KNEE IMPAIRMENT OF

J. ABRAMS · 2026 · Case ID: A26029571

MIXED

Summary

The Veteran served from May 2017 to January 2024. The Veteran appealed the AOJ's January 2025 rating decision, which reduced his right knee strain rating from 30% to 10% and denied service connection for right and left ankle disabilities, a general joint disability, and ADHD. The Board granted restoration of the 30% rating for the right knee strain, finding the reduction improper because the AOJ failed to demonstrate actual improvement in the Veteran's ability to function under ordinary conditions and because the evidence was in equipoise regarding improvement. The Board denied an increased rating for the right knee strain, finding the evidence did not support ratings higher than 30% based on the provided range of motion and symptom limitations. Service connection for the ankle and joint claims was denied due to insufficient evidence of a current disability, as the Veteran failed to attend scheduled VA examinations without good cause and did not provide sufficient clarification of the claimed joint disabilities. The ADHD claim was denied due to a lack of a current diagnosis in the record, despite a service treatment plan mentioning managing ADHD symptoms. The Board remanded claims for service connection for a back condition, chest pain, abnormal weight loss, and a jaw condition. These remands were based on pre-decisional duty to assist errors, including failure to reschedule examinations, inadequate examinations, and the need for Gulf War examinations to assess potential undiagnosed illnesses or chronic multi-symptom illnesses.

Rationale

Reduction from 30% to 10% was improper.; Improvement in ability to function under ordinary conditions not shown.; Evidence in equipoise regarding improvement.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250207-516809

Full Decision Text

Citation Nr: A26029571
Decision Date: 04/01/26 Archive Date: 04/01/26

DOCKET NO. 250207-516809
DATE: April 1, 2026

ORDER

Restoration of a 30 percent rating for a right knee strain, effective April 1, 2025, is granted.

Entitlement to an initial disability rating in excess of 30 percent for a right knee strain is denied.

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

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

Entitlement to service connection for a joint disability is denied.

Entitlement to service connection for attention deficit hyperactivity disorder (ADHD) is denied.

REMANDED

Entitlement to service connection for a back condition is remanded.

Entitlement to service connection for chest pain is remanded.

Entitlement to service connection for an abnormal weight loss condition is remanded.

Entitlement to service connection for a jaw condition is remanded.

FINDINGS OF FACT

1. In a January 2025 rating decision, the Agency of Original Jurisdiction (AOJ) reduced the Veteran's disability rating for a right knee strain from 30 percent to 10 percent, effective April 1, 2025; however, improvement of the Veteran's right knee strain that reflected an improvement in his ability to function under the ordinary conditions of life and work was not demonstrated.

2. Throughout the entire appeal period, the Veteran's right knee strain did not more nearly approximate extension limited to 30 degrees.

3. The evidence is persuasively against a finding of a current right ankle disability.

4. The evidence is persuasively against a finding of a current left ankle disability.

5. The evidence is persuasively against a finding of a current joint disability.

6. The Veteran does not have a current diagnosis of ADHD under the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

CONCLUSIONS OF LAW

1. The reduction of the rating for a right knee strain from 30 percent to 10 percent, effective April 1, 2025, was improper, and restoration of the 30 percent rating is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105, 3.344, 4.1, 4.2, 4.10, 4.71a, Diagnostic Code 5261.

2. The criteria for entitlement to an initial disability rating in excess of 30 percent for a right knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5261.

3. The criteria for entitlement to service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

5. The criteria for entitlement to service connection for a joint disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to service connection for ADHD have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Martinez-Bodon v. McDonough, 28 F.4th 1241 (Fed. Cir. 2022).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 2017 to January 2024.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from May 2024, July 2024, August 2024, October 2024, and January 2025 rating decisions by a VA regional office, which is the AOJ.

The Veteran elected the Board's Direct Review docket. See February 2025 VA Form 10182. This restricts the Board's review to the evidence of record at the time of the above rating decisions. 38 C.F.R. § 20.301.

The Board notes that evidence was associated with the claims file after the above rating decisions on appeal, which was during a period of time that is outside
7 to January 2024.

The Board notes that evidence was associated with the claims file after the above rating decisions on appeal, which was during a period of time that is outside the applicable evidentiary window.

For the issues being denied, the Board has not considered that evidence in its decision. 38 C.F.R. § 20.300(a). If the Veteran would like VA to consider the additional evidence that the Board could not consider, the Veteran may file a supplemental claim (VA Form 20-0995) and identify the evidence for the AOJ's consideration. 38 C.F.R. § 3.2501. Specific instructions for filing a supplemental claim are included with this decision.

For the issues being remanded, the AOJ will consider those issues in light of the entire claims file upon remand.

Restoration of Rating

Restoration of a 30 percent rating for a right knee strain, effective April 1, 2025, is granted.

The Veteran asserts that restoration of a 30 percent rating for a right knee strain is warranted.

Disability ratings are assigned in accordance with VA's Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from a disability. 38 U.S.C. § 1155.

Regarding whether the reduction was proper, the Board notes that at the time of the reduction, effective April 1, 2025, the 30 percent rating had been in effect for a period of less than five years. Thus, the provisions of 38 C.F.R. § 3.344(a) and (b) do not apply and reexamination disclosing improvement would warrant a rating reduction. 38 C.F.R. § 3.344(c).

The question of whether a disability has improved involves consideration of the applicable rating criteria. For the rating period at issue, the Veteran's right knee strain was rated under the criteria found at 38 C.F.R. § 4.71a, Diagnostic Code 5261. That diagnostic code provides ratings from zero percent to 50 percent based on the extent that extension of the knee is limited.

In Brown v. Brown, 5 Vet. App. 413 (1993), the United States Court of Appeals for Veterans Claims (Court) identified general regulatory requirements which are applicable to all rating reductions. Pursuant to 38 C.F.R. § 4.1, it is essential, both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. Brown, 5 Vet. App at 420. Similarly, 38 C.F.R. § 4.2 establishes that "[i]t is the responsibility of the rating specialist to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present." Id. Furthermore, per 38 C.F.R. § 4.13, the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms.

In any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but that such improvement reflects improvement in ability to function under ordinary conditions of life and work. See Brown, 5 Vet. App. at 420-421; see also 38 C.F.R. §§ 4.2, 4.10. The burden of proof is on VA to establish that a reduction is warranted. See Brown, 5 Vet. App. at 421; Kitchens v. Brown, 7 Vet. App. 320, 324 (1995). In general, the AOJ's reduction of a rating must have been supported by the evidence on file at the time of the reduction. Pertinent post-reduction evidence favorable to restoring the rating, however, also must be considered. See Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of
2, 4.10. The burden of proof is on VA to establish that a reduction is warranted. See Brown, 5 Vet. App. at 421; Kitchens v. Brown, 7 Vet. App. 320, 324 (1995). In general, the AOJ's reduction of a rating must have been supported by the evidence on file at the time of the reduction. Pertinent post-reduction evidence favorable to restoring the rating, however, also must be considered. See Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the veteran will receive the benefit of the doubt. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

A January 2025 rating decision reduced the Veteran's disability rating for a right knee strain from 30 percent to 10 percent, because recent evidence supposedly showed the improvement of the disability. That recent evidence appears to have been a September 2024 VA examination, which supposedly showed that extension of the right knee was less limited than before. The rating decision did not determine that the supposed improvement in the Veteran's right knee strain actually reflected an improvement in the Veteran's ability to function under the ordinary conditions of life and work. As such, the Board finds that the reduction was improper.

Additionally, even if the AOJ had determined that the improvement in the Veteran's right knee strain actually reflected an improvement in his ability to function under the ordinary conditions of life and work, the evidence is at least in relative equipoise that such an improvement in the Veteran's ability to function under the ordinary conditions of life and work has not been shown. Specifically, although the September 2024 VA examination estimated that extension of the right knee was less limited than before, it did not take place in an environment that reflected the ordinary conditions of life and work. See March 2024 C&P Exam; September 2024 C&P Exam.

In this case, the Veteran had two VA right knee examinations. The March 2024 VA examination showed the Veteran's report of constant right knee pain without any treatment or medications. The Veteran reported functional impairment consisting of difficulty walking sometimes and difficulty running sometimes. Active range of motion testing showed flexion to 100 degrees and extension to 10 degrees. The Veteran had limited ability to run, walk, or stand for prolonged periods. Estimates of range of motion after repeated use over time showed flexion to 90 degrees and extension to 15 degrees. Estimates of range of motion during flare-ups showed flexion to 80 degrees and extension to 20 degrees. The examiner stated that the Veteran's ability to perform work or recreational activities that involved repeated walking, running, squatting, lifting, prolonged sitting, and prolonged standing was limited.

The September 2024 VA examination showed the Veteran's report that right knee pain had progressively worsened since 2022; that he now took medication for the pain when needed; and that he had difficulty with bending, prolonged walking, and standing. Active range of motion testing showed flexion to 110 degrees and extension to 10 degrees. The Veteran had difficulty with bending, prolonged walking, and standing. Estimates of range of motion after repeated use over time showed flexion to 95 degrees and extension to 10 degrees. The examiner stated that the Veteran had difficulties with bending, prolonged walking, and standing.

The September 2024 VA examination showed the Veteran's report that the right knee pain had been getting worse since 2022, which could suggest that the pain may have gotten worse since the March 2024 VA examination. The fact that the Veteran was not previously taking medication around the time of the March 2024 examination but was taking medication when needed around the time of the September 2024 VA examination may also suggest that the pain may have worsened. Additionally, during the March 2024 VA examination, the Veteran reported that it was difficult to walk and run sometimes.

During the September 2024 VA examination, the Veteran reported that he had difficulty with prolonged walking, but now he also reported difficulty with bending and standing. This could suggest that the disability may have worsened. Notably, the September 2024 VA examination did not discuss whether the Veteran had difficulties with running, lifting, or sitting. As such, the September 2024 VA examination may not have been as thorough as the March 2024 VA examination, which did discuss those things.

Furthermore, the two examinations showed the same limitation of extension on active motion testing. Thus,
ened. Additionally, during the March 2024 VA examination, the Veteran reported that it was difficult to walk and run sometimes.

Furthermore, the two examinations showed the same limitation of extension on active motion testing. Thus, there did not appear to be any improvement for active motion. The September 2024 VA examination's estimate of limitation of extension after repeated use over time only showed slightly less limitation of extension than the March 2024 VA examination did. The March 2024 VA examination's limitation of extension during flare-ups result was also estimated. Because limitation of extension after repeated use over time and during flare-ups was based on estimates, the Board cannot determine that there was an actual improvement in the disability and not merely a difference in how the different examiners made estimates.

Most importantly, the September 2024 VA examiner did not state that there was improvement in the disability and did not state anything which suggested that any improvement reflected improvement in the ability to function under ordinary conditions of life and work. See Brown, 5 Vet. App. at 420-421; see also 38 C.F.R. §§ 4.2, 4.10. Without the examiner making such a finding, the Board cannot determine that there has been an actual improvement in the disability in the ability to function under ordinary conditions of life and work. See 38 C.F.R. § 4.13.

Therefore, for the above reasons, the Board finds that the reduction was improper, and restoration of a 30 percent rating for a right knee strain, effective April 1, 2025, is granted.

Increased Rating

Entitlement to an initial disability rating in excess of 30 percent for a right knee strain is denied.

The Veteran asserts that entitlement to an initial increased rating in excess of 30 percent for a right knee strain is warranted. The schedular rating criteria for the knee is found under 38 C.F.R. § 4.71a.

38 C.F.R. § 4.71a, Diagnostic Code 5055 deals with knee resurfacing or replacement (prosthesis). As will be seen below, the Veteran has not been shown to have had any right knee resurfacing or replacement. As such, this diagnostic code is inapplicable and will not be addressed further.

38 C.F.R. § 4.71a, Diagnostic Code 5256 deals with knee ankylosis. As will be seen below, the Veteran has not been shown to have had any right knee ankylosis and the evidence does not appear to show the functional equivalent of ankylosis. As such, this diagnostic code is inapplicable and will not be addressed further. See Chavis v. McDonough, 34 Vet. App. 1 (2021).

38 C.F.R. § 4.71a, Diagnostic Code 5257, deals with sprain, ligament tear, instability, and assistive devices. As will be seen below, the Veteran has not been shown to have any such problems and does not use assistive devices. As such, this diagnostic code is inapplicable and will not be addressed further.

38 C.F.R. § 4.71a, Diagnostic Code 5258 deals with dislocated semilunar cartilage. As will be shown below, the Veteran has not been shown to have had problems with semilunar cartilage. As such, this diagnostic code is inapplicable and will not be addressed further.

38 C.F.R. § 4.71a, Diagnostic Code 5259 deals with removal of symptomatic semilunar cartilage. As will be seen below, the Veteran has not been shown to have had problems with semilunar cartilage. As such, this diagnostic code is inapplicable and will not be addressed further.

Under 38 C.F.R. § 4.71a, Diagnostic Code 5260, a non-compensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees.

Under 38 C
5259 deals with removal of symptomatic semilunar cartilage. As will be seen below, the Veteran has not been shown to have had problems with semilunar cartilage. As such, this diagnostic code is inapplicable and will not be addressed further.

Under 38 C.F.R. § 4.71a, Diagnostic Code 5261, a non-compensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees.

38 C.F.R. § 4.71a, Diagnostic Code 5262 deals with impairment of the tibia and fibula. As will be seen below, the Veteran has not been shown to have had impairment of the tibia or fibula. As such, this diagnostic code is inapplicable and will not be addressed further.

38 C.F.R. § 4.71a, Diagnostic Code 5263 deals with genu recurvatum. As will be seen below, the Veteran has not been shown to have had genu recurvatum. As such, this diagnostic code is inapplicable and will not be addressed further.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The benefit of the doubt will be resolved in the veteran's favor. 38 C.F.R. § 4.3.

A March 2024 VA examination showed the Veteran's report of constant right knee pain. The Veteran reported flare-ups four-to-five times per week, which lasted for about one hour and caused severe pain. The Veteran also reported difficulty walking and running. The Veteran did not report or have a history of instability or recurrent subluxation. The Veteran did not report or have a history of frequent effusion.

Initial range of motion testing showed flexion to 100 degrees and extension to 10 degrees. Passive range of motion was the same. There was pain in active and passive motion. There was no pain in weight bearing and non-weight bearing. There was no objective evidence of crepitus. After repeated use over time, flexion was estimated to go to 90 degrees and extension was estimated to go to 15 degrees. During flare-ups, flexion was estimated to go to 80 degrees and extension was estimated to go to 20 degrees.

There was no muscle atrophy, ankylosis, recurrent subluxation or persistent instability, recurrent patellar instability, sprain, or ligament tear. The Veteran had never had a recurrent patellar dislocation, shin splints (medial tibial stress syndrome), stress fractures, or any other tibial or fibular impairment. The Veteran had never had genu recurvatum, a meniscus (semilunar cartilage) condition, or right knee surgery. The Veteran did not use any assisted devices and there were no other pertinent physical findings, complications, conditions, signs, or symptoms related to the right knee.

The Board finds the March 2024 VA examination highly probative as it was based on an in-person examination of the Veteran. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

A September 2024 VA examination showed the Veteran's report of having difficulty with bending, prolonged walking, and standing. The Veteran did not report and did not have a history of instability or recurrent subluxation. The Veteran did not report or have a history of frequent effusion of the knee.

Initial range of motion testing showed flexion to 110 degrees and extension to 10 degrees. Passive range of motion was the same. There was pain in active motion and passive motion. There was no pain in weight bearing and non-weight-bearing. There was no objective evidence of crepitus. After repeated use
odriguez v. Peake, 22 Vet. App. 295 (2008).

The Board finds the September 2024 VA examination highly probative as it was based on an in-person examination of the Veteran. See Nieves-Rodriguez, 22 Vet. App. at 295.

Based on the evidence of record, including the above evidence, the Board finds that a higher rating is not warranted because at no time during the appeal period does it appear that flexion was shown to be anywhere near being limited to 45 degrees and at no time during the appeal period does it appear that extension was shown to be anywhere near being limited to 30 degrees. Specifically, the Veteran's flexion more nearly approximated 60 degrees than it did 45 degrees and 60 degrees warrants a non-compensable rating. The Veteran's extension more nearly approximated degree measurements for ratings less than the 40 percent rating.

Therefore, entitlement to an initial increased rating in excess of 30 percent for a right knee strain is denied.

The Board finds that the March 2024 and September 2024 VA examination reports, describing the Veteran's right knee symptoms, to be the most probative evidence of record, as the examiners reviewed the claims file and provided a detailed rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). While the Veteran is competent to observe his right knee symptoms, he does not have the training or credentials to determine the current nature, severity, and duration of those symptoms. Additionally, he does not have the training or credentials to determine the proper disability evaluation concerning his right knee strain. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

Because of this, a disability rating in excess of 30 percent is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Neither the Veteran nor his attorney have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017).

The Board is sympathetic to the Veteran's reports and understands that his right knee strain has significant effects on his daily life. However, this condition more nearly approximates the currently assigned 30 percent rating and does not warrant an increase at this time.

The Board also notes that this decision does not leave the Veteran without recourse. If his right knee strain should worsen in the future, the Veteran is free to file claims for increased disability ratings at that time.

Service connection

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 200
Veteran without recourse. If his right knee strain should worsen in the future, the Veteran is free to file claims for increased disability ratings at that time.

Service connection

A current disability exists when a veteran has the disability at the time that the claim for service connection is filed or at any point during the pendency of the claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289 (2013).

Pain in conjunction with functional impairment in earning capacity can constitute a disability for purposes of service connection. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

1. Entitlement to service connection for a right ankle disability is denied.

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

The Veteran asserts that entitlement to service connection for right and left ankle disabilities is warranted.

When dealing with an original compensation claim, if entitlement to a benefit cannot be established without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination or reexamination, then the claim will be decided based on the evidence of record. See 38 C.F.R. § 3.655.

In the present case, the Veteran's ankle claims are original compensation claims. In May 2024, VA examinations for the ankles were scheduled, and the Veteran did not show up for them. See May 2024 Exam Request; June 2024 Exam Request. The Veteran then called to reschedule the VA examinations for the ankles. He reportedly was not able to attend the VA examinations before due to a work conflict. See July 2024 Report of General Information. In September 2024, VA examinations for the ankles were again scheduled, and the Veteran did not show up for them. See September 2024 Exam Request.

An October 2024 rating decision informed the Veteran that he had failed to show up for the examinations. To date, the Veteran has not provided an explanation as to why he missed the examinations. As such, the Veteran has not provided good cause for failing to show for the examinations.

Even if actual notice of the VA examinations was not on file, no mail has been returned as undelivered and the Veteran has not contended that notice of the examinations was not received. The Board thus concludes that the Veteran was properly notified of the scheduled examinations. See Ashley v. Derwinski, 2 Vet. App. 307 (1992) (regarding the presumption of regularity that public officers have properly discharged their official duties in absence of clear evidence to the contrary); Mindenhall v. Brown, 7 Vet. App. 271 (1994) (regarding the applicability of the presumption of regularity to RO actions).

Furthermore, the Board finds that entitlement to service connection for right and left ankle conditions cannot be established without a current VA examination or reexamination because there is currently insufficient medical evidence of record to determine whether the Veteran has right and/or left ankle disabilities or whether the reported right and/or left ankle pain results in functional impairment. The examinations would have provided information to address this. See September 2024 Exam Request. As such, the Veteran's ankle claims will be decided based on the evidence of record.

The first element of service connection is the existence of a current disability. VA received the ankle service connection claims in 2024. Evidence in favor of a current disability consists of the following. The Veteran reported ankle pain from running often. See April 2024 Fully Developed Claim. Notably, the Veteran did not report any further details, including what the disabilities were and whether there was functional loss.

Evidence against a current disability consists of the following. The evidence of record does not contain a
pain results in functional impairment. The examinations would have provided information to address this. See September 2024 Exam Request. As such, the Veteran's ankle claims will be decided based on the evidence of record.

Evidence against a current disability consists of the following. The evidence of record does not contain a diagnosis of a disability for either ankle at any time during the appeal period or around the time that the claims were filed. Additionally, it does not appear that any medical evidence of record shows any ankle problems. Finally, the Veteran did not report ankle pain resulting in a functional loss at any time during the appeal period or around the time that the claims were filed.

The Board has carefully reviewed the record, including the above evidence, and finds that the evidence is persuasively against a finding of a current right ankle disability and a current left ankle disability. Specifically, the evidence of record does not show disabilities for these body parts, and the evidence of record does not show that there is pain resulting in a functional impairment of earning capacity for these body parts during the appeal period or around the time that the claims were filed.

In the absence of proof of a current disability due to disease or injury, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). Therefore, discussion of the remaining criteria for service connection is not warranted. The claims for entitlement to service connection for right ankle and left ankle disabilities are denied.

3. Entitlement to service connection for a joint disability is denied.

The Veteran asserts that entitlement to service connection for a joint disability is warranted. The claim was received in April 2024. The Board notes that there are/have been separate service connection claims for the jaw, neck, back, knees, and ankles. As such, those joints are not part of this issue.

The Veteran reported joint pain when moving his body in certain ways when filing the claim. See April 2024 Fully Developed Claim. Notably, the Veteran did not report any further details, including what joints were being claimed, what the disabilities were, and whether there was functional loss. The Board notes that it does not appear that the Veteran provided any additional information at any other point during the appeal period.

The AOJ subsequently sent the Veteran a letter, asking him to specify what specific joints were part of the claim. See September 2024 Subsequent Notification Letter. It does not appear that the Veteran replied to that letter.

The Board acknowledges that VA has a duty to assist the Veteran in substantiating the claim; however, the duty to assist is not a one-way street. The Veteran has a duty to assist and cooperate with VA in developing evidence. See Wood v. Derwinski, 1 Vet. App. 190 (1991). VA asked the Veteran to assist and cooperate in developing evidence, but the Veteran did not do so. Because the Veteran did not clarify what specific joints were part of the claim, the Veteran has provided insufficient evidence of a current disability. A claim must at least provide information at a high level of generality to identify the sickness, disease, or injury for which benefits are sought. See Sellers v. Wilkie, 965 F.3d 1328, 1337 (Fed. Cir. 2020). Merely claiming "joint pain" is too vague and would require the Board to go on a fishing expedition in search of joint problems existing at any point during the appeal period. By contrast, the Veteran was specific in identifying problems with the jaw, neck, back, knees, and ankles for separate claims.

The Board finds that the evidence is persuasively against a finding of a current joint disability because the Veteran has provided insufficient evidence of a current disability. In the absence of proof of a current disability due to disease or injury, there can be no valid claim. See Brammer, 3 Vet. App. at 223. Therefore, discussion of the remaining criteria for service connection is not warranted. The claim for entitlement to service connection for a joint disability is denied.

The Veteran may file a supplemental claim when he is ready to identify the specific joints involved in this claim.

4. Entitlement to service connection for ADHD is denied.

The Veteran asserts that entitlement to service connection for ADHD is warranted.

The first element of service connection
finds that the evidence is persuasively against a finding of a current joint disability because the Veteran has provided insufficient evidence of a current disability. In the absence of proof of a current disability due to disease or injury, there can be no valid claim. See Brammer, 3 Vet. App. at 223. Therefore, discussion of the remaining criteria for service connection is not warranted. The claim for entitlement to service connection for a joint disability is denied.

The Veteran may file a supplemental claim when he is ready to identify the specific joints involved in this claim.

4. Entitlement to service connection for ADHD is denied.

The Veteran asserts that entitlement to service connection for ADHD is warranted.

The first element of service connection is the existence of a current disability. Evidence in favor of a current disability consists of the following. When filing the service connection claim, the Veteran reported having ADHD. See October 2023 Fully Developed Claim. However, the Veteran is not competent to provide a diagnosis of ADHD. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). Providing a diagnosis of ADHD does not lie within the range of common experience or common knowledge but requires special experience or special knowledge in the field of mental health. See Jandreau, 492 F.3d at 1372; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). As the evidence does not show that the Veteran has this medical expertise, his lay assertion of a medical diagnosis cannot constitute evidence upon which to grant the claim for service connection.

Other evidence in favor of a current disability includes a May 2022 behavioral health service treatment plan during service which listed a goal of verbalizing three coping skills to manage the Veteran's depression, anxiety, and ADHD mood instability. This plan was apparently made by the Veteran and his psychiatrist. See October 2023 STR.

However, for the following reasons, the Board finds that the evidence is persuasively against a finding of a diagnosis of ADHD. First, although the goal listed ADHD with other mental health problems, the assessments ultimately provided at the time by the psychiatrist only listed insomnia and depressive disorders; ADHD was not listed. If the Veteran had been found to have had ADHD by the psychiatrist, it is reasonable that the psychiatrist would have provided an assessment or diagnosis of ADHD at that time.

Second, a review of the Veteran's service records does not appear to show any assessment or diagnosis of ADHD or any other evidence (other than noted above) suggesting that the Veteran had ADHD. Notably, an April 2022 behavior health review of symptoms specifically found no reported symptoms of ADHD and did not provide an assessment of ADHD, while providing assessments of insomnia and depressive disorders. See October 2023 STR. As such, although a service record mentioned a goal of managing ADHD with other mental health problems, it does not appear that the Veteran was actually diagnosed with ADHD at any time during service. It is reasonable that if the Veteran had ADHD during service, such would have been given an assessment or diagnosis at some point during service like insomnia and depressive disorders were.

Other evidence against a current disability includes the following. A May 2024 VA examination found that the Veteran only had a diagnosis of unspecified trauma and stressor related disorder. The Board notes that the Veteran is service connected for this disability. The examiner specifically stated that the Veteran did not have more than one mental disorder diagnosed.

Finally, the evidence of record as a whole does not appear to contain any assessment or diagnosis of ADHD during the appeal period or around the time that the claim was filed.

The Board has carefully reviewed the record, including the above evidence, and finds that the evidence is persuasively against a finding of a diagnosis of ADHD under the DSM-5, which is required to grant service connection for ADHD. See Martinez-Bodon, 28 F.4th at 1241. Specifically, the Board finds the lack of an assessment or diagnosis of ADHD in the entire record much more probative than a single service record which listed a goal of managing ADHD with other mental health problems. Notably, the service record which listed the goal of managing ADHD with other mental health problems did not ultimately provide an assessment or diagnosis of ADHD, even while it provided assessments of insomnia and depressive disorders.

In the absence of proof of a current disability due to disease or injury, there can be no valid claim. See Brammer, 3 Vet. App. at 223.

For these reasons, entitlement to service connection for ADHD is denied.

REASONS FOR REMAND

1. Entitlement to
at 1241. Specifically, the Board finds the lack of an assessment or diagnosis of ADHD in the entire record much more probative than a single service record which listed a goal of managing ADHD with other mental health problems. Notably, the service record which listed the goal of managing ADHD with other mental health problems did not ultimately provide an assessment or diagnosis of ADHD, even while it provided assessments of insomnia and depressive disorders.

In the absence of proof of a current disability due to disease or injury, there can be no valid claim. See Brammer, 3 Vet. App. at 223.

For these reasons, entitlement to service connection for ADHD is denied.

REASONS FOR REMAND

1. Entitlement to service connection for a back condition is remanded.

The Veteran asserts that entitlement to service connection for a back condition is warranted.

A VA examination for the back was previously scheduled. See May 2024 Exam Request. The examination was cancelled because the Veteran was unavailable. See June 2024 Exam Request. Soon after, the Veteran contacted VA to reschedule the examination. He reported that he was unable to attend the examination because of a work conflict on that particular day. See July 2024 VA 27-0820. The AOJ did not reschedule the examination and denied the claim soon after. See July 2024 Rating Decision - Narrative.

However, under the M21-1 Adjudication Procedures Manual, Part IV, Subpart i, Chapter 2, VA will generally accept any reason offered by an individual as good cause for failure to report for an examination. In this case, the Veteran provided a reason for not reporting for the examination. As such, good cause was shown.

Additionally, a VA examination was warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Specifically, there is competent evidence of a current disability or persistent or recurrent symptoms of a disability. The Veteran reported back pain during the appeal period. See April 2024 Fully Developed Claim. The Veteran is competent to report back pain. See Layno, 6 Vet. App. at 465. There is evidence establishing that an event, injury, or disease occurred in service. Service records show the Veteran's report of back pain during service. See October 2023 STR. There is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service. The Veteran reported his belief that the back pain was related to ruck marches during service. See April 2024 Fully Developed Claim. Finally, there is insufficient competent medical evidence on file for VA to make a decision on the claim.

Furthermore, a VA Gulf War examination was warranted. Specifically, the Veteran served in Southwest Asia and joint pain and muscle pain are signs or symptoms of undiagnosed illness or medically unexplained chronic multi-symptom illness listed under 38 C.F.R. § 3.317. It is currently unclear whether the Veteran's reported back pain is an undiagnosed illness or a chronic multi-symptom illness of partially understood etiology and pathophysiology as no VA Gulf War examination has been provided on the issue. See 38 C.F.R. § 3.317; Colvin v. Derwinski, 1 Vet. App. 171 (1991).

Not scheduling the Veteran for another VA examination and not scheduling the Veteran for a VA Gulf War examination were pre-decisional duty to assist errors. Therefore, a remand is needed to schedule the Veteran for a VA examination and a VA Gulf War examination.

2. Entitlement to service connection for chest pain is remanded.

The Veteran asserts that entitlement to service connection for chest pain is warranted.

A March 2024 VA heart examination found that there was no current heart disability, and as such, the Veteran's reported chest pain symptoms were not due to a heart condition. The Board notes that the Veteran is competent to report chest pain. See Layno, 6 Vet. App. at 465. However, evidence suggests that the Veteran may have a non-heart related disability that may be causing chest pain. Specifically, service records from a few months prior to separation from service show a diagnosis of functional dyspepsia in the context of chest pain. See May 2024 JLV/MTF; February 2024 STR. However, no additional examination was conducted to determine if the Veteran had a current esophageal disability causing chest pain, and if so, whether such had its onset in or was otherwise related to service. When VA provides an examination, it must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303 (
6 Vet. App. at 465. However, evidence suggests that the Veteran may have a non-heart related disability that may be causing chest pain. Specifically, service records from a few months prior to separation from service show a diagnosis of functional dyspepsia in the context of chest pain. See May 2024 JLV/MTF; February 2024 STR. However, no additional examination was conducted to determine if the Veteran had a current esophageal disability causing chest pain, and if so, whether such had its onset in or was otherwise related to service. When VA provides an examination, it must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303 (2007). This is a pre-decisional duty to assist error.

Additionally, the Veteran served in Southwest Asia and gastrointestinal signs or symptoms is a sign or symptom of undiagnosed illness or medically unexplained chronic multi-symptom illness listed under 38 C.F.R. § 3.317. As noted above, the Veteran may have functional dyspepsia, which could involve the gastrointestinal system. It is currently unclear whether the Veteran's reported chest pain is an undiagnosed illness or a chronic multi-symptom illness of partially understood etiology and pathophysiology as no VA Gulf War examination has been provided on the issue. See 38 C.F.R. § 3.317; Colvin, 1 Vet. App. at 171. This is a pre-decisional duty to assist error.

Therefore, a remand is needed for an additional VA examination and for a VA Gulf War examination.

3. Entitlement to service connection for an abnormal weight loss condition is remanded.

The Veteran asserts that entitlement to service connection for an abnormal weight loss condition is warranted.

The Veteran reported abnormal weight loss and reported the recent loss of 10 pounds in three months. See April 2024 Fully Developed Claim; March 2024 C&P Exam. The Veteran is competent to report weight loss. See Layno, 6 Vet. App. at 465. The Veteran served in Southwest Asia and abnormal weight loss is one of the signs or symptoms of undiagnosed illness or medically unexplained chronic multi-symptom illness listed under 38 C.F.R. § 3.317. It is currently unclear whether the Veteran's reported abnormal weight loss is an undiagnosed illness or a chronic multi-symptom illness of partially understood etiology and pathophysiology as no VA Gulf War examination has been provided on the issue. See 38 C.F.R. § 3.317; Colvin, 1 Vet. App. at 171. This is a pre-decisional duty to assist error.

Therefore, a remand is needed for a VA Gulf War examination.

4. Entitlement to service connection for a jaw condition is remanded.

The Veteran asserts that entitlement to service connection for a jaw condition is warranted.

In April 2024, the Veteran reported jaw pain when moving the jaw. On August 1, 2024, the Veteran reported jaw pain. See April 2024 Fully Developed Claim; August 2024 Fully Developed Claim. At an August 2024 VA examination, approximately a couple of weeks following the Veteran's August 1, 2024, report of jaw pain, the Veteran apparently denied jaw pain. Although the Veteran's reported jaw pain may have resolved at the time of the August 2024 VA examination, the Veteran is competent to have reported jaw pain earlier during the appeal period. See Layno, 6 Vet. App. at 465. The Veteran served in Southwest Asia and joint pain is one of the signs or symptoms of undiagnosed illness or medically unexplained chronic multi-symptom illness listed under 38 C.F.R. § 3.317. It is currently unclear whether the Veteran's reported jaw pain is an undiagnosed illness or a chronic multi-symptom illness of partially understood etiology and pathophysiology as no VA Gulf War examination has been provided on the issue. See 38 C.F.R. § 3.317; Colvin, 1 Vet. App. at 171. This is a pre-decisional duty to assist error.

Therefore, a remand is needed for a VA Gulf War examination.

The matter is REMANDED for the following action:

1. Schedule an appropriate VA examination for the Veteran's back condition claim. Inform the examiner that "at least as likely as not" means that the likelihood is at least approximately balanced or nearly equal, if not higher. Following a review of the claims file and a copy of this remand, the reviewing examiner is requested to furnish an
iology as no VA Gulf War examination has been provided on the issue. See 38 C.F.R. § 3.317; Colvin, 1 Vet. App. at 171. This is a pre-decisional duty to assist error.

Therefore, a remand is needed for a VA Gulf War examination.

The matter is REMANDED for the following action:

(A) Identify all back disabilities which have existed at any point during the appeal period, even if they are currently asymptomatic or have resolved during the pendency of the appeal. If the examiner cannot identify a back disability, the examiner shall determine whether any back pain that the Veteran experiences results in a functional loss or impairment.

(B) For each identified disability (or pain resulting in a functional impairment) from (A), is it at least as likely as not that such had its onset in, or is otherwise related to service?

(C) Is it at least as likely as not that any back arthritis manifested to a compensable degree within one year following the Veteran's separation from active service?

(D) Is it at least as likely as not that any back arthritis was noted during active service, or within one year following the Veteran's separation from active service, with continuity of symptomatology since?

A complete rationale for all opinions offered should be provided. Address the Veteran's documented history and assertions and the evidence mentioned further up in this remand.

All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community's knowledge or due to the limits of the examiner's medical knowledge.

The Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

2. Schedule an appropriate VA esophageal examination for the Veteran's chest pain claim. Inform the examiner that "at least as likely as not" means that the likelihood is at least approximately balanced or nearly equal, if not higher. Following a review of the claims file and a copy of this remand, the reviewing examiner is requested to furnish an opinion with respect to the following:

(A) Identify all esophageal related disabilities which have existed at any point during the appeal period, even if they are currently asymptomatic or have resolved during the pendency of the appeal. If the examiner cannot identify an esophageal related disability, the examiner shall determine whether any esophageal related chest pain that the Veteran experiences results in a functional loss or impairment.

(B) For each identified disability (or pain resulting in a functional impairment) from (A), is it at least as likely as not that such had its onset in, or is otherwise related to service?

A complete rationale for all opinions offered should be provided. Address the Veteran's documented history and assertions and the evidence mentioned further up in this remand.

3. Schedule an appropriate VA Gulf War examination for the Veteran's back condition, chest pain, abnormal weight loss condition, and jaw condition claims. Inform the examiner that "at least as likely as not" means that the likelihood is at least approximately balanced or nearly equal, if not higher. Following a review of the claims file and a copy of this remand, the examiner is requested to furnish an opinion with respect to the following:

(A) Determine whether the Veteran's back pain, chest pain, weight loss, and jaw pain symptoms, existing at any point during the appeal period, even if they are currently asymptomatic or have resolved during the pendency of the appeal, are attributable to a known clinical diagnosis or a chronic multi-symptom illness of partially understood etiology and pathophysiology.
's back condition, chest pain, abnormal weight loss condition, and jaw condition claims. Inform the examiner that "at least as likely as not" means that the likelihood is at least approximately balanced or nearly equal, if not higher. Following a review of the claims file and a copy of this remand, the examiner is requested to furnish an opinion with respect to the following:

(B) For any symptoms that are attributable to a known clinical diagnosis or a chronic multi-symptom illness of partially understood etiology and pathophysiology, is it at least as likely as not that the disability is related to the Veteran's service, including but not limited to, environmental hazard exposure in Southwest Asia?

(C) For any symptoms that are not attributable to a known clinical diagnosis or a chronic multi-symptom illness of partially understood etiology and pathophysiology, does the Veteran have objective indications, as established by history, physical examination, and laboratory tests, of an undiagnosed illness or a medically unexplained chronic multi-symptom illness, manifested by identified symptoms that have existed for six months or more or exhibited intermittent episodes of improvement and worsening over a six-month period?

A "medically unexplained chronic multi-symptom illness" is defined as a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.

Whether the etiology of an illness is partially understood is particular to the claimant in each case and is based on a claimant's unique symptoms and the evidence of record.

A complete rationale for all opinions offered should be provided. Address the Veteran's documented history and assertions.

(Continued on next page)

J. Abrams

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Dougan, Adam T.

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

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