ANKLE IMPAIRMENT OF

ANTHONY C. SCIRÉ, JR · 2026 · Case ID: A26030776

MIXED

Summary

The Veteran, who served in the U.S. Army from June 1972 to May 1978, appeals multiple rating decisions. The Veteran sought service connection for bilateral ankle and hip disabilities, left knee disability, bilateral hearing loss, concussion residuals with memory loss, headaches, and skin cancer. The Veteran also appealed the rating for emphysema and the dismissal of a lumbar spine disability claim. The Board denied service connection for the ankle, hip, knee, and concussion claims, finding no current disability or no competent nexus to service. The Board denied service connection for bilateral hearing loss, noting normal hearing at separation and finding the evidence weighed against a nexus to in-service noise exposure and TERA. The Board granted a 10% rating for emphysema prior to May 10, 2024, but denied a compensable rating from that date forward, based on FEV-1 test results. The lumbar spine claim was dismissed as not appealable. Service connection for headaches and skin cancer were remanded for adequate medical opinions, as the existing opinions were found inadequate to decide the appeal. The Board noted the presumption of soundness applied to headaches as the entrance exam did not mention them, but the May 2024 opinion's rationale was unclear regarding aggravation.

Rationale

No current disability; No competent evidence of nexus

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250409-534476

Full Decision Text

Citation Nr: A26030776
Decision Date: 04/03/26 Archive Date: 04/03/26

DOCKET NO. 250409-534476
DATE: April 3, 2026

ORDER

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

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

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

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

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

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

Entitlement to service connection for left ear hearing loss is denied.

Entitlement to service connection for right ear hearing loss is denied.

Entitlement to service connection for concussion residuals with memory loss is denied.

Entitlement to a 10 percent rating, but no higher, for emphysema prior to May 10, 2024, is granted.

Entitlement to a compensable rating for emphysema from May 10, 2024, is denied.

Entitlement to a rating above 20 percent for a lumbar spine disability is dismissed.

REMANDED

Entitlement to service connection for a skin disability claimed as cancer is remanded.

Entitlement to service connection for headaches is remanded.

FINDINGS OF FACT

1. The Veteran does not have a current left ankle disability.

2. There is no competent evidence of a nexus between the Veteran's current right ankle symptoms and any claimed in-service injury.

3. There is no competent evidence of a nexus between the Veteran's current bilateral hip disabilities and any claimed in-service injury.

4. There is no competent evidence of a nexus between the Veteran's current bilateral hip disabilities and any claimed in-service injury.

5. The Veteran had a toxic exposure related activity (TERA) during his active service.

6. The Veteran was exposed to loud noise during his active service.

7. The Veteran's hearing was normal when he was discharged from active duty.

8. The Veteran has a current left ear hearing loss disability.

9. The evidence weighs against a nexus between the Veteran's left ear hearing loss and his in-service noise exposure and TERA.

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

11. The Veteran does not have a current disability, to include memory loss, due to an in-service head injury or concussion.

12. The evidence demonstrates that the forced expiratory volume in one second (FEV-1) test results are the best representation of the Veteran's lung functioning.

13. Prior to May 10, 2024, the Veteran's post-bronchodilator FEV-1 test results were 80 percent predicted.

14. As of May 10, 2024, the Veteran's post-bronchodilator FEV-1 test results were 93.1 percent predicted.

15. The September 2024, December 2024, and February 2025 rating decisions deferred adjudicating the issue of entitlement to a rating above 20 percent for a lumbar spine disability pending clarification of a medical examination.

16. The September 2024, December 2024, and February 2025 deferrals are not appealable decisions.

CONCLUSIONS OF LAW

1. 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.

2. 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.

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

7. The criteria for entitlement to service
right hip 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 left knee 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 a right knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for entitlement to service connection for left ear hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for entitlement to service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

10. The criteria for entitlement to service connection for concussions with memory loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

12. The criteria for entitlement to a 10 percent rating, but not higher, for emphysema prior to May 10, 2024, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code (DC) 6603.

13. The criteria for entitlement to a compensable rating for emphysema from May 10, 2024, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, DC 6603.

14. The criteria for dismissal of entitlement to a rating above 20 percent for a lumbar spine disability have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 1972 to May 1978.

The Veteran appeals February 2025, December 2024, September 2024, and May 2024 rating decisions. In the April 9, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. The Board held a hearing on December 2, 2025, and the transcript is in the record. Therefore, the Board may only consider the evidence of record at the time of the February 2025, December 2024, September 2024, and May 2024 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims of entitlement to
, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

However, because the Board is remanding the claims of entitlement to service connection for a skin disability claimed as skin cancer and headaches, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury, which is the "nexus" element. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Chronic diseases are presumed to be related to service if they are shown as chronic in service, or within an applicable presumptive period, unless they are clearly attributable to intercurrent causes; or, if they become manifest to a degree of 10% or more within an applicable presumptive period; or, if they are noted in service without sufficient evidence to establish that they are chronic in service, when there is continuity of symptomatology since service that is related to the chronic disease. See 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113(a); 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Arthritis is a chronic disease for the purpose of these presumptions. 38 C.F.R. § 3.309(a).

If a Veteran claims compensation with evidence of a disability and evidence of participation in a TERA and there is insufficient evidence to establish service connection, the Secretary shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38 U.S.C. § 1168(a). This provision does not apply if the Secretary determines that there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity. Id. § 1168(b). The Secretary has determined that non-presumptive disabilities based on physical trauma, such as joint conditions, are excepted from this provision. See U.S. Department of Veterans Affairs, Toxic Exposure Risk Activity (TERA) Exception Job Aid (Version 6) (August 18, 2025). Therefore, section 1168(a) does not apply to the Veteran's claims for compensation for ankle, hip, knee, and concussion disabilities.

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

The Veteran appeals the AOJ's denial of entitlement to service connection for a left ankle disability.

In March 1976, the Veteran sought treatment for left ankle pain. He felt stiffness and there was mild swelling. There was no loss of motion, but there was pain in the extremes. Later that month there was some improvement, and the Veteran's ankle had minimal swelling.

The Veteran's May 1978 discharge examination indicates that his lower extremity strength and range of motion were normal, and his feet were normal. The May 1978 report of medical history states that the Veteran reported an illness or injury near his ankles.

A January 2024 ankle conditions disability benefits questionnaire (DBQ) states that the Veteran reported that he is unable to walk for long periods of time due to ankle pain. His left ankle range of motion was normal, and the examiner noted that there was no evidence of pain, crepitus, or localized tenderness or pain on palpation of the joint or associated soft tissue. There was no additional range-of-motion loss following three repetitions. The examiner opined that there was no evidence suggesting additional disability after repeated use over time or during a flare
his lower extremity strength and range of motion were normal, and his feet were normal. The May 1978 report of medical history states that the Veteran reported an illness or injury near his ankles.

A January 2024 ankle conditions disability benefits questionnaire (DBQ) states that the Veteran reported that he is unable to walk for long periods of time due to ankle pain. His left ankle range of motion was normal, and the examiner noted that there was no evidence of pain, crepitus, or localized tenderness or pain on palpation of the joint or associated soft tissue. There was no additional range-of-motion loss following three repetitions. The examiner opined that there was no evidence suggesting additional disability after repeated use over time or during a flare up. The examiner opined that the Veteran's left ankle causes no functional impact to the Veteran's ability to perform occupational tasks, and she opined that there was no objective evidence to support a left ankle diagnosis.

During the hearing, the Veteran testified that he sprained his left ankle during his active service. He stated that his ankles have slight pain and are unstable, so they continue to sprain easily. He testified that he has not had any treatment for his ankle, and the pain is just something that he lives with.

The AOJ favorably determined that the Veteran had an in-service left ankle injury, and the Board finds that this determination is not clearly and unmistakably erroneous. See 38 C.F.R. § 20.801(a). Therefore, the second Shedden element is satisfied.

The Board finds that the evidence weighs against a finding that the Veteran has a current left ankle disability. The January 2024 examiner performed a thorough examination, and the examination was normal. The examiner found no objective evidence that the Veteran has any pain in his ankle, to include during range-of-motion testing or when she palpated the ankle joint and surrounding tissue. The examiner opined that there was no functional impairment in the Veteran's left ankle or objective evidence to support a diagnosis. The January 2024 examination report is thorough, heavily detailed, and entitled to great probative weight. The Board finds that the examination report weighs heavily against a finding that the Veteran has a current left ankle disability.

The Board acknowledges the Veteran's lay statements regarding left ankle impairment. However, a claimant cannot establish "service connection simply by asserting subjective pain." Saunders, 886 F.3d at 1367. A lay person's own testimony is typically not enough to "objectively" confirm pain. See Petitti v. McDonald, 27 Vet. App. 415, 428 (2015). Rather, there "must also be objective confirmation from a person other than the veteran or claimant, be it a medical examiner or a lay person, of a veteran's joint pain." Id. Therefore, the Board finds that the Veteran's assertions of pain have limited probative value on the issue of whether he has a current left ankle disability because they have not been objectively confirmed from a person other than the Veteran and are subjective only.

The Board is persuaded by the evidence of record that the Veteran does not have a current left ankle disability, and the first Shedden element is not satisfied. The most probative evidence of record persuasively weighs against the claim of entitlement to service connection for a left ankle, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-782 (Fed. Cir. 2021). Therefore, the appeal is denied.

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

The Veteran seeks service connection for a right ankle disability.

The Veteran's private treatment records document a right ankle injury in May 2009.

The Veteran's VA treatment records document complaints of chronic ankle pain.

During the hearing, the Veteran testified that he sprained his right ankle during his active service. He stated that his ankles have slight pain and are unstable, so they continue to sprain easily. He testified that he has not had any treatment for his ankle, and the pain is just something that he lives with.

The Veteran contends that he sprained his ankle during service, and there is medical and lay evidence of current right ankle symptomatology. However, there is no competent evidence of a nexus between the current symptoms and the Veteran's active service. The Board has considered the Veteran's hearing testimony, and it finds that the Veteran did not explain why he believes his current right ankle symptoms are related to his claimed in-service ankle spr
chronic ankle pain.

The Board acknowledges that the AOJ did not provide the Veteran with a medical examination or opinion for his right ankle. In disability compensation claims, the Secretary must provide a VA medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board can only remand for a medical examination or opinion if the AOJ committed a pre-adjudicatory duty to assist error by not obtaining one. 38 C.F.R. § 20.802(a). Therefore, the Board must determine whether the evidence of record prior to the May 2024 satisfied the McLendon criteria.

The Board has reviewed the record, and it finds that there is no medical or lay evidence predating the May 2024 rating decision that "indicates" that the Veteran's right ankle symptoms "may be" related to his claimed in-service ankle sprain or to any other in-service injury. McLendon, 20 Vet. App. at 81. The Board finds that the Veteran never explained why he believes that his current symptoms are related to his active service. Therefore, the Board finds that the AOJ did not err when it did not provide the Veteran with a medical examination or opinion for his right ankle. 38 C.F.R. § 20.802(a).

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for a right ankle disability, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-782. Therefore, the appeal is denied.

3. Entitlement to service connection for a left hip disability is denied.

4. Entitlement to service connection for a right hip disability is denied.

The Veteran seeks service connection for left and right hip disabilities.

The Veteran's May 1978 discharge examination report states that the strength and range of motion in the Veteran's lower extremities were normal.

The Veteran's VA treatment records state that he has osteoarthritis of the hips, document complaints of hip pain, and indicate that he has had a right hip replacement. The Veteran's private treatment records document treatment for hip pain and hip mobility.

During the hearing, the Veteran testified that he hurt his hip while running or when he played "combat football." He stated that he did not recall receiving any treatment for hip problems while he was in the military, although he would take medicine for pain. He said that his hips still have pain and that he has had a right hip replacement.

The evidence indicates that the Veteran has been diagnosed with osteoarthritis of the hips, and the Veteran credibly asserts that he participated in "combat football" during his active service. However, there is no competent medical or lay evidence of a nexus between the Veteran's current hip problems and his active service. There is no medical evidence suggesting such a link, and the Veteran's lay evidence does not explain why he thinks he has a current hip disability that is due to his in-service football playing. Therefore, the Board finds that

Because the Veteran has been diagnosed with arthritis, the Board has also considered the provisions for chronic diseases. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). The Board notes that
diagnosed with osteoarthritis of the hips, and the Veteran credibly asserts that he participated in "combat football" during his active service. However, there is no competent medical or lay evidence of a nexus between the Veteran's current hip problems and his active service. There is no medical evidence suggesting such a link, and the Veteran's lay evidence does not explain why he thinks he has a current hip disability that is due to his in-service football playing. Therefore, the Board finds that

Because the Veteran has been diagnosed with arthritis, the Board has also considered the provisions for chronic diseases. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). The Board notes that the evidence does not show that the Veteran had arthritis in either hip either during the Veteran's active service or within one year of his discharge. Id. It is also not clear that the Veteran has asserted continuity of symptomatology. But even if the Veteran's lay statements can be interpreted as asserting continuity of symptomatology, the evidence must demonstrate a nexus between the Veteran's current hip osteoarthritis and those symptoms. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) ("Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was 'noted' during service; (2) evidence of postservice continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the postservice symptomatology."); see Savage v. Gober, 10 Vet. App. 488, (1997). Osteoarthritis is a noninflammatory degenerative joint disease characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. Dorland's Illustrated Medical Dictionary 1326 (33rd Ed. 2020). Although the Veteran is competent to report hip pain, he is not competent to state that the pain is caused by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane-as opposed to some other cause such as a strain-because osteoarthritis is a complex disease process. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay evidence is generally not competent to identify complex conditions). Therefore, the evidence does not establish that the Veteran is entitled to service connection under the provisions for chronic diseases.

The Board notes that the AOJ did not provide the Veteran with a medical examination or opinion to support his claim. The Board finds that this was not error because the evidence before the AOJ-to include the lay evidence-did not satisfy the "low threshold" of indicating that his current symptoms "may be" associated with his active service. See McLendon, 20 Vet. App. at 81. By filing his claim, the Veteran has implicitly asserted that his hip disabilities are due to his active service, but he did indicate why his disabilities may be related to his service. See Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) ("Since all veterans could make such a statement, this theory would eliminate the carefully drafted statutory standards governing the provisions of medical examinations and require the Secretary to provide such examinations as a matter of course in virtually every veteran's disability case."). Therefore, the Board finds that there is no basis to remand the matter because there was no pre-adjudicatory duty to assist error when the AOJ did not obtain a medical examination or opinion.

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for bilateral hip disabilities, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-782. Therefore, the appeals are denied.

5. Entitlement to service connection for a left knee disability is denied.

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

The Veteran asserts that he has bilateral knee disabilities that are due to his active service.

In November 1973, the Veteran hurt his knees playing football, and he stated that they were stiff and sore. The treatment report states that there was no swelling, instability, of fluid, and there was "mild [illegible] of [the] patella." A September 1974 treatment record states that the Veteran sought medical treatment because both his knees were swollen. He hurt his left knee playing softball in June 1975, and he
782. Therefore, the appeals are denied.

5. Entitlement to service connection for a left knee disability is denied.

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

The Veteran asserts that he has bilateral knee disabilities that are due to his active service.

The Veteran's May 1978 discharge examination report states that the strength and range of motion in the Veteran's lower extremities were normal. His May 1978 report of medical history states that he has had a history of a trick or locked knee but no history of arthritis or bone or joint deformity.

A February 2023 VA treatment record states that the Veteran sought treatment for bilateral knee pain that had been ongoing for 20 to 30 years. His treatment records document treatment for bilateral knee pain, and they note that he has osteoarthritis in his right knee.

A January 2024 knee and lower leg DBQ states that the Veteran's current diagnosis is osteoarthritis in both knees. The Veteran reported that the date of onset of his knee pain was 20 to 30 years ago, which would be approximately 1994 to 2004.

A January 2024 VA medical opinion notes that the Veteran's discharge examination report states that the Veteran's left and right knees were physically negative. The examiner stated that there was no ongoing care for a chronic left or right knee condition, and the in-service injury appears acute in nature and resolved without becoming an ongoing chronic condition. The examiner also noted that in 2023 the Veteran reported that his knee pain began 20 to 30 years prior. The examiner stated that the Veteran's in-service knee injury was 46 years ago, and the current knee conditions are more likely related to the natural aging process or a more recent injury because there is no support for a chronic ongoing condition and the imaging studies show only mild changes. The examiner concluded that it is less likely than not that the Veteran's current knee disabilities are due to the Veteran's in-service injuries.

During the hearing, the Veteran testified that he believed his current knee disabilities were due to in-service wear and tear or a football injury during service.

The AOJ favorably determined that the Veteran has a current disability and an in-service injury. The Board is bound by these findings because they are not clearly and unmistakably erroneous. See 38 C.F.R. § 20.801(a). Therefore, the first two Shedden elements are satisfied.

The remaining issue is whether there is a nexus between the Veteran's current disability and his active service. The January 2024 medical examiner stated that the Veteran's negative discharge examination, his lack of ongoing care for knee disabilities, his statement that his knee pain began 20 to 30 years ago, and his mild x-rays indicated that his current knee disabilities are not likely related to his in-service injuries. The Board finds that this reasoning is understandable, adequate, and sufficient to fully inform the Board of the basis for the examiner's opinion. Consequently, the Board finds that the January 2024 medical opinion is entitled to great probative weight.

The only favorable evidence of a nexus to service are the Veteran's lay statements. The Veteran has osteoarthritis in both knees. As discussed above, osteoarthritis is a complex disease process, and the Board finds that the Veteran is not competent to provide an opinion regarding the etiology of his bilateral knee osteoarthritis. See Jandreau, 492 F.3d at 1377 n.4. Indeed, although he asserts that his bilateral knee arthritis is due to wear and tear during his active service or an in-service football injury, the Board finds that a determination of whether those activities are sufficient to cause osteoarthritis requires medical expertise that the Veteran does not possess. See Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011) (the severity, common symptomatology, and usual treatment for injuries are medical issues). Therefore, the Board finds that the lay evidence is not probative evidence of a nexus.

The Board has also considered whether the Board is entitled to service connection via the special provisions for chronic diseases. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). Although the
and tear during his active service or an in-service football injury, the Board finds that a determination of whether those activities are sufficient to cause osteoarthritis requires medical expertise that the Veteran does not possess. See Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011) (the severity, common symptomatology, and usual treatment for injuries are medical issues). Therefore, the Board finds that the lay evidence is not probative evidence of a nexus.

The Board has also considered whether the Board is entitled to service connection via the special provisions for chronic diseases. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). Although the Veteran's knee injuries were noted during his active service, the evidence does not establish that the knee disability was "chronic" during his service or in the year following his discharge. Specifically, the Board notes that there is no evidence suggesting that the Veteran had arthritis or osteoarthritis during that time. See Walker, 708 F.3d at 1338 (only diseases listed in 38 C.F.R. § 3.309(a) are chronic). The Board further finds that-to the extent that the Veteran has asserted that he has had continuity of symptoms-his lay statements are not competent evidence that his symptoms are due to osteoarthritis. As the Board has found, osteoarthritis involves complex processes such as deterioration of cartilage, and the Board is not competent to state whether those internal processes caused his symptoms throughout the period following his discharge. Therefore, the Board finds that the Veteran is not entitled to service connection under the regulations governing chronic diseases.

The Board has considered the evidence and finds that it weighs against a finding that the Veteran's current bilateral knee osteoarthritis was incurred during his active service or is related to any in-service injury, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-782. Therefore, the appeals are denied.

7. Entitlement to service connection for left ear hearing loss is denied.

The Veteran appeals the AOJ's denial of service connection for left ear hearing loss.

An October 1971 entrance examination report contains the following hearing test results:

Ear 500 Hz 1,000 Hz 2,000 Hz 3,000 Hz 4,000 Hz

Left 20 10 5 N/A 15

A January 1977 hearing conservation test showed:

Ear 500 Hz 1,000 Hz 2,000 Hz 3,000 Hz 4,000 Hz

Left 5 0 0 0 0

The Veteran's May 1978 discharge examination states that his audiometric test results were:

Ear 500 Hz 1,000 Hz 2,000 Hz 3,000 Hz 4,000 Hz

Left 0 0 0 N/A 15

A January 2024 VA audiometric examination showed the following test results:

Ear 500 Hz 1,000 Hz 2,000 Hz 3,000 Hz 4,000 Hz CNC

Left 15 10 5 25 45 100%

The examiner opined that the use of a speech discrimination score was appropriate for the Veteran. The examiner noted that the Veteran was exposed to noise during his active service that included artillery fire and being near an explosion. The examiner opined that the Veteran's left ear hearing loss was not likely related to his active service because the medical evidence showed that he had normal hearing in 1971 and 1978. In a separate form, the examiner opined that the Veteran's TERA was not due to his in-service TERA. The examiner reasoned that the Veteran's hearing did not undergo a threshold shift during his active service, which indicates that his hearing loss is likely due to a later cause. The examiner opined that it is less likely than not that the Veteran's current left ear hearing loss is due to his TERA. In an undated addendum, the examiner reiterated that because the Veteran's hearing was normal in 1971 and 1978, it is not likely that the current hearing loss was caused by or is a result of an event during his active service.

A May 2024 memorandum confirms that the Veteran's TERA consists of exposure to 2-chlorobenzalmalononitrile (CS) gas.

During the December 2025 hearing, the Veteran testified that he believes that his hearing loss began during his active service.

The AOJ favorably determined that the Veteran was exposed to CS gas and that, although he had a low probability of noise exposure during his active service, he had a qualifying event, injury
his TERA. In an undated addendum, the examiner reiterated that because the Veteran's hearing was normal in 1971 and 1978, it is not likely that the current hearing loss was caused by or is a result of an event during his active service.

A May 2024 memorandum confirms that the Veteran's TERA consists of exposure to 2-chlorobenzalmalononitrile (CS) gas.

During the December 2025 hearing, the Veteran testified that he believes that his hearing loss began during his active service.

The AOJ favorably determined that the Veteran was exposed to CS gas and that, although he had a low probability of noise exposure during his active service, he had a qualifying event, injury, or disease during his active service. The AOJ also determined that he has left ear hearing loss. These findings are not clearly and unmistakably erroneous, and they bind the Board. See 38 C.F.R. § 20.801(a).

The January 2024 medical opinions and the subsequent addendum, which the Board reads as a whole, state that the Veteran's left ear hearing loss is due to either his in-service noise exposure or his TERA. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) ("the medical report must be read as a whole"), overruled on other grounds Euzebio v. McDonough, 989 F.3d 1305 (Fed. Cir. 2021); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012). The examiner explained that the Veteran's left ear hearing was normal when he entered and exited the military, and the test results demonstrate that his hearing did not undergo a threshold shift during that time. She reasoned that this evidence indicates that his current hearing loss is more likely due to a post-service cause than to an in-service cause such as noise exposure or CS gas exposure. The Board has reconciled the examiner's reasoning from the two opinions and the addendum, and the Board finds that the explanation is adequate and fully understandable. See Monzingo, 26 Vet. App. at 106. Consequently, the Board finds that the January 2024 examiner's opinions weigh heavily against a nexus between the Veteran's left ear hearing loss and his active service.

The Board also notes that the Veteran has asserted that his hearing loss is due to his active service. Although the Veteran can report subjectively diminished hearing, he is not competent to opine as to when he developed a hearing loss disability for VA purposes because section 3.385 requires auditory threshold and Maryland CNC Test results to make that determination. 38 C.F.R. § 3.385. The Board also finds that because the workings of the inner ear are medically complex, the Veteran is not competent to provide an opinion as to the cause of his hearing loss. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay evidence is generally not competent to identify complex conditions). Therefore, the Board finds that the lay evidence is not probative on the issue of whether there is a nexus to service.

The Board has also considered whether the Veteran is entitled to presumptive service connection for chronic diseases. However, there is no evidence that the Veteran developed a hearing loss disability for VA purposes within one year of his discharge, and his hearing loss was not noted during his active service. See 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113(a); 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). Therefore, the presumptive service connection provisions are inapplicable here.

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for left ear hearing loss, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-782. Therefore, the appeal is denied.

8. Entitlement to service connection for right ear hearing loss is denied.

The Veteran asserts that he has right ear hearing loss due to noise exposure during his active service.

8. Entitlement to service connection for right ear hearing loss is denied.

The Veteran asserts that he has right ear hearing loss due to noise exposure during his active service.

For VA purposes, impaired hearing is 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. See 38 C.F.R. § 3.385. Unless the hearing loss meets these minimum thresholds, it is not a "disability" for VA compensation purposes. Palczewski v. Nicholson, 21 Vet. App. 174, 177-79 (2007).

The requirements in 38 C.F.R. § 3.385 apply before VA makes a service connection determination. See McKinney v. McDonald, 28 Vet. App. 15, 25 (2016). This "means that if a veteran's hearing loss is not a 'disability' under § 3.385, there is no need for VA to determine whether the hearing loss is related to service because no entitlement to disability compensation exists if the hearing loss falls below the minimum standards." Id. If the veteran's hearing loss does not meet section 3.385's standards, VA will deny disability compensation benefits for hearing loss. Id.

The January 2024 examination report revealed the following hearing test results:

Ear 500 Hz 1,000 Hz 2,000 Hz 3,000 Hz 4,000 Hz Average CNC

Right 15 15 15 30 35 23.75 96%

The first inquiry for whether the Veteran is entitled to service connection for bilateral hearing loss is whether he has a current disability under 38 C.F.R. § 3.385. Because section 3.385 requires auditory threshold and Maryland CNC Test results, the Board finds that the lay evidence of record is not competent evidence of a hearing loss disability for VA purposes. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay evidence is generally not competent to identify complex conditions). The auditory threshold results from January 2024 demonstrate that the Veteran did not have an auditory threshold of 40 decibels or greater in any frequency. The test also demonstrated that the Veteran did not have an auditory threshold of 26 decibels or greater for any three frequencies. Lastly, the Maryland CNC Test results is greater than 94 percent. Therefore, the Board finds that the Veteran did not have a current bilateral hearing loss disability for VA purposes. See 38 C.F.R. § 3.385.

The Board is persuaded by the competent evidence of record that the Veteran does not have a current hearing loss disability. "Without a current disability, of course, there can be no service connection, and thus, no disability compensation." Palczewski, 21 Vet. App. at 181. The most probative evidence of record persuasively weighs against the claim of entitlement to service connection for bilateral hearing loss, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-782. Therefore, the appeal is denied.

9. Entitlement to service connection for concussion residuals with memory loss is denied.

The Veteran asserts that he has memory loss due to an in-service head injury that he describes as a concussion.

The Veteran reported a history of a head injury on his May 1978 report of medical history.

VA primary care treatment records dated May 5, 2021, May 16, 2022, and May 12, 2023, state that the Veteran does not have memory loss.

VA obtained a traumatic brain injury (TBI) examination in April 2024, which was conducted by a neurologist. The examiner found that the Veteran had no complaints of impairment of memory, attention, concentration, or executive functions, normal judgment, normal social interaction, orientation to person, time, place, and situation, normal motor activity, normal visual spatial orientation, and no neurobehavioral effects. The Veteran's consciousness was normal, and he was able to communicate by spoken and written language. The examiner found no subjective symptoms attributable to a T
care treatment records dated May 5, 2021, May 16, 2022, and May 12, 2023, state that the Veteran does not have memory loss.

VA obtained a traumatic brain injury (TBI) examination in April 2024, which was conducted by a neurologist. The examiner found that the Veteran had no complaints of impairment of memory, attention, concentration, or executive functions, normal judgment, normal social interaction, orientation to person, time, place, and situation, normal motor activity, normal visual spatial orientation, and no neurobehavioral effects. The Veteran's consciousness was normal, and he was able to communicate by spoken and written language. The examiner found no subjective symptoms attributable to a TBI and no other pertinent physical findings. The examiner opined that there was no functional impairment.

The Veteran testified at his Board hearing that he believes that he has memory loss that began five to ten years ago. His wife testified that the Veteran will repeat things frequently and writes notes to help him remember. She asserted that this began five or six years ago.

The evidence of whether the Veteran has a memory loss disability is mixed. On one hand, the Veteran and his wife have testified that he has trouble remembering things and repeats himself. On the other hand, his VA treatment records specifically state that he did not have memory loss in 2021, 2022, and 2023. The April 2024 VA examiner also found that the Veteran does not have memory loss, and he conducted a thorough examination that found that the Veteran does not have any deficits attributable to a head injury. The April 2024 examiner found no functional impairment. Although the Board does not doubt the Veteran and his wife's sincerity, it finds that the medical evidence is more probative because medical professionals have the medical training to determine whether the Veteran has memory loss in the clinical sense, while the Veteran and his wife do not have the training to state at what level repeating oneself or having trouble with memory rise to the level of what constitutes a memory loss disability. Therefore, the Board finds that the most persuasive evidence weighs against a finding that the Veteran has a current memory loss disability or any other disability related to an in-service head injury, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-782. The appeal is denied.

10. Entitlement to an initial 10 percent rating for emphysema prior to May 10, 2024, is granted.

11. Entitlement to a compensable rating for emphysema from May 10, 2024, is denied.

The Veteran seeks a compensable rating for emphysema, which the AOJ rated under DC 6603. The Board will use post-bronchodilator pulmonary function tests (PFTs) to rate emphysema unless they are poorer than the pre-bronchodilator results. Id. § 4.96(d)(5). However, post-bronchodilator PFTs are not required when the pre-bronchodilator tests are normal. Id. § 4.96(d)(4). When there is a disparity between the results of different PFTs that would result in different evaluations, the regulations require the use of the test result that the examiner states most accurately reflects the level of disability. Id. § 4.96(d)(6). A 10 percent rating is when the FEV-1 is 71 to 80 percent predicted, or, FEV-1/forced vital capacity (FVC) is 71 to 80 percent, or the diffusion capacity of the lung for carbon monoxide by the single breath method test (DLCO (SB)) is 66 to 80 percent predicted. Id. § 4.97, DC 6603.

When there is a question as to which of two ratings applies, the Board will assign the higher rating if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. If the evidence does not satisfy the criteria for a compensable rating, the Board will assign a zero percent (noncompensable) evaluation. 38 C.F.R. § 4.31.

PFTs from September 2023 state that the Veteran's post-bronchodilator test FEV-1 was 80 percent predicted, and the FEV-1/FVC was 57 percent. See January 2024 Examination Report. The examiner opined that the FEV-1 test most accurately reflects the Veteran's disability level.

PFTs from May 2024 state that the Veteran's post-bronchodil
rating. 38 C.F.R. § 4.7. If the evidence does not satisfy the criteria for a compensable rating, the Board will assign a zero percent (noncompensable) evaluation. 38 C.F.R. § 4.31.

PFTs from May 2024 state that the Veteran's post-bronchodilator test FEV-1 was 93.1 percent predicted, while the FEV-1/FVC was 76.8 percent. See August 2024 Examination Report. The examiner opined that the Veteran's FEV-1 result most accurately reflects his disability level.

The Board observes that there are two PFTs in the record, and the test results reflect different disability levels. The January 2024 examiner opined that the Veteran's FEV-1 test most accurately reflects his disability level, and the September 2023 FEV-1 was 80 percent predicted, which is consistent with a 10 percent rating. The August 2024 examiner opined that the Veteran's FEV-1 test most accurately reflects his disability level, and the May 2024 FEV-1 was 93.1 percent predicted. The May 2024 FEV-1 is consistent with a non-compensable rating, and it demonstrates an improved FEV-1 test result. "When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Such separate disability ratings are known as staged ratings." O'Connell v. Nicholson, 21 Vet. App. 89, 91 (2007). The FEV-1 test results are objective findings that show improved lung functioning as opposed to a difference in how the examiners subjectively describe the Veteran's disability. Because the FEV-1 test results show different levels of impairment, the Board finds that a staged rating is warranted here. Consequently, the Board will award a 10 percent rating, but no higher, for the period prior to May 10, 2024. As of May 10, 2024, the FEV-1 test results are consistent with a non-compensable rating, which warrants a staged non-compensable rating from that date. Accordingly, the most probative evidence of record persuasively weighs against the claim for a rating greater than 10 percent prior to May 10, 2024, and against a compensable rating from May 10, 2024, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th at 781-782. Therefore, the appeal is denied to that extent.

12. Entitlement to a rating above 20 percent for a lumbar spine disability is dismissed.

The Veteran seeks Board review of the issue of entitlement to a rating greater than 20 percent for a lumbar spine disability.

A claimant can request Board review within one year after the AOJ "renders a decision on a claim." 38 U.S.C. § 5104C(a)(1); 38 C.F.R. § 3.2500(a). However, the AOJ's "decision to defer a ruling until a later date does not constitute a final decision by the administrative agency. When the [AOJ] defers a rating decision, all factual and legal questions relevant to the claim are reserved for resolution at a later date." Shipley v. Shinseki, 24 Vet. App. 458, 462 (2011). Consequently, a claimant cannot appeal an AOJ determination that defers a decision on a claim. Id.

The September 2024, December 2024, and February 2025 rating decisions deferred adjudicating the issue of entitlement to a rating greater than 20 percent for a lumbar spine disability. Although the decisions state that the 20 percent rating "is continued," the portion of each decision listing the reasons for the decisions states that the evaluation is "deferred . . . pending clarification of examination." Because the September 2024, December 2024, and February 2025 AOJs deferred a decision on the issue, the Veteran's attempt to seek Board review is premature in this docket. Shipley, 24 Vet. App. at 462. The AOJ did issue an appealable decision in April 2025, shortly after the Veteran submitted the VA Form 10182 that initiated this appeal. The Board addressed the Veteran's appeal of the April 2025 rating decision in docket number 250923-589640. However, the September 2024, December 2024, and February 2025 AOJ deferrals are not appealable decisions, the Board will dismiss the attempt to appeal the issue of entitlement to a rating greater than 20 percent for a lumbar spine disability from those deferrals.

REASONS FOR REMAND

1. Entitlement to service connection for headaches is remanded.

The Board finds that remand is warranted because the May 2024 medical opinion is not adequate to decide the appeal. See 38 C.F.R. §§ 4.2, 20.802(a); see also Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (holding that once VA provides a medical opinion in a service connection claim, it must ensure that it is adequate). The Board notes that the AOJ determined that the Veteran's headaches pre-dated his active duty and that the evidence rebutted the presumption of soundness.

The three-element test for service connection generally requires evidence of: (1) 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 in-service disease or injury, which is the "nexus" element. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The presumption of soundness presumes that a veteran is sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). To be "noted" within the meaning of the statute and regulation, the condition must be recorded in the entrance examination report. Id. Here, the Veteran's October 1971 entrance examination report does not state that he had a pre-existing headache disability.

Before the presumption of soundness applies, "there must be evidence that a disease or injury that was not noted upon entry to service manifested or was incurred in service." Gilbert v. Shinseki, 26 Vet. App. 48, 52 (2012). If the presumption applies, the correct standard for rebutting it requires the government to show by clear and unmistakable evidence that (1) the veteran's disability existed prior to service and (2) that the pre-existing disability was not aggravated during service." Wagner v. Principi, 370 F.3d 1089, 1097 (Fed. Cir. 2004). If the presumption of soundness applies and the Secretary is unable to rebut the presumption, "the disease or injury manifested in service is deemed incurred in service, such that the second element of service connection is established." Gilbert, 26 Vet. App. at 52. "Even if an injury or disease is deemed incurred in service by virtue of the presumption of soundness (or found to be actually incurred in service), a veteran still must establish that he has a current disability that is related to the in-service injury or disease." Id.

The May 2024 examiner checked a box stating that the "claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness." However, the examiner's rationale states that "references to disorders that reportedly existed prior to active duty cannot be substantiated and there is no additional commentary absent relevant/valid/accurate characterization of any such primary and/or secondary headache disorder to begin with." The examiner's rationale is unclear at best, and it appears to imply that the examiner did not believe that the Veteran had either a pre-existing or in-service headache condition or symptoms. Although the examiner provided an addendum in February 2025, that opinion only addresses the issue of aggravation and does not clarify the deficiencies regarding whether the Veteran's headaches pre-existed his active services or manifested during his active service. Because the opinion is not adequate to decide the appeal, the Board will remand the matter to correct this pre-decisional duty to assist error. 38 C.F.R. § 20.802(a).

2. Entitlement to service connection for a skin disability claimed as skin cancer is remanded.

The Board finds that remand is warranted because the October 2024 medical examination report is not adequate to decide the appeal. See 38 C.F.R. §§ 4.2, 20.802(a). The examiner determined that the Veteran does not have a current skin condition and has not had "any treatments or procedures other than systemic or topical medications in the past 12 months for any skin condition." However, although a February 28, 2024, VA treatment record states that the Veteran has "no history of skin cancer or skin disorders," it also states that he was treated during that visit for two seborrheic keratosis lesions, which indicates that the Veteran did have treatment for a skin condition within the previous 12 months. See McLain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the requirement that a claimant have a current disability is satisfied if the claimant has a current disability at the time he or she files the VA claim or during the pendency of that claim even if the disability resolves); Clemons v. Shinseki, 23 Vet. App. 1, 4 (2009) ("multiple medical diagnoses or diagnoses that differ from the claimed condition do not necessarily represent wholly separate claims"). Consequently, the October 2024 medical examination is not adequate for the Board to determine whether the Veteran has a current skin disability, to include, but not limited to, skin cancer, and the Board will remand the matter to correct this pre-adjudicatory duty to assist error. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) ("An opinion is adequate where it is based upon consideration of the veteran's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation will be a fully informed one.") (internal quotation omitted); 38 C.F.R. § 20.802(a).

The matter is REMANDED for the following action:

1. Send the Veteran's electronic claims file to an appropriate medical professional to obtain a medical opinion regarding the Veteran's headaches. The Veteran's electronic claims file, including a copy of this remand, must be accessible to the designated professional for review. The examiner must provide a detailed rationale for any opinion that he or she provides, and the opinion must state that the examiner has reviewed the Veteran's electronic claims file and this remand.

After the examiner reviews the claims file, the examiner must respond to the following:

(a) Is it at least as likely as not (at least approximately balanced or nearly equal) that the Veteran had headache symptoms or a headache disability during his active service? The examiner must consider the medical and lay evidence of record to answer this question.

(b) Is it at least as likely as not (at least approximately balanced or nearly equal) that the Veteran's current headache disability is related to or has a nexus to any in-service headache symptoms or headache disability?

If the answers to questions (a) and (b) are yes, proceed to question (c):

If the answer to question (c) is yes, proceed to question (d):

(d) Is there clear and unmistakable evidence that any pre-existing headache disability did not worsen during the Veteran's active service?

(e) If there is not clear and unmistakable evidence that the Veteran's headache disability did not worsen during his active service, is there clear and unmistak
at least approximately balanced or nearly equal) that the Veteran's current headache disability is related to or has a nexus to any in-service headache symptoms or headache disability?

If the answers to questions (a) and (b) are yes, proceed to question (c):

If the answer to question (c) is yes, proceed to question (d):

(d) Is there clear and unmistakable evidence that any pre-existing headache disability did not worsen during the Veteran's active service?

(e) If there is not clear and unmistakable evidence that the Veteran's headache disability did not worsen during his active service, is there clear and unmistakable evidence that any increase in disability is due to the natural progression of the disease?

The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without a new examination, one should be scheduled.

2. Schedule the Veteran for a VA opinion with an appropriate medical professional for the claimed skin cancer disability. The Veteran's electronic claims file, including a copy of this remand, must be accessible to the designated professional for review. The examiner must provide a detailed rationale for any opinion that he or she provides, and the opinion must state that the examiner has reviewed the Veteran's electronic claims file and this remand.

After reviewing the claims file, the examiner must respond to the following:

(a) Is it at least as likely as not (at least approximately balanced or nearly equal) that the Veteran has or has had a current skin disability at any time during the pendency of his claim for VA benefits for a skin disability claimed as skin cancer? The examiner must address the February 28, 2024, treatment for seborrheic keratosis lesions in the discussion of whether the Veteran has a current disability.

(b) If the Veteran does have a current skin disability, is it at least as likely as not (at least approximately balanced or nearly equal) that the current skin disability is related to the Veteran's TERA? The examiner must consider and discuss (1) the total potential exposure through all the Veteran's applicable military deployments and (2) the synergistic, combined effect of all the Veteran's toxic exposure risk activities.

ANTHONY C. SCIRÉ, JR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B.B., Counsel

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

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