PSYCHOTIC DISORDERS

HARVEY P. ROBERTS · 2026 · Case ID: A26031672

MIXED

Summary

The veteran, who served from October 2003 to April 2009, appeals the denial of service connection for several conditions, including a psychiatric disability (other than tobacco use disorder), tobacco use disorder, erectile dysfunction, hypertension, bilateral hand disabilities, bilateral hearing loss, and migraine headaches. The Board denied the psychiatric disability claim, finding no evidence of a current diagnosis during the appeal period, and noted that tobacco use disorder is not a service-connectable disability. Erectile dysfunction was denied as it was not shown to be related to service or any service-connected condition, as no primary psychiatric disability was established. Hypertension and bilateral hand disabilities were denied due to a lack of current diagnosis or functional limitation documented in the record, and the Board found the weight of the evidence against these claims. Bilateral hearing loss was denied because the veteran failed to attend a scheduled VA examination without good cause, and no other competent medical evidence linked the condition to service. The claim for an increased rating for migraines was also denied, as the veteran failed to attend a scheduled VA examination to assess the severity, and the existing evidence did not support a higher rating. The Board remanded claims for right shoulder, left shoulder, neck, right knee, left knee, right elbow, left elbow disabilities, and GERD for additional development, as the prior examiner's opinions were less likely than not related to service or toxic exposure, and further etiological opinions were needed.

Rationale

No current psychiatric diagnosis found during appeal period; Weight of evidence against claim; Lay person not competent to diagnose or opine on etiology

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251103-617106

Full Decision Text

Citation Nr: A26031672
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 251103-617106
DATE: April 7, 2026

ORDER

Entitlement to service connection for a psychiatric disability, other than tobacco use disorder, is denied.

Entitlement to service connection for tobacco use disorder is denied.

Entitlement to service connection for erectile dysfunction is denied.

Entitlement to service connection for hypertension is denied.

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

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

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to a disability rating in excess of 0 percent for migraine headaches, effective July 5, 2024 is denied.

REMANDED

Entitlement to service connection for a right shoulder disability is remanded.

Entitlement to service connection for a left shoulder disability is remanded.

Entitlement to service connection for a neck disability is remanded.

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

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

Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

Entitlement to service connection for a left elbow disability is remanded.

Entitlement to service connection for a right elbow disability is remanded.

FINDINGS OF FACT

1. The weight of the evidence is against a finding that the Veteran has a current psychiatric diagnosis, other than tobacco use disorder, that is etiologically related to service.

2. Tobacco use disorder is not a disability for which service connection can be established.

3. Erectile dysfunction is not secondary to a service-connected disability and is not otherwise related to service or any event, injury, or disease during service.

4. The weight of the evidence is against a finding that the Veteran has any current hypertension or bilateral hand disability diagnosis; or functional limitation that can be considered a disability or a diagnosis contemporaneous to the appeal period.

5. The weight of the evidence is against associating any hearing loss disability with any incident or injury incurred during active service, and against a finding that any claimed hearing loss disability was caused or aggravated by any service-connected disability.

6. Effective July 5, 2024, the Veteran did not experience migraines with characteristic of prostrating attacks averaging one in two months over the last several months.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a psychiatric disability, other than tobacco use disorder, have not been met. 38?U.S.C. §§?1110, 1131, 1132, 5103A, 5107;?38?C.F.R. §§?3.102, 3.159, 3.303

2. The criteria for entitlement to service connection for tobacco use disorder have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38C.F.R. §§ 3.102, 3.310.

4. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

5. The criteria for entitlement to service connection for a left hand disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

6. The criteria for entitlement to service connection for a right hand disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

7. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38?U.S.C. §§?1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §?3.303, 3.307, 3.309, 3.310, 3.655.

8. The criteria for entitlement to a disability rating in excess of 0 percent for
met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

7. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38?U.S.C. §§?1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §?3.303, 3.307, 3.309, 3.310, 3.655.

8. The criteria for entitlement to a disability rating in excess of 0 percent for migraine headaches, effective July 5, 2024 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.400, 4.1-4.14, 4.121, 4.122, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 2003 to April 2009.????

This case comes before the?Board of Veterans' Appeals (Board) on appeal from November 2024 and January 2025?rating decisions by the Department of Veterans Affairs (VA)?Veterans Benefits Administration?Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). In?November 2025, the Veteran requested a direct review of the appeal by the Board.? ?????

The current appeal stems from the Veteran's election of direct review. The Veteran acknowledged that the review will be based upon the evidence?submitted?to VA at the time of the?previous?AOJ decisions on the issues on appeal. Therefore, only evidence of record as of the date of November 2024 and January 2025?rating decisions will be considered. VA will not seek?additional?evidence on behalf of the Veteran as part of the review.

A January 2026 rating decision established service connection for tinnitus Therefore, the claim for service connection for tinnitus, previously the subject of?the?appeal, has?been resolved in the Veteran's favor, and there is no longer a case?in controversy for appellate consideration as to that claim.? Therefore, that claim is not on appeal before the Board.

Service Connection

Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38?U.S.C. §§?1110, 1131; 38?C.F.R. §§?3.303, 3.304. In order to establish service connection for a claimed disability, there must be (1)?medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12?Vet. App.?247 (1999).

Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in-service. 38?U.S.C. §?1113(b); 38?C.F.R. §?3.303(d); Cosman v. Principi, 3?Vet. App.?503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic.

Secondary?service connection may be established for a disability that is proximately due to, or aggravated by, a service-connected disability.? 38?C.F.R. §?3.310.

Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38?C.F.R. §?3.159(a)(2). Lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and may provide sufficient support for a claim of service connection. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran is competent to provide testimony concerning factual matters of which he has firsthand knowledge, such as experiencing a physical symptom such as pain. Barr v. Nicholson, 21?Vet. App.?303 (2007); Washington v. Nicholson, 19?Vet. App.?362 (2005). Therefore, the Board must assess the competence and credibility of lay statements. Barr v. Nicholson, 21?Vet. App.?303 (2007).

Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while weight and credibility are factual determinations going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10?Vet. App.?67 (1997).

A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9?Vet. App.?518 (1996).

While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, the evidence submitted by or on behalf of the Veteran. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review the entire record but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14?Vet. App.?122 (2000).

1. Entitlement to service connection for a psychiatric disability, other than tobacco use disorder.

The Veteran contends that a current psychiatric disability was caused by active service.

The Board finds that the evidence of record does not show that the Veteran has had a current psychiatric disability diagnosis, other than tobacco use disorder, contemporary to the appeal period. Therefore, as the weight of evidence is against a finding that the Veteran has a current psychiatric disability diagnosis, other than tobacco use disorder, or has had the claimed disability during or contemporary to the claims period, the claim for service connection must be denied.

Here, the evidence of record shows no evidence of a current psychiatric disability diagnosis, other than tobacco use disorder.

A January 2025 rating decision found that the Veteran was diagnosed with tobacco use disorder. The Board is bound by that finding.

An analysis of post-service medical records shows no diagnosed psychiatric disability, other than tobacco use disorder. The Veteran has not submitted any competent evidence that demonstrates a current psychiatric disability diagnosis, other than tobacco use disorder, during the claim period. No post-service treatment record documents any diagnosed psychiatric disability, other than tobacco use disorder.

At a December 2024 VA examination, the examiner diagnosed moderate tobacco use disorder. The examiner stated that the Veteran did not have more than one mental disorder diagnosis. The examiner stated that there was no diagnosis of generalized anxiety disorder or depression because there were no findings, signs, or symptoms to support those diagnoses.

The Board notes that competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.? 38?C.F.R. §?3.159(a)(2); Bruce v. West,?11?Vet. App.?405?(1998) (one not a medical expert is nevertheless competent to offer evidence of her symptoms in support of a claim for an increased rating); Layno v. Brown,?6?Vet. App.?465 (1994). The Board acknowledges that the Veteran has claimed a disability that is related to service. However, the Board finds that the Veteran, as a lay person, is not competent to provide a diagnosis of a psychiatric disability, and thus is not competent to diagnose any disability or provide an opinion as to the etiology of any disability. Jandreau v. Nicholson,?492 F.3d 1372 (Fed. Cir. 2007).

The Veteran has not submitted competent evidence that supports a finding of a diagnosed psychiatric disability, other than tobacco use disorder, during the pendency of the claim.

Competent evidence concerning the nature and etiology of the Veteran's claimed psychiatric disability has been provided by a medical professional who has examined the Veteran, and the underlying medical history of the condition, and found that a diagnosis of a psychiatric disability, other than tobacco use disorder, was not warranted. To the extent that?there?is?a conflict between the lay and medical evidence, the Board finds the observations and findings of a trained professional to be more probative than any lay assertions in this case.

After a careful review of the evidence of record, the Board finds the weight of the evidence is against the claim of entitlement to service connection for a psychiatric disability, other than tobacco use disorder. None of the Veteran's medical treatment providers have given any indication that the Veteran has?been diagnosed with current, chronic psychiatric disability, other than tobacco use disorder, during the course of this appeal. Further, the Veteran has not submitted any competent medical evidence which supports the claim of a current, chronic psychiatric disability, other than tobacco use disorder, or shows a relationship between any diagnosed psychiatric disability, other than tobacco use disorder, and service.

In the absence of competent medical evidence finding a current, chronic diagnosis, the threshold requirement for substantiating the claims for service connection is not met. Brammer v. Derwinski,?3?Vet. App.?223?(1992).

The Board acknowledges that VA?is?statutorily required to resolve reasonable doubt in favor of the Veteran when there?is?an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. However, the Board finds that the weight of the evidence is against a finding of any current diagnosis for a psychiatric disability, other than tobacco use disorder, or that any psychiatric disability is related to active service. Therefore, the claim of entitlement to service connection for psychiatric disability, other than tobacco use disorder, must be denied. The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran. 38?U.S.C. §?5107;?38?C.F.R. §?3.102.

2. Entitlement to service connection for tobacco use disorder.

The Veteran contends that a current psychiatric disability is caused by active service.

A January 2025 rating decision found that the Veteran was diagnosed with tobacco use disorder. The Board is bound by that finding.

The provisions of 38 U.S.C. § 1103 prohibit service connection for a disability as a result of disease or injury attributable to the use of tobacco products during a veteran's active service. The term tobacco products includes cigarettes. 38 C.F.R. § 3.300(a). The statute does not prohibit service connection if the disability resulted from a disease that is otherwise shown to have been incurred in service, meaning that the disability can be service-connected on some basis other than as a result of a Veteran's use of tobacco products in service. 38 C.F.R. § 3.300(b). Secondary service connection may be awarded for a tobacco-related disability that is caused or aggravated by a primary

The Veteran's VA treatment records show a diagnosis of tobacco use disorder.

However, tobacco use disorder itself is not eligible for service connection. Additionally, there is no argument or medical indication that the condition may have been caused or aggravated by a service-connected disability.

The evidence is not in approximate balance as to service connection, and there is no reasonable doubt to be resolved in the Veteran's favor. Therefore, the appeal is denied.

3. Entitlement to service connection for erectile dysfunction.

The Veteran claims entitlement to service connection for erectile dysfunction secondary to a psychiatric disability.

The Board notes that, to date, the Veteran has not established service connection for any psychiatric disability. A claimed secondary disability cannot be service-connected where the claimed primary disability is not service-connected.

Service connection can be awarded on a direct basis under 38 C.F.R. § 3.303. However, there is no evidence in the service medical records of any erectile complaints. There is also no evidence in the post-service records of any symptoms that are deemed causally connected to service. The Veteran has not provided any additional information related to the claims on a direct service connection basis. The Veteran has not provided any arguments related to the claims on a direct basis.

Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. The evidence does not include any competent opinion relating any erectile disability to service or to any event, injury, or disease during service.

The Board notes that, on the July 2024 VA Form 21-526EZ, Fully Developed Claim, the Veteran explicitly stated that he now experiences erectile dysfunction, exacerbated by anxiety.

The Veteran has made no contention relating any erectile dysfunction to service; to any event, injury, or disease during service; or to any disability for which service connection has been established.

The Board concludes that, while the Veteran may have erectile dysfunction, the Veteran is not service-connected for any psychiatric disability. Service connection on a secondary basis cannot be established where the claimed primary disability is not service-connected. The evidence does not otherwise show that any erectile dysfunction is related to service or any service-connected disability.

Accordingly, the Board finds that the weight of the evidence is against the claim for service connection for erectile dysfunction. The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claim must be denied. 38 U.S.C. § 5107.

4. Entitlement to service connection for hypertension.

5. Entitlement to service connection for a left hand disability.

6. Entitlement to service connection for a right hand disability.

The Veteran has claimed that hypertension and bilateral hand disabilities are the result of or began during active service.

At the time of the January 2025 rating decision on appeal, the Board finds that the evidence of record does not show that the Veteran was diagnosed with any chronic left or right hand or hypertensive disabilities. The evidence does not show medical findings of functional limitation that could be considered a disability. Therefore, as the weight of evidence is against a finding that the Veteran had a current chronic diagnosis or has had the claimed disability contemporary to the claims period, the Board finds that the claims for service connection must be denied.

The threshold consideration for any service connection claim is the existence of a current disability. In the absence of proof of a present disability, there is no valid claim for service connection. Brammer v. Derwinski,?3?Vet. App.?223?(1992). At the time of the January 2025 rating decision on appeal, the evidence of record showed no evidence of current, chronic left or right hand or hypertension disability diagnoses.

An analysis of post-service medical records shows no diagnosed chronic left or right hand or hypertension disabilities. At the time of the rating decision on appeal, the Veteran had not submitted any competent evidence that demonstrated a current diagnosis of any left or right hand or hypertensive disabilities during or contemporary
The threshold consideration for any service connection claim is the existence of a current disability. In the absence of proof of a present disability, there is no valid claim for service connection. Brammer v. Derwinski,?3?Vet. App.?223?(1992). At the time of the January 2025 rating decision on appeal, the evidence of record showed no evidence of current, chronic left or right hand or hypertension disability diagnoses.

Prior to January 10, 2025, the date of the rating decision on appeal, no post-service medical record documents any chronic left or right hand or hypertensive disability diagnosis. The evidence also does not show that any left or right hand or hypertensive disability resulted in a functional limitation that could be considered a disability.

The Board notes that competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.? 38?C.F.R. §?3.159; Bruce v. West,?11?Vet. App.?405?(1998) (one not a medical expert is nevertheless competent to offer evidence of her symptoms in support of a claim for an increased rating); Layno v. Brown,?6?Vet. App.?465 (1994). The Board acknowledges that the Veteran has claimed several chronic disabilities related to service. However, the Board finds that the Veteran, as a lay person, is not competent to provide a diagnosis of any disability and thus is not competent to diagnose any chronic disability or provide an opinion as to the etiology of any disability. Jandreau v. Nicholson,?492 F.3d 1372 (Fed. Cir. 2007). The Veteran has not submitted competent evidence that supports a finding of a chronic left or right hand or hypertensive disability during the pendency of the claim.

At a December 2024 VA hand examination, the examiner explicitly noted that the Veteran did not have a current diagnosis associated with the hand or fingers.

At a December 2024 VA hypertension examination, the Veteran was not found to have a current diagnosis of hypertension.

Although VA has a duty to assist the Veteran in substantiating a claim, that duty is not a?one-way street, and it is important that the Veteran make efforts to assist VA in gathering evidence relevant to the claim. Woods v. Gober,?14?Vet. App.?214 (2000); Hurd v. West,?13?Vet. App.?449?(2000). The Board finds that the Veteran's bare assertion, without more, that the Veteran has an alleged disability that is related to service, does not require more of VA's duty to assist. Waters v. Shinseki, 601 F.3d 1274?(Fed. Cir. 2010).

After a careful review of the evidence of record, the Board finds the weight of the evidence is against the claims of entitlement to service connection for left or right hand and hypertension disabilities.

Prior to January 2025, none of the Veteran's medical treatment providers have given any indication that the Veteran has?been diagnosed with a chronic left or right hand or hypertensive disability; or had a related chronic disability resulting in functional impairment. The Veteran did not submit any competent medical evidence which supports the presence of any current left or right hand or hypertensive disabilities; or shows a relationship between any diagnosed disability?and service.

The Board notes, in the abstract, that a singular acute diagnosis, even in service, is not a showing of a chronic disability for which service connection can be established. The Board finds that the evidence does not show any current, chronic left or right hand or hypertension disabilities contemporaneous to the appeal period.

In the absence of competent medical evidence providing a current, recurrent chronic left or right hand or hypertension disability diagnosis, or a showing of functional loss constituting a disability, the threshold requirement for substantiating the claims for service connection is not met. Brammer v. Derwinski, 3?Vet. App.?223?(1992).

The Board acknowledges that VA?is?statutorily required to resolve reasonable doubt in favor of the Veteran when there?is?an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. However, the Board finds that the weight of the evidence is against a finding of any diagnosis for left or right hand or hypertension disabilities, or functional loss resulting in disability, or any left or right hand or hypertensive disability is related to active service or a service- connected disability. The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claims for service connection for left and right hand and hypertension disabilities must be denied. 38?U.S.C. §?5107; 38?C.F.R. §?3.102.

7. Entitlement to service connection for bilateral hearing loss.

The Veteran contends that a bilateral hearing loss disability is due to service.

A November 2024 rating decision found that the Veteran's Military Occupational Specialty (MOS) of aviation boatswain's mate had a high probability of noise exposure. The Board is bound by that finding.

In July 2024, the RO attempted to schedule a VA examination concerning the etiology of bilateral hearing loss. The Veteran did not attend the scheduled examination. The Veteran did not provide good cause?for not attending the examination or request that the examination be rescheduled.

On review of the record, there is no indication, either by the Veteran or any representative, that an attempt has been made to reschedule or otherwise provide good cause?for failure to appear for the VA examination. Moreover,?there is no indication in the record that the letter notifying the Veteran of the scheduled VA examination?was not received. There is a presumption of regularity that public officers have properly discharged their official duties in absence of clear evidence to the contrary. Ashley v.?Derwinski,?2?Vet. App.?62?(1992);?Mindenhall?v. Brown,?7?Vet. App.?271?(1994). The Board finds no evidence of any VA error in notifying or assisting the Veteran.

While VA has a statutory duty to assist in developing evidence pertinent to a claim, a Veteran also has a duty to assist and cooperate with VA in developing evidence. The duty to assist is not a one-way street. Wood v. Derwinski,?1?Vet. App.?190 (1991). VA's duty must be understood as a duty to assist a Veteran in developing a claim, rather than a duty on the part of VA to develop the entire claim with the Veteran performing a passive role. Turk v. Peake,?21?Vet. App.?565 (2008). Therefore, remand for an additional VA examination is not warranted.

When entitlement cannot be established or confirmed without a current VA examination or reexamination and a claimant, without?good cause, does not report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a supplemental claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied. 38 C.F.R. §?3.655.

The Board recognizes that the Veteran has asserted that a hearing loss disability is due to service. However, the Board finds that the Veteran, as a lay person without the appropriate medical training and expertise, is not competent to provide an opinion as to whether any disability is either caused or aggravated beyond the normal progression by any incident of active service, or by another service-connected disability. Madden v. Gober,?125 F.3d 1477?(Fed. Cir. 1997). The Veteran has not been shown to possess the adequate medical knowledge, education, or training, to competently opine as to the diagnosis or etiology of any disability.

In addition, the Veteran has not provided any medical statement, from a competent medical provider, relating any bilateral hearing loss disability to service or a service-connected disability.

The Veteran was provided with notice of the need to schedule examination and did not attend. Consequently, adjudication on the merits of the existing record is proper. Therefore, as no probative, competent,
by any incident of active service, or by another service-connected disability. Madden v. Gober,?125 F.3d 1477?(Fed. Cir. 1997). The Veteran has not been shown to possess the adequate medical knowledge, education, or training, to competently opine as to the diagnosis or etiology of any disability.

In addition, the Veteran has not provided any medical statement, from a competent medical provider, relating any bilateral hearing loss disability to service or a service-connected disability.

The Veteran was provided with notice of the need to schedule examination and did not attend. Consequently, adjudication on the merits of the existing record is proper. Therefore, as no probative, competent, medical evidence has been presented to show any relationship between service or service- connected disabilities and any bilateral hearing loss disability, service connection must be?denied.

As the Veteran, without?good cause, did not attend a scheduled VA examination, and as entitlement to service connection for bilateral hearing loss cannot be established without a VA examination, the Board will adjudicate on the basis of the evidence of record. However, the evidence of record does not support a finding that any current bilateral hearing loss disability is related to service or any event, injury, or disease during service, or was caused or aggravated by any service-connected disability.

The Board finds that the weight of the evidence is against a finding that any bilateral hearing loss disability is related to service; any event, injury, or disease during service; or was caused or aggravated by a service-connected disability. The Board finds that there is no medical evidence of record that shows that it is approximately as likely as not that the claimed disability is related to service or caused or aggravated by service-connected disabilities. Accordingly, the claim of service connection for bilateral hearing loss must be denied. The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claim must be denied. 38?C.F.R. §?3.655.

8. Entitlement to a disability rating in excess of 0 percent for migraine headaches, effective July 5, 2024.

The Veteran's migraine headache disability has been rated pursuant to Diagnostic Code 8100 which provides ratings for migraine headaches. Diagnostic Code 8100 provides that a 0 percent rating is assigned for less frequent attacks. A 10 percent rating is assigned for characteristic prostrating attacks occurring an average of once every two months over the several months. A 30 percent rating is assigned for characteristic prostrating attacks occurring on an average of once a month over the last several months. A maximum 50 percent rating is assigned for very frequent completely prostrating attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

The claim for an increased rating stems from a July 5, 2024 increased rating claim filing. Therefore, the period on appeal is from July 5, 2024, the date VA received the increased rating claim, to November 6, 2024, the date of the rating decision on appeal. The Board may examine the evidence within one year prior to receipt of the claim for increase to determine whether a factually ascertainable increase in disability was shown that warrants an increased rating. 38 C.F.R. § 3.400(o).

The Veteran contends that he is entitled to an increased rating for a service-connected migraine disability, currently rated 0 percent, effective July 5, 2024, pursuant to Diagnostic Code 8100.

In conjunction with this claim, in July 2024, VA attempted to schedule a VA examination to determine the current severity of the Veteran's migraine headache condition. However, the Veteran did not attend the examination.

On review of the record, there is no indication, either by the Veteran or the representative, that an attempt has been made to reschedule or provide good cause for the failure to appear for the VA examination, or that the Veteran has requested that the examination be rescheduled.

While VA has a statutory duty to assist in developing evidence pertinent to a claim, a Veteran also has a duty to assist and cooperate with VA in developing evidence; the duty to assist is not a one-way street. Wood v. Derwinski, 1 Vet. App. 190 (1991). VA's duty must be understood as a duty to assist a Veteran in developing his or her claim, rather than a duty on the part of VA to develop the entire claim with the Veteran performing a passive role. Turk v. Peake, 21 Vet. App. 565 (2008). Therefore, remand for additional VA examination is not warranted.?

The Board finds that a VA examination is necessary to
cheduled.

The Board finds that a VA examination is necessary to decide the claim for an increased rating for migraine headache. Here, even considering the evidence of record, to include the Veteran's lay statements and assertions regarding the severity of the disability, there is insufficient competent evidence to demonstrate that any higher rating is warranted.

The Veteran did not attend the scheduled VA examination. The examination may have provided evidence to substantiate the increased rating claim. At the examination, symptoms would have been elicited from the Veteran, if present, that may have supported the criteria for an increased rating. Therefore, the Board must find that entitlement to a higher rating cannot be established without examination, which the Veteran did not attend. The Veteran has not provided a statement of good cause for not attending the examination or expressed a willingness to attend another scheduled examination.

The Board finds that a remand to schedule another examination would cause further unnecessary delay in the proceedings. Moreover, the Veteran's representative did not acknowledge or state good cause for why the Veteran failed to appear for the examination. The Veteran's representative has not confirmed that the Veteran would appear for an examination or that the Veteran himself is requesting that the examination be scheduled.

Accordingly, the Board finds that, during the period on appeal, the service-connected migraine headaches do not warrant a rating in excess of 0 percent. The symptoms the Veteran experiences do not more nearly approximate those described under the criteria for a 10 percent rating. The weight of the evidence does not show that headaches result in characteristic prostrating attacks of any duration. No examiner found the Veteran to have characteristic prostrating attacks of head pain. The evidence does not show headaches resulting in prostration, even without considering any use of medication. Therefore, the Board finds that a rating in excess of 0 percent is not warranted for migraine headaches.

As the Veteran, without good cause, did not appear for the scheduled VA examination, and as entitlement to increased rating for migraine headaches cannot be established without a current VA examination, or based on evidence of record, the appeal for an increased rating must be denied. 38 C.F.R. § 3.655.

The Board is appreciative of the Veteran's faithful and honorable service. However, the Board finds that the Veteran's disability picture more nearly approximates a rating of 0 percent for migraines, and not higher, from July 5, 2024, the date of the claim filing, to November 6, 2024, the date of the rating decision on appeal, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. Thus, the claim for an increased rating is denied. The Board finds that the weight of the evidence is against the assignment of any higher rating. The Board finds that the evidence does not more nearly approximate the criteria for any higher ratings. The evidence is not in approximate balance, and there is no reasonable doubt to be resolved in favor of the Veteran. Therefore, the appeal must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

The Board notes that an October 2025 rating decision increased the disability rating for migraines to 50 percent, effective March 26, 2025.

Under the AMA, an effective date can be preserved if the claim is continuously pursued by filing an appropriate administrative review option to an AMA decision, generally within one year from when the decision was issued. 38 C.F.R. § 3.2500(c). If an AMA claim is continuously pursued, it will be considered filed as of the date of the first claim in the continuously pursued chain, not the date the most recent request for review was received. 38 C.F.R. § 3.2500(h).

If the Veteran wants VA to consider any evidence that was submitted that the Board cannot consider in adjudicating the claim for an increased rating, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify that evidence. 38 C.F.R. § 3.2501. If the evidence is new
one year from when the decision was issued. 38 C.F.R. § 3.2500(c). If an AMA claim is continuously pursued, it will be considered filed as of the date of the first claim in the continuously pursued chain, not the date the most recent request for review was received. 38 C.F.R. § 3.2500(h).

If the Veteran wants VA to consider any evidence that was submitted that the Board cannot consider in adjudicating the claim for an increased rating, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify that evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Specific instructions for filing a Supplemental Claim are included with this decision.

REASONS FOR REMAND

1. Entitlement to service connection for a right shoulder disability is remanded.

2. Entitlement to service connection for a left shoulder disability is remanded.

3. Entitlement to service connection for a neck disability is remanded.

4. Entitlement to service connection for a left knee disability is remanded.

5. Entitlement to service connection for a right knee disability is remanded.

6. Entitlement to service connection for a left elbow disability is remanded.

7. Entitlement to service connection for a right elbow disability is remanded.

8. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

Although the Board regrets the delay, additional development is needed prior to further disposition of the claims of entitlement to service connection for GERD, neck, bilateral shoulder, bilateral knee, and bilateral elbow disabilities.

VA's statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1?Vet. App.?121 (1991); Snuffer v. Gober, 10?Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim. 38?U.S.C. §?5103A(d); 38?C.F.R. §?3.159.

On a July 2024, VA 21-526EZ, Fully Developed Claim (compensation), the Veteran asserted that current musculoskeletal disabilities were due to the wear and tear of the physical nature of active service. The Veteran also asserted that GERD was caused by the irregular eating schedules during service.

A January 2025 rating decision found that the Veteran has been diagnosed with GERD, bilateral elbow, bilateral knee, neck, and bilateral shoulder disabilities. The rating decision also noted that the Veteran participated in a toxic exposure risk activity (TERA). The Board is bound by those favorable findings.

For all the claimed disabilities, during a December 2024 VA examination, the examiner opined that the claimed conditions were less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

Prior to the January 2025 rating decision on appeal, no examiner addressed the Veteran's assertion that the claimed disabilities were due to the wear and tear of the physical nature of service; or that GERD was caused by the irregular eating schedules during service.

Prior to the January 2025 rating decision on appeal, adequate etiological opinions had not been obtained that discuss the theory of entitlement for GERD, neck, bilateral shoulder, bilateral knee, and bilateral elbow disabilities on a direct basis, as asserted by the Veteran. That is a pre-decisional duty to assist error.

Here, the Board acknowledges that, subsequent to the January 2025 rating decision on appeal, VA obtained etiological opinions concerning GERD, neck, bilateral shoulder, bilateral knee, and bilateral elbow disabilities relating to a separate appeal. However, this remand seeks additional information not contained within those examination reports.

Because the Veteran may have a disability that is related to service, the Board finds that the Veteran should be provided VA examination to determine the nature and etiology of the Veteran's claimed disabilities. Therefore, on remand an examination should be scheduled and an opinion as to the etiology of the Veteran's disabilities should be requested. McLendon v. Nicholson, 20?Vet. App.?79 (2006); 38?U.S.C. §?5103A;?38?C.F.R. §?3.159.

In approaching the examinations,
, bilateral shoulder, bilateral knee, and bilateral elbow disabilities relating to a separate appeal. However, this remand seeks additional information not contained within those examination reports.

In approaching the examinations, the Veteran is reminded that the duty to assist is not a one-way street. A Veteran is required to cooperate with the examiner's efforts to evaluate the nature and current severity of symptomology. Wood v. Derwinski, 1 Vet. App. 190 (1991). The Veteran is notified that it is the Veteran's responsibility to report for any scheduled examination and to cooperate in the development of these claims. The consequences for failure to cooperate with or report for a VA examination without good cause may include denial of the claim. 38 C.F.R. § 3.655. The Veteran is notified that failure to cooperate during the requested VA examination may result in an adverse determination. 38 C.F.R. § 3.655; Connolly v. Derwinski, 1 Vet. App. 566 (1991).

The matters are REMANDED for the following action:

1. Obtain an opinion regarding the nature and etiology of any neck, bilateral shoulder, bilateral knee, and bilateral elbow disabilities. The examiner must review the claims file, including this Remand and?the Veteran's lay statements and should indicate review of the file in the report. The examiner is advised that current neck, bilateral shoulder, bilateral knee, and bilateral elbow disabilities have been conceded by VA. For each neck, shoulder, knee, and elbow disability diagnosed or shown during the pendency of the claim, to include any?pain?resulting in?functional loss that constitutes a disability, the examiner must opine whether it is as likely as not that any disability is etiologically related to active service or any event, disease, or injury during service, including whether any right and left shoulder, knee, elbow, or neck disability (1) began during active service or is related to any incident during service, (2)?manifested as arthritis within one year after separation from service, (3) was noted during service with continuity of the same symptomatology since service. Please cite to any evidence to support a finding of arthritis within one year following separation from service. The examiner is specifically asked to opine whether it is as likely as not that the physical nature of active duty service contributed to or caused the claimed disabilities. A clearly stated rationale for each opinion offered must be provided and cannot be solely based on the lack of a record in service of the claimed disability. In writing the report, the examiner should refer to?any service medical records indicating treatment in service for shoulder, knee, elbow, or neck complaints.

2. Schedule the Veteran for a VA examination to determine the nature and etiology of GERD. The examiner must review the claims file, including this Remand, and should indicate review of the file in the report. For each chronic gastrointestinal disability diagnosed or shown during the pendency of the claim, the examiner must opine whether it is as likely as not that each gastrointestinal disability is etiologically related to active service or any event, disease, or injury during service, including whether any disability (1) began during active service or is related to any incident during service; or (2) was noted during service with continuity of the same symptomatology since service; or (3)?is related to conceded toxic exposure risk activities during active service. When providing the opinion, the examiner must consider the total potential exposure through all applicable deployments; and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. A clearly stated rationale for each opinion should be provided and cannot be based solely on the lack of a record in service of the claimed disability. The examiner is advised that the absence of a diagnosed disability from the list of disabilities which are presumed to be the result of exposure is not a sufficient explanation for a negative opinion.? The examiner is specifically asked to opine whether it is as likely as not that an irregular eating schedule during active duty service contributed to or caused the claimed disability. The?examiner should refer to?any service medical records indicating treatment in service for relevant gastrointestinal complaints.

Harvey P. Roberts

Veterans Law Judge

Board of Veterans' Appeals

Attorney for

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