed with left upper extremity radiculopathy that had its onset during service.

10.  The Veteran is diagnosed with voiding dysfunction which had its onset during service.

11. There is no indication of a diagnosis of pseudo folliculitis barbae close in proximity to or during the pendency of the claim.

12. There is no indication of a diagnosis of right wrist pain which causes functional impairment of earning capacity close in proximity to or during the pendency of the claim.

13. There is no indication of a diagnosis of left wrist pain which causes functional impairment of earning capacity close in proximity to or during the pendency of the claim.

14. There is no indication of a diagnosis of right hip pain which causes functional impairment of earning capacity close in proximity to or during the pendency of the claim.

15. There is no indication of a diagnosis of left hip pain which causes functional impairment of earning capacity close in proximity to or during the pendency of the claim.

16. The Veteran does not have a right ear hearing loss disability for VA compensation purposes.

CONCLUSIONS OF LAW

1. The criteria for service connection for a lower back disability are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2.  The criteria for service connection for erectile dysfunction (ED) are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for tension headaches are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4.  The criteria for service connection for OSA are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5.  The criteria for presumptive service connection for chronic sinusitis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309(a).

6.  The criteria for service connection for vertigo are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

7.  The criteria for service connection for a neck disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

8.  The criteria for service connection for right upper extremity radiculopathy
. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309(a).

6.  The criteria for service connection for vertigo are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

7.  The criteria for service connection for a neck disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

8.  The criteria for service connection for right upper extremity radiculopathy are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303

9.  The criteria for service connection for left upper extremity radiculopathy are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for service connection for a voiding dysfunction are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

11. The criteria for service connection for pseudo folliculitis barbae are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

12.  The criteria for service connection for right wrist pain are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

13.  The criteria for service connection for left wrist pain are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

14.  The criteria for service connection for right hip pain are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

15.  The criteria for service connection for left hip pain are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

16. The criteria for service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1990 to June 2000, from February 2002 to September 2002, from February 2003 to March 2005, and from April 2005 to September 2005, including service in the Southwest Asia (SWA) theatre of operations.

The rating decisions on appeal were issued in November 2024 and February 2025 and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

By way of history, the Veteran filed a new November 2023 claim seeking service connection for, as relevant here, OSA and hearing loss in the right ear. In January 2024, the Veteran another new claim seeking, as relevant here, service connection for OSA. The agency of original jurisdiction (AOJ) issued a March 2024 rating decision denying service connection for both claims. 

The Veteran then filed a July 2024 supplemental claim seeking service connection for OSA and right ear hearing loss. On that same day, the Veteran filed a new claim seeking service connection for ED, frequent urination, neck pain, headaches, sinusitis, vertigo, back pain, bilateral hip pain, bilateral wrist pain, bilateral upper extremity radiculopathy, and pseudofolliculitis barbae. In the November 2024 rating decision on appeal, the AOJ denied service connection for OSA, back pain, bilateral hip pain, bilateral wrist pain, and right ear hearing loss, and deferred a decision on the rest of the claims. In December 2024, the AOJ deferred a decision on ED, frequent urination, neck disability, headaches, sinusitis, vertigo, bilateral upper extremity radiculopathy, and pseudo folliculitis. In the February 2025 rating decision on appeal, the AOJ denied all of the deferred claims.

The Veteran then filed three November 2025 Notices of Disagreement appealing the denial of all of
iculopathy, and pseudofolliculitis barbae. In the November 2024 rating decision on appeal, the AOJ denied service connection for OSA, back pain, bilateral hip pain, bilateral wrist pain, and right ear hearing loss, and deferred a decision on the rest of the claims. In December 2024, the AOJ deferred a decision on ED, frequent urination, neck disability, headaches, sinusitis, vertigo, bilateral upper extremity radiculopathy, and pseudo folliculitis. In the February 2025 rating decision on appeal, the AOJ denied all of the deferred claims.

The Veteran then filed three November 2025 Notices of Disagreement appealing the denial of all of the above mentioned claims.  

In the three November 19, 2025 VA Forms 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the November 2024 and February 2025 AOJ decisions on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Forms 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service.  38?U.S.C. §?1110; 38?C.F.R. §?3.303. 

Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b).

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

For any Veteran who engaged in combat with the enemy in active service of the United States during a period of war, campaign, or expedition, VA shall accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by that service satisfactory lay or other evidence of service incurrence or aggravation of that injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of that incurrence or aggravation in such service.  VA shall resolve every reasonable doubt in favor of the Veteran.  Service connection of that injury or disease may be rebutted by clear and convincing evidence to the contrary.  38 U.S.C. §1154(b); see also Collette v. Brown, 82 F.3d 389 (Fed. Cir. 1996) (under 38 U.S.C. §1154(b), a combat veteran's assertions of an event during combat are to be presumed if consistent with the time, place, and circumstances of such service). 

In Maxson v. Gober, the Federal Circuit stated that the combat presumption is an "evidenti
 is no official record of that incurrence or aggravation in such service.  VA shall resolve every reasonable doubt in favor of the Veteran.  Service connection of that injury or disease may be rebutted by clear and convincing evidence to the contrary.  38 U.S.C. §1154(b); see also Collette v. Brown, 82 F.3d 389 (Fed. Cir. 1996) (under 38 U.S.C. §1154(b), a combat veteran's assertions of an event during combat are to be presumed if consistent with the time, place, and circumstances of such service). 

In Maxson v. Gober, the Federal Circuit stated that the combat presumption is an "evidentiary mechanism [that] involves a three-step analysis." 230 F.3d 1330, 1332 (Fed. Cir. 2000). The first two steps require (1) determining "whether the veteran has presented 'satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease'" and (2) determining "whether the evidence is 'consistent with the circumstances, conditions, or hardships of such service.'"  Id. at 1323-33 (quoting 38 U.S.C. §1154(b)).  The Federal Circuit established that, "[i]f these two steps are met, the Secretary shall accept the evidence as 'sufficient proof of service-connection,' regardless of the absence of official records."  Id. at 1333 (quoting 38 U.S.C. §1154(b)). The third step then requires an analysis of whether service connection "may be rebutted by clear and convincing evidence to the contrary." 38 U.S.C. §1154(b); Maxson, 230 F.3d at 1333.

The combat presumption not only allows the occurrence of both the "cause" of a disability, but the "disability itself." See Reeves v. Shinseki, 682 F.3d 988, 998-9 (Fed. Cir. 2012) ("In short, although the record contained evidence of the cause of Reeves' disability... he still had the right to invoke the section 1154(b) presumption in order to show that he incurred the disability itself while in service.") (citing Shedden, 381 F.3d at 1166-67).

The combat presumption reduces for veterans who have engaged in combat the burden of presenting evidence of incurrence of an injury in service but does not eliminate the nexus requirement. Collette, 82 F.3d at 392.  The Veteran must show that the disability he incurred in service was a chronic condition that persisted in the years following his active duty. Reeves, 682 F.3d. at 988. 

A layperson is competent to report on the onset and continuity of his current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994).  It is the Board's principal responsibility to assess the credibility, and therefore the probative value of the evidence of record in its entirety. Owens v. Brown, 7 Vet. App. 429 (1995); Elkins v. Gober, 229 F.3d 1369 (Fed. Cir. 2000); Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997); Guimond v. Brown, 6 Vet. App. 69 (1993); Hensley v. Brown, 5 Vet. App. 155 (1993).  In determining whether evidence submitted by a Veteran is credible, the Board may consider internal consistency, facial plausibility, and consistency with other information submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995).  The Board is not required to accept a veteran's uncorroborated account of active service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991).

The Board did not find any evidence to impugn the Veteran's character in any of his 16 service connection claims to be discussed below. 

1. Service connection for back pain

The Veteran contends that he has lumbar spine strain which is worsened due to his service connected right knee strain. Specifically, the Veteran contends that the pain is located in his lower lumbar area, just lateral to the spine, without radiation of pain to his legs. See April 30, 2024 Post Service VA Medical Records. His pain is worse after prolonged sitting and at its worst when he first gets up from bed or from a seated position. Id. 

On November 19, 2025, the Veteran timely submitted an August 
).

The Board did not find any evidence to impugn the Veteran's character in any of his 16 service connection claims to be discussed below. 

1. Service connection for back pain

The Veteran contends that he has lumbar spine strain which is worsened due to his service connected right knee strain. Specifically, the Veteran contends that the pain is located in his lower lumbar area, just lateral to the spine, without radiation of pain to his legs. See April 30, 2024 Post Service VA Medical Records. His pain is worse after prolonged sitting and at its worst when he first gets up from bed or from a seated position. Id. 

On November 19, 2025, the Veteran timely submitted an August 2025 private medical report rendering a positive secondary nexus opinion. Id. The physician found, after comprehensive review of the Veteran's medical history, that the Veteran has a documented history of chronic right knee pathology, including surgical intervention for ACL repair. Id. Per the physician, this chronic right knee pathology has resulted in ongoing pain, joint instability, and episodes of altered biomechanics, most notably an antalgic and/or unsteady gait. Id. The physician added that such an abnormal gait pattern is clinically recognized to induce compensatory musculoskeletal strain and biomechanical overload on adjacent and opposing musculoskeletal regions, including the lumbar spine. Id. 

The physician further explained that given the duration and severity of the Veteran's right knee disease, it is medically reasonable and consistent with the known pathophysiology that compensatory loading of the lumbar spine has resulted in chronic lumbar strain. Id. The physician also cited to several medical journal articles supportive of his opinion. Id. As such, the Board finds that this competent medical opinion is highly probative. The Board did not find any other relevant and competent medical records or opinions to evaluate as to this matter. Accordingly, and resolving any doubt in favor of the Veteran, the evidence is at least in approximate balance as to whether the Veteran's lumbar back strain is worsened by the service connected right knee strain. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

2. Service connection for ED

The Veteran contends that he has ED related to his service. The Veteran did not provide a specific theory as to how the ED was related to his service.

The Board is bound by the AOJ's favorable finding that the Veteran is currently diagnosed with ED. 38 CFR § 3.104(c); See February 2025 Rating Decision.

Although a December 2024 VA examiner rendered a negative nexus opinion, the opinion is inadequate on its face because it fails to consider direct or secondary service connection, concluding only that there is no medical or scientific evidence available that provides any indication of a relationship between the development of the ED at issue and the Veteran's in-service TERA. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Therefore, the Board has attached low probative value to this opinion. 

The Veteran submitted the aforementioned August 2025 private medical report rendering a positive secondary nexus opinion. The private physician found that the Veteran's diagnosed ED was worsened due to his service connected posttraumatic stress disorder (PTSD). Id. 

The physician found that PTSD can lead to psychological symptoms such as anxiety, depression, hypervigilance, and intrusive thoughts related to the traumatic event. Id. He further found that psychological factors can interfere with sexual arousal, desire, and performance, potentially leading to erectile difficulties. Id. PTSD is often associated with chronic hyperarousal, where individuals are in a constant state of heightened physiological and emotional arousal. Id. Finally, the physician explained that this chronic activation of the stress response system can disrupt normal sexual function, including the ability to achieve and maintain an erection. Id. 

The physician cited to at least three medical journal articles in support of his opinion and explained that he had thoroughly reviewed the Veteran's records. Accordingly, the Board finds this opinion highly probative. Therefore, resolving any doubt in favor of the Veteran, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's ED is worsened by the service connected PTSD. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

3. Service connection for OSA

The Veteran contends that he has OSA which is related to his service. Specifically, the Veteran contends both that he has OSA due to his conceded in-service TERA, and that his service connected shoulders and knee disabilities have led to obesity which have caused the OSA to worsen. See November 2023 and January 2024 Claims.

The Board is bound by the AOJ's favorable finding that the Veteran
 the Veteran, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's ED is worsened by the service connected PTSD. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

3. Service connection for OSA

The Veteran contends that he has OSA which is related to his service. Specifically, the Veteran contends both that he has OSA due to his conceded in-service TERA, and that his service connected shoulders and knee disabilities have led to obesity which have caused the OSA to worsen. See November 2023 and January 2024 Claims.

The Board is bound by the AOJ's favorable finding that the Veteran is currently diagnosed with OSA. 38 CFR § 3.104(c); See November 2024 Rating Decision.

Although an August 2024 VA examiner rendered a negative nexus opinion, the opinion is inadequate in that it does not consider whether the Veteran's OSA was worsened due to his service connected shoulders and knee disabilities, with obesity as an intermediate step. See, e.g. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). The August 2024 VA examiner did mention the Veteran's obesity but concluded that it was the more likely cause of the Veteran's OSA, without consideration of his contended theory that his service connected disabilities contributed to his obesity.

Turning again to the aforementioned August 2025 private medical report submitted by the Veteran, the physician rendered a positive secondary nexus opinion finding that the Veteran's service connected PTSD worsened the symptoms of his diagnosed OSA. The private physician found that PTSD often causes hyperarousal, which is a state of increased alertness and anxiety. Id. He explained that this can lead to increased muscle tension, including in the muscles of the airway, which can contribute to the narrowing of the airway and make it more susceptible to collapse during sleep. Id. Moreover, the physician found that PTSD patients suffer from nightmares and flashbacks which can disrupt their sleep and lead to fragmented and poor-quality sleep which can contribute to the development or exacerbation of OSA. Id. 

The private physician cited to several supportive medical journal articles and noted that he had thoroughly reviewed the Veteran's records of evidence. Accordingly, the Board finds this opinion highly probative. Therefore, resolving any doubt in favor of the Veteran, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's OSA is worsened by the service connected PTSD. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

4. Service connection for tension headaches

The Veteran contends that he has headaches which are related to his service. He did not put forth a specific theory as to why his headaches are related to his service. 

The Board is bound by the AOJ's favorable finding that the Veteran is currently diagnosed with tension headaches. 38 CFR § 3.104(c); See July 2024 Rating Decision. 

Although a December 2024 VA examiner rendered a negative nexus opinion, the opinion is inadequate on its face in that it found that the Veteran's tension headaches are not related to his Gulf War service on a presumptive basis, without first considering direct service connection. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Therefore, the Board has assigned no probative value to this opinion.

The remaining medical opinion in the evidence of record for the Board to evaluate is the aforementioned August 2024 private medical opinion. The private physician rendered a positive secondary nexus opinion, finding that the Veteran's tension headaches were worsened by his service connected PTSD. Id. The physician cited to medical journal articles which found that PTSD was the cause of headaches. Id. He explained that PTSD has a hyperactive stress response system, which leads to increased muscle tension and trigger headaches. Id. He added that PTSD can also lead to changes in the brain and nervous system that can contribute to the development of headaches. Id. 

For example, he noted that research has shown that individuals with PTSD may have alterations in the hypothalamic -pituitary-adrenal (HPA) axis, which can affect the regulation of pain and contribute to headache symptoms. Id. In addition, he explained that individuals with PTSD have co-occurring conditions such as depression and anxiety, which can also contribute to the development of headaches. Id. Finally, the private physician explained that these conditions can lead to changes in neurotransmitter levels and alterations in pain processing, which can contribute to headache symptoms. Id. 

The physician noted to have reviewed the Veteran's evidence of record in forming his opinion. Accordingly, the Board finds this opinion highly probative. Therefore, resolving any doubt
 Id. 

For example, he noted that research has shown that individuals with PTSD may have alterations in the hypothalamic -pituitary-adrenal (HPA) axis, which can affect the regulation of pain and contribute to headache symptoms. Id. In addition, he explained that individuals with PTSD have co-occurring conditions such as depression and anxiety, which can also contribute to the development of headaches. Id. Finally, the private physician explained that these conditions can lead to changes in neurotransmitter levels and alterations in pain processing, which can contribute to headache symptoms. Id. 

The physician noted to have reviewed the Veteran's evidence of record in forming his opinion. Accordingly, the Board finds this opinion highly probative. Therefore, resolving any doubt in favor of the Veteran, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's tension headaches are worsened by the service connected PTSD. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

5. Service connection for sinusitis

The Veteran contends that he has sinusitis that is related to his service.

The Board is bound by the AOJ's favorable finding that the Veteran is currently diagnosed with sinusitis, and that he participated in a TERA. 38 CFR § 3.104(c); See February 2025 Rating Decision.

A service treatment record in 1992 notes that the Veteran complained of congestion.

The Board notes that lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. See Layno v. Brown; 38 C.F.R. § 3.159(a)(2). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Id. Competent lay evidence can be sufficient on its own to establish any element of a claim. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

Although a December 2024 VA examiner opined that the Veteran's diagnosed sinusitis was not chronic in nature, that opinion is inadequate in that it fails to take into account the Veteran's lay statements as to the onset and chronicity of his symptoms. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007). The Veteran reported to the VA examiner that while he was on active duty he had nasal congestion which affected his activities at work, with persistent nasal congestion, discharge and drip, plus sinus and eye irritation and pain which had progressed and or worsened since separation. See December 2024 VA Examination Report. The Veteran reported his current symptoms were persistent nasal congestion, with sinus and eye irritation and watery eyes, and pain sensation of pressure at the nose. Id. 

Per MERRIAM-WEBSTER'S COLLEGIATE DICTIONARY, www.merriam-webster.com/dictionary/severe, visited on March 13, 2026, "chronic" means "continuing or occurring again and again for a long time." The Board is not sure how a conclusion was drawn from the lay evidence noted above that the Veteran's sinusitis was not chronic. The AOJ did not obtain a medical nexus opinion, instead denying presumptive service connection was warranted because the Veteran's sinusitis was not "chronic." The Board reiterates that this Veteran served in the SWA theatre of operation. Furthermore, his symptom of congestion was noted in a 1992 service treatment record. The Board finds the Veteran is competent to report persistent symptoms such as congestion, discharge and drip, plus sinus and eye irritation and pain, had their onset in service and progressed beyond separation and to therefore establish chronicity since service. See Buchanan, supra. Accordingly, the Board resolves all doubt in the Veteran's favor and finds that he is presumptively service connected for chronic sinusitis. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

6. Service connection for vertigo

The Veteran contends that he has vertigo related to his service. Specifically, the Veteran contends that beginning in service, since approximately 1992, he experiences episodes where his surroundings feel as if they are moving and this causes him to lose his balance. See December 2024 VA Examination Report.

The Board is bound by the AOJ's favorable finding that the Veteran is currently diagnosed with benign paroxysmal positional vertigo (BPPV). 38 CFR § 3.104(c); See February 202
3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

6. Service connection for vertigo

The Veteran contends that he has vertigo related to his service. Specifically, the Veteran contends that beginning in service, since approximately 1992, he experiences episodes where his surroundings feel as if they are moving and this causes him to lose his balance. See December 2024 VA Examination Report.

The Board is bound by the AOJ's favorable finding that the Veteran is currently diagnosed with benign paroxysmal positional vertigo (BPPV). 38 CFR § 3.104(c); See February 2025 Rating Decision.

Service treatment records note the following: On October 10, 1991 the Veteran complained of ear pain and was diagnosed with ear infection. On December 24, 1991 the Veteran was treated for a blocked right ear which made him uncomfortable. On July 14, 1992 the Veteran had been treated for ear infection in the prior year. Id. In March 1993 the Veteran was treated for dizziness. Id. 

A December 2024 VA examiner found that the Veteran experienced signs of Meniere's syndrome, specifically, benign paroxysmal positional vertigo, which occurred one to four times a month and lasted for under one hour. The examiner found that occupational tasks that would cause risk of fall or injury should be avoided. Id. The examiner laid forth the Veteran's contentions mentioned above but nevertheless rendered an opinion seeming to deny presumptive service connection based on the Veteran's SWA service without providing a direct service connection opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007); Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). 

The VA examiner concluded that vertigo was most often caused by a dysfunction in the vestibular system from a peripheral or central lesion, without then explaining why this Veteran who she diagnosed with vertigo did not have a dysfunction in the vestibular system from a peripheral or central lesion as a result of his service. Id. It should be noted that the VA examiner did not explicitly deny service connection such that the Board is able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Rather, she appeared to have simply defined vertigo. See December 2024 VA Examination Report. As such, the Board has assigned low probative value to this opinion. 

The Board did not find any other relevant and competent medical opinion to evaluate in the evidence of record. The Board finds that the Veteran is competent to report symptoms of dizziness which had their onset during service and continue to affect him to the current day. See Layno v. Brown; 38 C.F.R. § 3.159(a)(2); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Accordingly, the Board resolves all doubt in the Veteran's favor and finds that the evidence is at least in approximate balance as to whether the Veteran's vertigo had its onset during service. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

7. Service connection for neck pain

8. Service connection for right upper extremity radiculopathy 

9. Service connection for left upper extremity radiculopathy 

The Veteran contends that he has neck pain and bilateral upper extremity radiculopathy which had their onset during service. Specifically, the Veteran contends that his neck disability started with injuries related to physical fitness training and injuries to his shoulders during service, and that the conditions have continued to affect him to the current day. See December 2024 VA Examination Report.

The Board is bound by the AOJ's favorable finding that (1) the Veteran is currently diagnosed with cervical degenerative arthritis and (2) the Veteran is currently diagnosed with bilateral upper extremity radiculopathy. 38 CFR § 3.104(c); See February 2025 Rating Decision. 

The Board notes that the Veteran is service connected for shoulder disabilities which had their onset during service. Service treatment records note that the Veteran fell inside or out of a helicopter during combat operations when his helicopter took ground fire from the enemy. See March 8, 2025 Service Treatment Record. Additionally, a March 2, 2015 service treatment record notes that the Veteran had mild degenerative changes affecting the thoracic spine, which lies adjacent to the
 by the AOJ's favorable finding that (1) the Veteran is currently diagnosed with cervical degenerative arthritis and (2) the Veteran is currently diagnosed with bilateral upper extremity radiculopathy. 38 CFR § 3.104(c); See February 2025 Rating Decision. 

The Board notes that the Veteran is service connected for shoulder disabilities which had their onset during service. Service treatment records note that the Veteran fell inside or out of a helicopter during combat operations when his helicopter took ground fire from the enemy. See March 8, 2025 Service Treatment Record. Additionally, a March 2, 2015 service treatment record notes that the Veteran had mild degenerative changes affecting the thoracic spine, which lies adjacent to the cervical spine.  

Although the December 2024 VA examiner rendered a negative nexus opinion, the Board finds that the opinion is inadequate in that it both impermissibly ignored the Veteran's lay assertions that he had sustained injuries during service and considered the absence of evidence as substantive negative evidence. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007); See also Fountain v. McDonald, 27 Vet. App. 258, 272 (2015); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011). Therefore, the Board has assigned low probative value to this opinion. 

The Board did not find another relevant and competent medical opinion to evaluate in the evidence of record. 

As mentioned above, a combat Veteran's assertions of an event during combat are to be presumed if consistent with the time, place, and circumstances of such service. 38 U.S.C. §1154(b). The Veteran must show that the disability he incurred in service was a chronic condition that persisted in the years following his active duty. The Board finds the Veteran competent to report that symptoms of pain in his cervical spine and bilateral upper extremities had their onset during service and continue to the current day. In addition, the Board finds that his in-service injury, current symptomology, and diagnoses are consistent with the time, place, and circumstances of his service. The Board did not find any clear and convincing evidence to the contrary. See Collette v. Brown; Maxson v. Gober, 230 F.3d 1330, 1332 (Fed. Cir. 2000). Therefore, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's cervical degenerative arthritis, claimed as neck pain, and bilateral upper extremity radiculopathy had their onset during service. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

10. Service connection for frequent urination

The Veteran contends that he has frequent urination that had its onset during service, and that the symptoms have stayed the same since separation. See December 2024 VA Examination.

The Board is bound by the AOJ's favorable finding that the Veteran is currently diagnosed with voiding dysfunction. 38 CFR § 3.104(c); See February 2025 Rating Decision.

Although a December 2024 VA examiner rendered a negative nexus opinion, the opinion is inadequate on its face because it fails to consider direct or secondary service connection, concluding only that there is no medical or scientific evidence available that provides any indication of a relationship between the development of a voiding dysfunction and the Veteran's in-service TERA. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Therefore, the Board has attached low probative value to this opinion.

As discussed above, lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. See Layno v. Brown; 38 C.F.R. § 3.159(a)(2). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Id. Competent lay evidence can be sufficient on its own to establish any element of a claim. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Here, the Board finds that the Veteran is competent to report the in-service onset of urinary frequency which has continued after separation to the current date.

Therefore, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's voiding dysfunction, claimed as urinary frequency, had its onset during service. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 

11. Service connection for pseudo folliculitis barbae

12. Service connection for right wrist pain 

13. Service connection for left wrist
 any element of a claim. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Here, the Board finds that the Veteran is competent to report the in-service onset of urinary frequency which has continued after separation to the current date.

Therefore, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's voiding dysfunction, claimed as urinary frequency, had its onset during service. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 

11. Service connection for pseudo folliculitis barbae

12. Service connection for right wrist pain 

13. Service connection for left wrist pain 

14. Service connection for right hip pain 

15. Service connection for left hip pain 

Although the Veteran filed a claim seeking service connection for these contended conditions, he does not set forth any theory as to their onset and etiology. In addition, the Veteran does not have a current diagnosis for any of these conditions.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). In the absence of proof of a present disability there can be no valid claim. Lay evidence is competent to prove any element of a service connection claim, if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. See Layno v. Brown; 38 C.F.R. § 3.159(a)(2); Competent lay evidence can be sufficient on its own to establish any element of a claim. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

As regards pseudo folliculitis barbae, the Veteran was afforded a December 2024 VA examination for the claimed condition. However, the VA examiner opined that there was no sign or symptom that the Veteran had this condition. As such, the evidence is not in approximate balance that the Veteran has pseudo folliculitis barbae connected to his service. Lynch, supra.

As regards the bilateral wrist and bilateral hip pain, VA must provide an examination when there is competent evidence of a disability (or persistent or recurrent symptoms of a disability) that may be associated with an in-service event, injury, or disease, but there is insufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Lay testimony as to continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service, and the threshold for finding that the disability (or symptoms of a disability) may be associated with service is low. Id. Here, the Veteran did not provide any lay testimony as to the onset, etiology or chronicity of bilateral wrist pain or bilateral hip pain. Therefore, the Board finds that the AOJ did not err when it did not provide the Veteran with a VA examination for these claimed conditions.

The Board finds that the Veteran is competent to report symptoms like pain, and that for VA purposes, a disability is any condition that results in functional impairment of earning capacity. However, the Veteran has not made any contention for the Board to evaluate as to whether his pain causes him any functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Nor has the Veteran made an assertion of an event during combat which would allow the Board to presume the condition is related to service, nor to evaluate whether any assertion can is consistent with the time, place, and circumstances of his service. 

Based on the above, the Board finds that the evidence is not in approximate balance that the Veteran has for bilateral wrist or bilateral hip pain which had their onset in service. 

16. Service connection for right ear hearing loss 

The Veteran is currently service connected for left hearing loss at a noncompensable rating and did not appeal that issue in the instant case. Therefore, in the instant decision, the Board will only address his appeal of the denial of service connection for right ear hearing loss. The Veteran contends that he has right ear hearing loss due to his exposure to hazardous noise during service. Specifically, the Veteran contends that he has "hearing loss due to working on and flying jet aircraft for 20 years." See November 2023 Claim. 

The Board is bound by the AOJ's favorable finding that the Veteran's military occupational specialty as a flight engineer placed him in a hazardous noise work environment. 38 CFR § 3.104(c); See November 2024 Rating Decision.

Loss of hearing acuity is evaluated under
ensable rating and did not appeal that issue in the instant case. Therefore, in the instant decision, the Board will only address his appeal of the denial of service connection for right ear hearing loss. The Veteran contends that he has right ear hearing loss due to his exposure to hazardous noise during service. Specifically, the Veteran contends that he has "hearing loss due to working on and flying jet aircraft for 20 years." See November 2023 Claim. 

The Board is bound by the AOJ's favorable finding that the Veteran's military occupational specialty as a flight engineer placed him in a hazardous noise work environment. 38 CFR § 3.104(c); See November 2024 Rating Decision.

Loss of hearing acuity is evaluated under 38 C.F.R. § 4.85, which establishes eleven auditory hearing acuity levels designated from Level I, for essentially normal hearing acuity, through Level XI, for profound deafness. Disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing, including puretone thresholds and speech discrimination percentages. See Lendenmann v. Principi, 3 Vet. App. 345 (1992).

For the purposes of applying the laws administered by VA, impaired 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. 38 C.F.R. 3.385.

The Veteran was afforded two VA examinations for hearing loss, and both addressed the functional loss of the Veteran's hearing loss. A January 2024 VA examination reveals that the Veteran reported that he frequently asks people to repeat themselves. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007).  A May 2024 VA examination reveals that the Veteran reported that hearing conservations in noisy environments is difficult. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007).

The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows:  

January 2024	HERTZ

 	1000	2000	3000	4000	Avg	CNC

RIGHT	25	15	15	30	21	94

LEFT	N/A	N/A	N/A	N/A	N/A	N/A

  

May 2024	HERTZ

 	1000	2000	3000	4000	Avg	CNC

RIGHT	25	10	20	20	19	96

LEFT	N/A	N/A	N/A	N/A	N/A	N/A

The puretone threshold average in in the right ear in January 2024 was 21 and in May 2024 was 19. Using the Maryland CNC speech recognition test, speech audiometry results revealed speech recognition ability score of 94 percent in the right ear in January 2024 and 96 percent in the right ear in May 2024. Under Table VI of 38 C.F.R. § 4.85, both scores for the right ear correlate to a Roman Numeral I. A rating of zero percent is warranted under DC 6100 when these auditory levels are entered into Table VII of 38 C.F.R. § 4.85.

The objective results from the January 2024 and May 2024 VA examinations did not show the requisite levels of pure-tone thresholds or speech recognition scores to constitute a current right ear hearing loss disability for VA purposes. a disability. Without probative evidence of a current disability, the claim must be denied. See Degmetich v. Brown, 1328, 1332 (1997); See Romanowsky v. Shinseki, 26 Vet. App. 289, 321 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007). 

The Veteran's reports of current right ear hearing loss do not constitute competent evidence of a hearing loss disability, as the record does not reflect that he has the requisite audiological expertise to diagnose such. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Medical expertise along with appropriate audiological testing is required to confirm the presence of bilateral hearing loss. In sum, there is no medical evidence of record showing the presence
1997); See Romanowsky v. Shinseki, 26 Vet. App. 289, 321 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007). 

The Veteran's reports of current right ear hearing loss do not constitute competent evidence of a hearing loss disability, as the record does not reflect that he has the requisite audiological expertise to diagnose such. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Medical expertise along with appropriate audiological testing is required to confirm the presence of bilateral hearing loss. In sum, there is no medical evidence of record showing the presence of a right ear hearing loss disability for VA purposes; thus, the claim of entitlement to service connection for right ear hearing loss must be denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

 

S. C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackson, Atossa K.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.