OSTEOARTHRITIS

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26032148

MIXED

Summary

The veteran served from January 1977 to July 1983 and again from February 1992 to May 1992. The veteran appealed the denial of service connection for several conditions and sought readjudication for others. The Board granted service connection for degenerative arthritis in the right elbow, right knee joint osteoarthritis, and residuals of a ventral hernia. The Board found that the veteran's lay statements regarding the onset of symptoms in service and continuity of symptomatology were competent and credible, and in the absence of clear and unmistakable evidence to the contrary, resolved any doubt in the veteran's favor, granting service connection for these conditions. The Board noted that the service treatment records for the ventral hernia were largely unavailable, which heightened the Board's obligation to consider all favorable evidence, including lay statements. The Board remanded claims for service connection for a lumbar spine disability, diabetes mellitus type II, a dental disorder (gum disease), a psychiatric disorder, and erectile dysfunction (ED). These remands were necessary to obtain VA medical examinations to determine the nature and etiology of the diagnosed conditions and their relationship to service or other service-connected disabilities, as the evidence was mixed or insufficient for a final decision. The TDIU claim was also remanded, pending the determination of the underlying service connection claims and the assignment of ratings for the granted conditions.

Rationale

Grant based on competent and credible lay statements; Benefit of the doubt resolved in veteran's favor; RO conceded in-service injury and diagnosis

Special Benefit

TDIU

Docket No.

250710-563756

Full Decision Text

Citation Nr: A26032148
Decision Date: 04/08/26 Archive Date: 04/08/26

DOCKET NO. 250710-563756
DATE: April 8, 2026

ORDER

Entitlement to service connection for degenerative arthritis in the right elbow is granted.

Entitlement to service connection for right knee joint osteoarthritis is granted.

Entitlement to service connection for residuals of a ventral hernia is granted.

REMANDED

Entitlement to service connection for a lumbar spine disability is remanded.

Entitlement to service connection for diabetes mellitus, type II, is remanded.

Entitlement to service connection for a dental disorder, including gum disease, is remanded.

Entitlement to service connection for a psychiatric disorder is remanded.

Entitlement to service connection for erectile dysfunction (ED) is remanded.

Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in favor of the Veteran, his chronic right elbow disability had its onset in service.

2. Resolving reasonable doubt in favor of the Veteran, his chronic right knee disability had its onset in service.

3. The Veteran's service treatment record shows the Veteran had a ventral hernia and surgery with scarring prior to entering active-duty service.

4. Resolving all doubt in his favor, the Veteran's residuals of a ventral hernia manifested in service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for degenerative arthritis in the right elbow have been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309.

2. The criteria for entitlement to service connection for right knee joint osteoarthritis have been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309.

3. The criteria for entitlement to service connection for residuals of a ventral hernia have been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in active duty from January 1977 to July 1983 and February 1992 to May 1992.

The rating decisions on appeal were issued in July 2024, January 2025, and March 2025. In July 2025, the Veteran elected the modernized review system. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (codified at 38 C.F.R. § 19.2(d)).

The Veteran elected the Direct Review lane. Accordingly, the Board will consider evidence of record as of the July 2024, January 2025, and March 2025 rating decisions. The Board finds that the claims for service connection for right elbow and knee disorders were essentially readjudicated on the merits, and the Board will therefore an analysis as to whether new and relevant evidence was submitted to readjudicate the claims.

Evidence was added to the claims file during a period of time when new evidence was not allowed. Therefore, the Board may not consider this evidence. 84 Fed. Reg. 138, 182 (Jan. 18, 2019) (codified at 38 C.F.R. § 20.300). The Veteran may file a Supplemental Claim and submit or identify this evidence. 84 Fed. Reg. 138, 182 (Jan. 18, 2019) (codified at 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. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki,
.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. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999).

Service connection may also be granted where disability is proximately due to or the result of already service-connected disability. 38 C.F.R. § 3.310.

A veteran is presumed to be in sound condition when examined and accepted into the service except for defects or disorders noted when examined and accepted for service. 38 U.S.C. § 1111, 1137. In order to rebut the presumption of sound condition under 38 U.S.C. § 1111, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. The disease or injury must be clearly specified or diagnosed on the induction examination; vague symptoms are not enough to rebut the presumption.

However, where a preexisting disease or injury is noted on the entrance examination, section 1153 of the statute provides that "[a] preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease." 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition itself, as contrasted with mere symptoms, has worsened. Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993); Green v. Derwinski, 1 Vet. App. 320, 323 (1991); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). If an increase in disability is shown during service, clear and unmistakable evidence is required to rebut the presumption of aggravation. 38 C.F.R. § 3.306(b).

The presumption of aggravation only requires evidence of an actual worsening of a preexisting condition during service; it does not require direct evidence of nexus, that is, that the worsening was actually caused by service. Smith v. Shinseki, 24 Vet. App. 40, 47-48 (2010). Therefore, a veteran must initially establish only that a preexisting condition worsened during service, and at that point the veteran has the benefit of the presumption of aggravation. Moreover, the presumption of aggravation applies where there was a worsening of the disability in service, regardless of whether the degree of worsening was enough to warrant compensation per the Schedule for Rating Disabilities (Rating Schedule). Browder v. Derwinski, 1 Vet. App. 204, 206-207 (1991).

If a permanent increase is shown, the presumption of aggravation may be rebutted only by clear and unmistakable evidence that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a), (b). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service
was enough to warrant compensation per the Schedule for Rating Disabilities (Rating Schedule). Browder v. Derwinski, 1 Vet. App. 204, 206-207 (1991).

If a permanent increase is shown, the presumption of aggravation may be rebutted only by clear and unmistakable evidence that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a), (b). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306(b); Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002) (which holds that evidence of a temporary flare-up, without more, does not satisfy the level of proof required of a non-combat Veteran to establish an increase in disability).

The requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007).

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007).

Competent medical evidence is the type of evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. It may also include statements conveying sound medical principles found in medical treatises and/or statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1).

Competent lay evidence is any kind of 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). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement to service connection for degenerative arthritis in the right elbow

The Veteran contends that readjudication of the claim of entitlement to service connection for a right elbow disability is warranted.

The Board initially notes that, in the July 2024 rating decision, the RO found that the Veteran had been diagnosed with right elbow degenerative arthritis. Also in that decision, the RO found that the evidence shows a qualifying event, injury, or disease had its onset during the Veteran's service, in September 1984, noting that he injured his right elbow when he fell from a vehicle. The Board is bound by these favorable findings. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)).

Therefore, as the first and second elements required to establish service connection have been conceded, these elements have been met.

As to the final element of a service connection claim, the nexus between the Veteran's right elbow disability and the in-service injury, the evidence is mixed.

At the September 2012 and May 2016 VA examinations, the Veteran stated that his right elbow disability began after he fell off a vehicle in September 1984. The Veteran stated that in-service treatment to his right elbow alleviated his pain, but that it has continued ever since his service until the present.

As to the final element of a service connection claim, the nexus between the Veteran's right elbow disability and the in-service injury, the evidence is mixed.

The Veteran believed that his right elbow disability had its origin due to his in-service injury. The Veteran was considered competent to provide statements to establish the occurrence of medical symptoms. Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). However, the Veteran was not medically qualified to prove a matter requiring medical expertise. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). Thus, while the Veteran's statements that he had pain in his right elbow and right knee since he was in active service are both competent and credible, his statements alone are not sufficient to medically attribute his current disabilities to the injury he experienced in service.

The examiner in May 2016 confirmed the Veteran's diagnosis of arthritis of the right elbow, but did not provide a nexus opinion, as the VA examiner believed the Veteran was service connected at a noncompensable rating. However, there was an earlier addendum opinion from July 2015 that provided a negative opinion due to the lack of contemporaneous post treatment records.

The Board notes that the addendum examiner in July 2015 did not adequately consider the Veteran's lay statements of the in-service injury and the continuity of symptoms. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (finding a medical examination inadequate where the examiner impermissibly ignored the appellant's lay assertions regarding onset of symptoms or injury during service). Lay evidence concerning continuity of symptoms after service, if credible, can ultimately be considered competent, regardless of a lack of contemporaneous medical evidence, and can alternatively establish a relationship between the current disability and injury in service. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

The Board finds that the competent evidence of record is at least in relative balance as to whether the Veteran's right elbow disorder had its onset in service, and the record reflects that while his original injury may have occurred in the Reserves, the record reflects that he also had subsequent active service. Accordingly, under these circumstances, and granting the Veteran the benefit of the doubt in this matter, since arthritis is one of those disabilities that may be presumed service connected based on the credible assertions by the Veteran of continuity of symptoms, the Board finds that service connection for arthritis in the right elbow is warranted.

2. Entitlement to service connection for right knee joint osteoarthritis

The Veteran asserts that readjudication of the claim of entitlement to service connection for a right knee disability is warranted.

The Board initially notes that, in the July 2024 rating decision, the RO found that the Veteran had been diagnosed with right knee joint osteoarthritis. The Board is bound by this favorable finding. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)).

Therefore, as the first element required to establish service connection has been conceded, the element has been met.

The Board notes that the Veteran fell off a vehicle in September 1984, which has been conceded. At the May 2016 VA examination, the Veteran stated that his right knee disability began after this incident. Accordingly, under these circumstances, and granting the Veteran the benefit of the doubt in this matter, the Board finds that the second element required for service connection has been met.

As to the final element of a service connection claim, the nexus between the Veteran's right knee disability and the in-service injury, the evidence is mixed.

The Veteran believed that his right knee disability had its origin due to his in-service injury. The Veteran was considered competent to provide statements to establish the occurrence of medical symptoms. Kahana, 24 Vet. App. at 438. However, the Veteran was not medically qualified to prove a matter requiring medical expertise. Barr, 21 Vet. App. at 307-08; Espiritu, 2 Vet. App. at 494-495. Thus, while the Veteran's statements
finds that the second element required for service connection has been met.

As to the final element of a service connection claim, the nexus between the Veteran's right knee disability and the in-service injury, the evidence is mixed.

The Veteran believed that his right knee disability had its origin due to his in-service injury. The Veteran was considered competent to provide statements to establish the occurrence of medical symptoms. Kahana, 24 Vet. App. at 438. However, the Veteran was not medically qualified to prove a matter requiring medical expertise. Barr, 21 Vet. App. at 307-08; Espiritu, 2 Vet. App. at 494-495. Thus, while the Veteran's statements that he had pain in his right elbow and right knee since he was in active service are both competent and credible, his statements alone are not sufficient to medically attribute his current disabilities to the injury he experienced in service.

The examiner in May 2016 confirmed the Veteran's diagnosis of arthritis of the right knee, but did not provide a nexus opinion, as the VA examiner believed the Veteran was service connected at a noncompensable rating. In fact, the Board notes that there is no nexus opinion in the claims file.

Lay evidence concerning continuity of symptoms after service, if credible, can ultimately be considered competent, regardless of a lack of contemporaneous medical evidence, and can alternatively establish a relationship between the current disability and injury in service. Buchanan, 451 F.3d at 1331.

The Board finds that the competent evidence of record is at least in relative balance as to whether the Veteran's right knee disorder had its onset in service, and the record reflects that while his original injury may have occurred in the Reserves, the record reflects that he also had subsequent active service. Accordingly, under these circumstances, and granting the Veteran the benefit of the doubt in this matter, since arthritis is one of those disabilities that may be presumed service connected based on the credible assertions by the Veteran of continuity of symptoms, the Board finds that service connection for arthritis in the right knee is also warranted.

3. Entitlement to service connection for residuals of a ventral hernia

The Veteran and his attorney assert that the Veteran is entitled to service connection for a ventral hernia because his preexisting hernia surgery caused a surgical scar that worsened during his active-duty service, and this aggravation resulted in his current disability of a surgical scar.

In the March 2025 rating decision, the RO found that the claimed issue of a ventral hernia existed prior to the Veteran's service. Also in that decision, the RO found that the Veteran had been diagnosed with left inguinal hernia status-post surgical repair, according to a VA examination report from March 2025. The Board is bound by these favorable findings. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)). Accordingly, the first element for establishing service connection has been met.

The Board observes that the Veteran's service treatment records (STRs) are largely unavailable. When service records are incomplete the Board has a heightened obligation to explain its findings and conclusions and carefully consider the benefit-of-the-doubt rule. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, the case law does not lower the legal standard for proving a claim of service connection, but rather increases the Board's obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the Veteran. Russo v. Brown, 9 Vet. App. 46 (1996). Moreover, there is no presumption, either in favor of the claimant or against VA, arising from missing records. Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) (wherein the Court declined to apply an "adverse presumption" where records have been lost or destroyed while in government control which would have required VA to disprove a claimant's allegation of injury or disease).

As previously noted, in order to rebut the presumption of sound condition under 38 U.S.C. § 1111, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service.

Where an entrance examination is lost or missing, the presumption of soundness attaches. Doran v. Brown, 6 Vet. App. 283, 286 (1994). Therefore, in this case, in order to rebut the presumption of soundness, it
to apply an "adverse presumption" where records have been lost or destroyed while in government control which would have required VA to disprove a claimant's allegation of injury or disease).

Where an entrance examination is lost or missing, the presumption of soundness attaches. Doran v. Brown, 6 Vet. App. 283, 286 (1994). Therefore, in this case, in order to rebut the presumption of soundness, it will be necessary for there to be clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service.

The Board notes that the Veteran has noted complaints of abdominal pain during his reserve duty.

During the March 2025 VA examination, the Veteran reported that after the hernia surgery in 1976, the Veteran started having left lower quadrant pain after the surgery with a stretching and pulling pain.

Accordingly, the Board finds that the question with regard to an in-service occurrence has been established and that while his surgical scar may have preexisted service, there is not clear and unmistakable evidence that this condition was not aggravated in service. Thus, the presumption of soundness applies and the case becomes one of direct service connection.

Accordingly, the Board finds that the evidence is thus at least in relative balanced as to whether the Veteran's residuals of a ventral hernia are related to the Veteran's military service. As the reasonable doubt created by this relative balance in the evidence must be resolved in favor of the Veteran, entitlement to service connection for residuals of a ventral hernia is therefore also warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for a lumbar spine disability is remanded.

The Veteran and his attorney claim that his lumbar spine disability originated due to a fall he experienced in September 1984, during his active-duty service. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review.

In the January 2025 decision, the RO found that the Veteran had been diagnosed with lower back pain, according to VA treatment records from November 2012. The Board is bound by this favorable finding. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)).

The Veteran was not afforded a VA examination. As the Veteran's lay statements, and treatment records indicate that the Veteran has a disability that could be related to active-duty service, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature and etiology of the Veteran's diagnosed lumbar spine disability.

2. Entitlement to service connection for diabetes mellitus, type II, is remanded.

The Veteran and his attorney assert that his diabetes mellitus originated due to a sugary diet during his active-duty service. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review.

In the January 2025 decision, the RO found that the Veteran had been diagnosed with diabetes mellitus, according to VA treatment records. The Board is bound by this favorable finding. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)).

The Veteran was not afforded a VA examination. As the Veteran's lay statements, and treatment records indicate that the Veteran has a disability that could be related to active-duty service, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 70. Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature and etiology of the Veteran's diagnosed diabetes mellitus.

3. Entitlement to service connection for a dental disorder, including gum disease, is remanded.

The Veteran and his attorney assert that his dental disorder originated due to the food he consumed during his active-duty service. Although further delay is regret
lay statements, and treatment records indicate that the Veteran has a disability that could be related to active-duty service, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 70. Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature and etiology of the Veteran's diagnosed diabetes mellitus.

3. Entitlement to service connection for a dental disorder, including gum disease, is remanded.

The Veteran and his attorney assert that his dental disorder originated due to the food he consumed during his active-duty service. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review.

In the September 2024 claim, the Veteran asserted that sugary foods from service caused his dental disorder and diabetes.

The Veteran was not afforded a VA examination. As the Veteran's claims indicate that the Veteran may have a disability that could be related to active-duty service or another disability, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 70. Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature and etiology of the Veteran's claimed dental disorder, to include gum disease.

4. Entitlement to service connection for a psychiatric disorder is remanded.

The Veteran and his attorney assert that his diagnosed psychiatric disorder originated due to his in-service experiences. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review.

In the January 2025 decision, the RO found that the Veteran had been diagnosed with a major depressive disorder according to VA treatment records from December 2024. The Board is bound by this favorable finding. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)).

The Veteran was not afforded a VA examination. As the Veteran's lay statements, and treatment records indicate that the Veteran has a psychiatric disorder that could be related to active-duty service, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 70. Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature, etiology, and severity for the Veteran's diagnosed psychiatric disorder.

5. Entitlement to service connection for erectile dysfunction (ED) is remanded.

The Veteran and his attorney claim that his ED originated due to disabilities that are pending service connection claims. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review.

In the January 2025 decision, the RO found that the Veteran had been diagnosed with ED, according to VA treatment records. The Board is bound by this favorable finding. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)).

The Veteran was not afforded a VA examination. As the Veteran's lay statements, and treatment records indicate that the Veteran has a disability that could be related to another disability that has a pending service-connection claim, the Board finds that the instant claim is an intertwined claim, and that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 70. Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature and etiology of the Veteran's diagnosed ED.

6. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

The Board has herein remanded the service connection claims for a dental disorder, to include gum disease; a lumbar spine disability; diabetes mellitus, type II; a psychiatric disorder; and ED. Therefore, the service connection claims for these disabilities, and the TDIU claim are intertwined. As such, a remand is necessary pending the determination of the service connection claims. 38 C.F.R. § 20.802(a). The Board further finds that given the Board's grant of service connection for a right elbow disorder, a right knee disorder, and residuals of ventral hernia, a decision with respect to TDIU should be deferred pending the assignment of the ratings for these disorders.

The matters are
The Board has herein remanded the service connection claims for a dental disorder, to include gum disease; a lumbar spine disability; diabetes mellitus, type II; a psychiatric disorder; and ED. Therefore, the service connection claims for these disabilities, and the TDIU claim are intertwined. As such, a remand is necessary pending the determination of the service connection claims. 38 C.F.R. § 20.802(a). The Board further finds that given the Board's grant of service connection for a right elbow disorder, a right knee disorder, and residuals of ventral hernia, a decision with respect to TDIU should be deferred pending the assignment of the ratings for these disorders.

The matters are REMANDED for the following action:

1. The Veteran must be afforded a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran's diagnosed lumbar spine disability. Any and all studies, tests, and evaluations that are deemed necessary by the VA examiner should be performed. The claims folder, including a copy of this remand, the Veteran's lay statements, and private medical records, should be made available and be reviewed by the examiner.

Following a complete review of the record, the examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed lumbar spine disability originated during, or is etiologically related to, active-duty service.

A complete rationale must be provided for all opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to mere speculation.

2. The Veteran must be afforded a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran's diagnosed diabetes mellitus, type II. Any and all studies, tests, and evaluations that are deemed necessary by the VA examiner should be performed. The claims folder, including a copy of this remand, the Veteran's lay statements, and private medical records, should be made available and be reviewed by the examiner.

Following a complete review of the record, the examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed diabetes mellitus, type II originated during, or is etiologically related to, active duty service.

3. The Veteran must be afforded a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran's claimed dental disorder, to include gum disease. Any and all studies, tests, and evaluations that are deemed necessary by the VA examiner should be performed. The claims folder, including a copy of this remand, the Veteran's lay statements, and private medical records, should be made available and be reviewed by the examiner.

Following a complete review of the record, the examiner is asked to:

a. Confirm a current diagnosis as to the Veteran's claimed dental disorder.

b. Provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed dental disorder, to include gum disease, originated during, or is etiologically related to, active-duty service.

c. Provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed dental disorder, to include gum disease, was caused by, or was aggravated by the Veteran's diabetes mellitus, type II.

4. The Veteran must be afforded a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran's diagnosed psychiatric disorder. Any and all studies, tests, and evaluations that are deemed necessary by the VA examiner should be performed. The claims folder, including a copy of this remand, the Veteran's lay statements, and private medical records, should be made available and be reviewed by the examiner.

Following a complete review of the record, the examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least
speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to mere speculation.

Following a complete review of the record, the examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed psychiatric disorder originated during, or is etiologically related to, active-duty service.

5. The Veteran must be afforded a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran's diagnosed ED. Any and all studies, tests, and evaluations that are deemed necessary by the VA examiner should be performed. The claims folder, including a copy of this remand, the Veteran's lay statements, and private medical records, should be made available and be reviewed by the examiner.

Following a complete review of the record, the examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed ED originated during, or is etiologically related to, a service-connected disability.

A complete rationale must be provided for all opinions rendered. If the examiner cannot provide the requested opinions without resorting to mere speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to mere speculation.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A.R. Montalvo, 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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