HEARING LOSS

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26032932

MIXED

Summary

The Veteran, an Army Veteran who served from October 2013 to March 2020, appeals the denial of service connection for bilateral hearing loss, headaches, left knee disability, right knee disability, and psychiatric disability. The Veteran also appeals the denial of an increased rating for his service-connected right hip flexor strain. The Board granted service connection for headaches secondary to TBI, bilateral knee disabilities, and a psychiatric disability (unspecified adjustment disorder). Service connection for bilateral hearing loss was denied due to insufficient evidence of a service connection. The claim for an increased rating for the right hip flexor strain was denied as the criteria for a higher rating were not met. The Board remanded claims for left hip disability secondary to right hip strain, digestive disability (pain and diarrhea), and bilateral carpal tunnel syndrome and wrist disabilities. The Board found the VA hip examination inadequate for failing to address the left hip pain's origin or its relation to the right hip strain. The VA intestinal examination was also deemed inadequate for failing to diagnose IBS or chronic diarrhea, despite the Veteran's reported symptoms and need for medication. The Board noted the Veteran's testimony regarding bilateral knee pain and the evidence being in equipoise for that claim, leading to a grant of service connection.

Rationale

No current bilateral hearing loss for VA benefits purposes.; Criteria to establish service connection for bilateral hearing loss not met.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210215-139865

Full Decision Text

Citation Nr: A26032932
Decision Date: 04/09/26 Archive Date: 04/09/26

DOCKET NO. 210215-139865
DATE: April 9, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for headaches, as secondary to service-connected traumatic brain injury (TBI), is granted.

Entitlement to service connection for a left knee disability, to include pain, is granted.

Entitlement to service connection for a right knee disability, to include pain, is granted.

Entitlement to service connection for a psychiatric disability, diagnosed as unspecified adjustment disorder, is granted.

Entitlement to an initial rating in excess of 10 percent for service-connected right hip flexor strain is denied.

REMANDED

Entitlement to service connection for a left hip disability, to include as secondary to service-connected right hip strain, is remanded.

Entitlement to service connection for a digestive disability, to include pain and diarrhea, is remanded.

Entitlement to service connection for carpal tunnel syndrome, left upper extremity is remanded.

Entitlement to service connection for carpal tunnel syndrome, right upper extremity is remanded.

Entitlement to service connection for a right wrist disability, to include pain, is remanded.

Entitlement to service connection for a left wrist disability, to include pain, is remanded.

FINDINGS OF FACT

1. The Veteran does not currently have bilateral hearing loss for VA benefits purposes.

2. The Veteran's headaches are a residual of his in-service TBI.

3. The evidence is at least in equipoise as to whether the Veteran's bilateral knee pain is related to service.

4. The Veteran's acquired psychiatric disability is directly related to service.

5. The Veteran's right hip disability has not manifested limitation of flexion of the hip joint to 45 degrees or loss of abduction beyond 10 degrees.

CONCLUSIONS OF LAW

1. The criteria to establish service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.309, 3.385.

2. The criteria to establish secondary service connection for headaches are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria to establish service connection for a left knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria to establish service connection for a right knee disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria to establish service connection for a psychiatric disability, diagnosed as unspecified adjustment disorder, have been met. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304.

6. The criteria for entitlement to an initial rating in excess of 10 percent for right hip flexor strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5252-5253.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from October 2013 to March 2020.

These matters come before the Board of Veterans' Appeals (Board) on appeal from the March 2020 and November 2020 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) which denied entitlement to service connection for headaches, left hip, IBS, bilateral knee, bilateral wrist, bilateral carpal tunnel syndrome, and psychiatric disabilities. In the March 2020 rating decision, the RO granted service connection for right hip flexor strain with a rating of 10 percent from March 11, 2020.

In the February 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on August 6, 2024, and a transcript is in the record. Therefore, the Board may only consider the evidence of record at the time of the March 2020 and November 2020 agency of original jurisdiction (AOJ) decisions on appeal
, IBS, bilateral knee, bilateral wrist, bilateral carpal tunnel syndrome, and psychiatric disabilities. In the March 2020 rating decision, the RO granted service connection for right hip flexor strain with a rating of 10 percent from March 11, 2020.

In the February 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on August 6, 2024, and a transcript is in the record. Therefore, the Board may only consider the evidence of record at the time of the March 2020 and November 2020 agency of original jurisdiction (AOJ) decisions on appeal, and any evidence submitted by the Veteran or 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 decision 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.

SERVICE CONNECTION

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

For chronic disorders, including hearing loss, service connection may be granted on a presumptive basis if there is evidence of: (1) an in-service diagnosis of a chronic condition; (2) manifestations within the applicable period (usually a year); or (3) a showing of continuity of symptomatology. 38 C.F.R. § 3.309(a). Even where service connection may not be presumed, service connection may still be established on a direct basis.

Further, lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 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). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, VA shall give the benefit of the doubt to the Veteran. Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).

1. Entitlement to service connection for bilateral hearing loss.

The Veteran claims entitlement to service connection for bilateral hearing loss is warranted based on noise exposure during active service. See August 2024 Hearing Transcript, pg. 11.

Applicable regulations provide that impaired hearing shall be considered a disability when the auditory thresholds in any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hz are 40 decibels or greater; the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores are 94 percent or less. 38 C.F.R. § 3.385.

38 C.F.R. § 3.385 does not preclude service connection for a current hearing loss disability where the Veteran's hearing was within normal limits on audiometric testing at separation from service. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Rather, when audiometric test results at a veteran's separation from service
500, 1000, 2000, 3000, and 4000 Hz are 40 decibels or greater; the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores are 94 percent or less. 38 C.F.R. § 3.385.

38 C.F.R. § 3.385 does not preclude service connection for a current hearing loss disability where the Veteran's hearing was within normal limits on audiometric testing at separation from service. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Rather, when audiometric test results at a veteran's separation from service do not meet the requirements of 38 C.F.R. § 3.385, a veteran may nevertheless establish service connection for current hearing disability by submitting medical evidence that the current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155 (1993).

Where the requirements for hearing loss disability pursuant to 38 C.F.R. § 3.385 are not met until several years after separation from service, the record must include evidence of exposure to disease or injury in service that would adversely affect the auditory system and post-service test results meeting the criteria of 38 C.F.R. § 3.385. Hensley, 5 Vet. App. at 155. If the record shows (a) acoustic trauma due to significant noise exposure in active service and audiometric test results reflect an upward shift in tested thresholds while in such service, though still not meeting the requirements for "disability" under 38 C.F.R. § 3.385, and (b) post service audiometric testing produces findings which meet the requirements of 38 C.F.R. § 3.385; then the rating authorities must consider whether there is a medically sound basis to attribute the post service findings to the injury in service, or whether these findings are more properly attributable to intervening causes. Id. at 159.

As to the claim for service connection for hearing loss, the first threshold question that must be addressed is whether the Veteran has the disability for which service connection is sought. In the absence of proof of a present disability, there is no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

The Veteran was afforded one VA audiological examination after service. In December 2019, the examination presented the following pure tone thresholds: 10 dB at 500 Hz, 5 dB at 1000 Hz, 5 dB at 2000 Hz, 15 dB at 3000 Hz, and 15 dB at 4000 Hz, for the right ear; and 5 dB at 500 Hz, 5 dB at 1000 Hz, 0 dB at 2000 Hz, 5 dB at 3000 Hz, and 5 dB at 4000 Hz, for the Veteran's left ear. Additionally, the Veteran's speech recognition ability, using the Maryland CNC test, was 100 percent for both ears.

Based on the foregoing, the audiological findings of record do not meet the required criteria for hearing loss for VA purposes. In this regard, the Board fully acknowledges the Veteran's reported history of military noise exposure to demolition explosives and gunfire. See December 2019 VA Examination. However, the Board finds that the Veteran's statements are outweighed by the above-noted objective clinical testing that shows the Veteran unfortunately does not yet have hearing loss for VA purposes. Thus, based on the VA examination results and evidence of record, service connection for bilateral hearing loss must be denied because there is no current hearing loss disability for VA benefits purposes. For the above stated reasons, the most persuasive and probative evidence is against the claim, the benefit of the doubt doctrine does not apply, and entitlement to service connection for bilateral hearing loss is not warranted. 38 U.S.C. § 5107(b).

2. Entitlement to service connection for headaches, as secondary to service-connected traumatic brain injury (TBI).

The Veteran asserts that he is entitled to service connection for recurring headaches. See October 2019 Claim Application.

Service connection for a disability can be granted on a secondary basis if a Veteran has a (1) current disability, (2) a separate disability already subject to service connection, and (3) the first disability is proximately due to, the result of, or aggravated beyond its natural progress by the service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995).

Following a review of the evidence, the Board finds that the probative evidence of record is at least in approximate
2. Entitlement to service connection for headaches, as secondary to service-connected traumatic brain injury (TBI).

The Veteran asserts that he is entitled to service connection for recurring headaches. See October 2019 Claim Application.

Following a review of the evidence, the Board finds that the probative evidence of record is at least in approximate balance to resolve in favor of the Veteran's claim.

Regarding the first element of the Veteran's secondary service connection claim (a current disability), the Board notes that VA examinations confirm a history of headaches. See December 2019 Headaches and TBI Examinations. The first element is thereby met.

As for the second element of the Veteran's claim (a separate disability already subject to service connection), the Board notes that the Veteran is service connected for TBI. See March 2020 Rating Decision. The second element is thus satisfied.

Finally, the Board must determine whether the Veteran's current headaches are proximately due to, the result of, or aggravated by his service-connected TBI. The Board must then consider and weigh the following medical evidence.

In December 2019, the Veteran submitted a private cognitive screening, in which the provider noted the Veteran's headaches are residuals of his TBI.

During the same month, a VA examiner acknowledged the Veteran's reports of infrequent headaches and found that they are related to his TBI. See December 2019 VA TBI Examination.

The Veteran also underwent a VA headache examination in December 2019, wherein he attributed his headaches to the 2015 parachute operation that caused his TBI. The VA examiner noted the Veteran's reports of headache pain and sensitivity to light but did not provide a diagnosis.

Lastly, in the November 2020 VA psychiatric examination, the examiner stated that the Veteran's TBI appears to mostly bother him in the form of headaches.

The Board finds that the above medical statements carry substantial probative value, as they are based on a review of the Veteran's medical reports, credible lay statements, and professional expertise. Thus, absent a contrary medical opinion, the Board concludes that the evidence of record sufficiently establishes a link between the Veteran's headaches and his service-connected TBI. The final element of secondary service connection, a medical nexus, is thereby met.

Accordingly, entitlement to service connection for headaches, as secondary to his service-connected TBI, is warranted.

3. Entitlement to service connection for a left knee disability, to include pain.

4. Entitlement to service connection for a right knee disability, to include pain.

The Veteran claims that his knee disabilities had their onset during service and have continued since then to the present. Notably, the Veteran attributes his bilateral knee pain to running, parachute jumping, and other physical activities during service. See August 2024 Hearing Transcript.

Following a review of the evidence of record, the Board affords the Veteran the benefit of the doubt and grants his service-connection claims for bilateral knee disabilities. The reasons for this decision follow.

Notably, the Veteran's STRs reflect complaints and treatment for bilateral knee pain.

A November 2019 medical report noted a complaint of bilateral knee pain and locking. See March 2020 STR, pg. 4. Another medical report shows evidence of left knee pain within the same month. See March 2020 STR, pg. 92. The examiner at that time noted running as an aggravating factor for the Veteran's pain. Id.

Later, during the separation examination, the Veteran reported knee pain.

Thereafter, VA treatment records continue to show complaints of bilateral knee pain. See November 2020 CAPRI.

In December 2019, the Veteran underwent a VA knee examination, in which the examiner did not provide a diagnosis but acknowledged the Veteran's report of bilateral knee pain since 2014. The examiner also noted the Veteran's report of severe flare-ups and his difficulty walking/running due to pain.

As to the first element of service connection (a current disability), review of the pertinent medical evidence reflects that the Veteran has bilateral knee pain causing functional impairment sufficient to warrant a disability for VA purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that pain alone can constitute a disability if it results in functional impairment, despite the absence of an identified underlying diagnosis).

Regarding the second element (an in-service injury
examination, in which the examiner did not provide a diagnosis but acknowledged the Veteran's report of bilateral knee pain since 2014. The examiner also noted the Veteran's report of severe flare-ups and his difficulty walking/running due to pain.

Regarding the second element (an in-service injury or event), the Veteran's complaints of bilateral knee pain are well-documented in service. Moreover, during the August 2024 hearing, the Veteran provided credible testimony as to his in-service physical activities, including parachute jumping. He especially recounted two incidents in 2014 and 2015, wherein he injured one knee respectively while running or jumping. See August 2024 Hearing Transcript, pgs. 14-15.

The Board finds the Veteran's testimony to be competent and probative evidence. 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). Here, the Veteran personally experienced readily observable events, such as landing hard on his legs and knees after parachute jumping. The Board is thus satisfied that the Veteran's lay statements are competent and probative. The Veteran receipt of the parachutist badge also supports the Veteran's testimony in this regard. See March 2020 Form DD 214. Resolving reasonable doubt in the Veteran's favor, the second element of the Veteran's service-connection claim is therefore met. Lynch, 21 F.4th at 781-82.

Finally, the Board must determine whether there is a medical nexus between the Veteran's bilateral knee disabilities and his military service.

As noted above, the December 2019 VA examiner did not reach the issue of nexus, as he/she found the Veteran did not have a current knee disability. The opinion is thus given minimal probative value because the examiner failed to consider a disability for VA purposes pursuant to the holding in Saunders.

While the Board has considered remand, the Board finds there is adequate circumstantial evidence of record that is sufficient to decide the claim. Specifically, the Board notes that the Veteran has a current disability manifested by pain under Saunders and a reported in-service cause underscored by credible lay statements, STRs, and personnel records. Absent contrary evidence, the Board finds that the most competent evidence of record is at least in approximate balance as to whether the Veteran's bilateral knee pain constitutes disability that is related to his military service.

From all of the foregoing, and resolving reasonable doubt in the Veteran's favor, the final element of the Veteran's service-connection claim is met. See 38 U.S.C. § 5107(b). Entitlement to service connection for bilateral knee disabilities, to include pain, is therefore warranted.

5. Entitlement to service connection for a psychiatric disability, diagnosed as unspecified adjustment disorder.

The Veteran asserts that he is entitled to service connection for a psychiatric disability (claimed as post-traumatic stress disorder (PTSD)). See November 2020 Claim Application.

Upon review of the evidence of record, the Board finds that the most probative and persuasive evidence supports a nexus between the Veteran's diagnosed psychiatric disability and military service. The reasons for this decision follow.

Regarding the first element of the Veteran's claim (a current disability), the Board notes that the November 2020 psychiatric examination reveals a diagnosis of adjustment disorder (unspecified). The first element for service connection is thus satisfied.

Regarding the second element of the Veteran's claim (an in-service injury or event), the Veteran has consistently reported witnessing two traumatic in-service events. The first being a truck destroyed by a vehicle-borne improvised explosive device (VBIED) while serving in Afghanistan around November 2017. See November 2020 VA Psych Examination; see also August 2024 Hearing Transcript, pg. 6. Two soldiers were reportedly paralyzed and others were severely wounded. Id. Next, the Veteran described being stuck in a minefield in Afghanistan. The Veteran stated that while no one was hurt at the time, it was still "very frightening" when a truck hit a mine. Id.

For combat veterans, under 38 U.S.C. § 1154(b), lay evidence alone can establish the in-service element of service connection, if consistent with the circumstances, conditions, or hardships of
destroyed by a vehicle-borne improvised explosive device (VBIED) while serving in Afghanistan around November 2017. See November 2020 VA Psych Examination; see also August 2024 Hearing Transcript, pg. 6. Two soldiers were reportedly paralyzed and others were severely wounded. Id. Next, the Veteran described being stuck in a minefield in Afghanistan. The Veteran stated that while no one was hurt at the time, it was still "very frightening" when a truck hit a mine. Id.

For combat veterans, under 38 U.S.C. § 1154(b), lay evidence alone can establish the in-service element of service connection, if consistent with the circumstances, conditions, or hardships of such service, even if there is no official record. 38 C.F.R. § 3.304(d). This is commonly referred to as the "combat presumption." However, there are restrictions; namely, the presumption is rebuttable by clear and convincing evidence to the contrary. Id. In addition, the combat presumption can only be used to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to the current disorder. See Libertine v. Brown, 9 Vet. App. 521, 522- 23 (1996). Significantly, 38 U.S.C. § 1154(b) does not establish service connection for a combat veteran but rather aids him or her in relaxing the adjudicative evidentiary requirements for determining what happened in service. Clyburn v. West, 12 Vet. App. 296, 303 (1999).

Notably, the AOJ confirmed an in-service stressor in the November 2020 rating decision on appeal based on the Veteran's receipt of the Combat Action Badge (CAB). The Veteran's service personnel records also reflect receipt of the Afghanistan campaign medal and combat/hostile fire pay that specifically denote combat with the enemy. His DD 214 shows a MOS of combat engineer, which is further supportive of combat. From the foregoing, the Board finds the Veteran's statements are credible and consistent with the circumstances of his service. Layno v. Brown, 6 Vet. App. 465 (1994). Thus, absent any contrary evidence, the Board concludes that the combat presumption applies, and the second element for service connection is met.

The remaining question is whether there is sufficient evidence of a nexus between the Veteran's adjustment disorder and his military service.

In November 2020, the Veteran underwent a VA psychiatric examination, in which the examiner diagnosed adjustment disorder based on a review of the Veteran's current psychiatric symptoms and lay statements of onset. The examiner also opined that while the Veteran's condition does not meet the criteria for PTSD, his diagnosed disability "appears to be related to both in-service stressors and difficulty adjusting to life outside of the military." As a rationale, the examiner described how the Veteran's current psychiatric symptoms, including his intrusive thoughts, anxiety, and hypervigilance, are all related to his reported in-service trauma(s). Cultural differences and COVID post-service were also noted as aggravating factors.

As the only nexus opinion of record is favorable, and in view of the other evidence of record, the Board finds that the most persuasive and probative evidence of record weighs in the Veteran's favor. Consequently, the Board finds that the final element for service connection is satisfied. See 38 U.S.C. § 5107(b). Entitlement to service connection for a psychiatric disability, diagnosed as unspecified adjustment disorder, is therefore also warranted.

Increased Rating

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the VA Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 U.S.C. § 5107.

VA has a duty to consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will also
. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 U.S.C. § 5107.

VA has a duty to consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will also consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Hart v. Mansfield, 21 Vet. App. 505 (2007).

Moreover, when evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in such cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011).

Instead, in Mitchell, the Court explained that, pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, and less or more movement than is considered normal, weakened movement, excess fatigability, and pain on movement (with swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors.

6. Entitlement to an initial rating in excess of 10 percent for service-connected right hip flexor strain.

The Veteran seeks a higher disability rating for his service-connected right hip flexor strain, which is currently rated as 10 percent disabling under Diagnostic Code (DC) 5252.

Under this DC, a 10 percent disability rating is assigned for flexion of the thigh limited to 45 degrees. For the next higher rating of 20 percent, there must be limitation of flexion to 30 degrees. A 30 percent rating is assigned for flexion limited to 20 degrees, and a 40 percent rating assigned for flexion limited to 10 degrees.

Under DC 5253, a 10 percent rating is assigned for adduction resulting in the inability to cross the legs and for rotation where the affected leg is limited to 15 degrees of toe out rotation. For the next higher rating of 20 percent rating, there must be abduction loss beyond 10 degrees. See 38 C.F.R. § 4.71a, Diagnostic Codes 5252-5253.

For comparison purposes only, normal range of motion for the hips consists of flexion to 125 degrees, extension to 0 degrees, and abduction to 45 degrees. 38 C.F.R. § 4.71a, Plate II.

The Board first notes that the evidence of record does not show impairment of the flail joint or femur at any time during the appeal period, and so the provisions of DCs 5254 and 5255 are not applicable. 38 C.F.R. § 4.71a, Diagnostic Codes 5254, 5255. Moreover, DC 5255 was revised effective from February 7, 2021, so because the Veteran's right hip disability has not been manifested by nonunion or malunion of the femur at any point during the appeal period, the relevant rating criteria remain the same. The Veteran has also not reported experiencing any incapacitating exacerbations regarding the right hip at any time during the appeal period, and it involves only one major joint, thus a higher rating under DC 5003 is inappropriate. 38 C.F.R. § 4.71a, Diagnostic Code 5003.

During the appeal period, only one VA examination is relevant.

In December 2019, the Veteran underwent a VA hip examination, in which the examiner provided a diagnosis of right hip flexor strain. The Veteran described his
, so because the Veteran's right hip disability has not been manifested by nonunion or malunion of the femur at any point during the appeal period, the relevant rating criteria remain the same. The Veteran has also not reported experiencing any incapacitating exacerbations regarding the right hip at any time during the appeal period, and it involves only one major joint, thus a higher rating under DC 5003 is inappropriate. 38 C.F.R. § 4.71a, Diagnostic Code 5003.

During the appeal period, only one VA examination is relevant.

In December 2019, the Veteran underwent a VA hip examination, in which the examiner provided a diagnosis of right hip flexor strain. The Veteran described his current symptoms as pain and loss of motion. The Veteran also reported having severe flare-ups at least once every two months and regarding functional impact, the Veteran stated that his hip becomes very painful and "locks up."

Then, upon physical examination, the VA examiner noted that the Veteran's right hip had initial flexion to 110 degrees with pain and abduction to 45 degrees. Furthermore, upon review of all data, including the Veteran's history, exam findings, and medical treatment records, the examiner found he/she could not estimate loss of range of motion (ROM) during flare-ups without depending on mere speculation. The examiner especially stated that for the Veteran, "there is no persistent evidence of record, considered to be valid or reproducible for ratings purposes, that indicates a loss of function during these conditions." The examiner also concluded that "there is no evidence of significant limitation or inability to conduct duties due to complaint."

From the foregoing, the Board observes that the Veteran has never demonstrated compensable loss of motion. Rather, the already assigned 10 percent rating is in contemplation of painful motion. There is no basis in the record for a higher rating.

Lastly, as to whether additional compensation is warranted for functional loss, the Veteran reported functional loss due to pain and when the joint "locks up." Such may reasonably interfere with walking, standing, and climbing; however, his current rating incorporates compensation for painful motion and clinical findings do not reflect that the joint remains locked on a prolonged basis. Additional compensation for functional loss is therefore not warranted. 38 C.F.R. §§ 4.40, 4.45, 4.59. Accordingly, the Board finds that the Veteran's right hip disability is currently adequately compensated for by the already assigned 10 percent rating and a higher or additionally separate compensable rating is not warranted.

REASONS FOR REMAND

1. Entitlement to service connection for a left hip disability, to include as secondary to service-connected right hip flexor strain.

The Veteran seeks entitlement to service connection for a left hip disability. See February 2021 Form 10182.

Under the AMA, the Board must remand to the AOJ to correct pre-decisional DTA errors (including when the AOJ failed to make reasonable efforts to obtain VA treatment records or relevant federal or private treatment records, failed to obtain a VA examination, or provided an inadequate VA examination or opinion). 38 C.F.R. § 20.802(a).

In December 2019, the Veteran underwent a VA hip examination, in which he reported bilateral hip pain and stiffness since 2015. While the examiner diagnosed right hip flexor strain, he/she did not address whether the Veteran's left hip pain is secondary to the right hip disability.

The Board finds that the VA examination is inadequate because the examiner did not address or discuss the possible origin of the Veteran's reported left hip pain, especially when the source of his bilateral pain may be shared. As the examination did not consider all theories of entitlement raised by the record, there is a pre-decisional DTA error that needs correcting. A remand is therefore warranted to address whether the Veteran's left hip pain is related to military service, to include as secondary to service-connected right hip flexor strain.

2. Entitlement to service connection for a digestive disability, to include pain and diarrhea.

The Veteran seeks service connection for irritable bowel syndrome (IBS). The Board has recharacterized the Veteran's claim into the broader claim of service connection for a digestive disability, to include pain and diarrhea. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).

In December 2019, the Veteran underwent a
connection for irritable bowel syndrome (IBS). The Board has recharacterized the Veteran's claim into the broader claim of service connection for a digestive disability, to include pain and diarrhea. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).

In December 2019, the Veteran underwent a VA intestinal examination, during which he reported having cramps/diarrhea since service due to eating military food. The examiner declined to provide a diagnosis but noted current symptoms of intermittent diarrhea with certain foods or medication and occasional episodes of bowel disturbance with abdominal distress. The examiner also indicated that the Veteran's intestinal condition requires continuous medication (i.e. probiotics) to control. Finally, the examiner concluded that while the Veteran has occasional diarrhea related to foods or medications, it does not constitute IBS or chronic diarrhea.

The Board finds that the VA opinion is inadequate because the examiner failed to consider whether the Veteran's symptoms of pain and diarrhea are related to his conceded in-service toxic exposure. See March 2020 Form DD 214; see also October 2023 TERA. Additionally, the examiner did not fully explain the various criteria used or how he/she applied the criteria to the reported symptoms. See Nieves-Rodriguez, 22 Vet. App. at 295, 302-04 (explaining that most of the probative value of a medical opinion comes from the discussion of its underlying reasoning or rationale). Thus, the Board concludes that the December 2019 opinion is little more than a conclusionary statement, which is inadequate for adjudication purposes.

From the foregoing, the AOJ failed to provide an adequate medical opinion, constituting a pre-decisional DTA error. Remand is therefore warranted to correct this error.

3. Entitlement to service connection for carpal tunnel syndrome, left upper extremity.

4. Entitlement to service connection for carpal tunnel syndrome, right upper extremity.

5. Entitlement to service connection for a right wrist disability, to include pain.

6. Entitlement to service connection for a left wrist disability, to include pain.

The Veteran seeks entitlement to service connection for a bilateral wrist disability, to include pain and carpal tunnel syndrome. See February 2021 Form 10182.

During a December 2019 VA wrist examination, the Veteran reported bilateral wrist pain and loss of motion since he suffered a fall in July 2016. The examiner declined to provide a diagnosis due to a lack of findings, signs and or symptoms to support same. However, the examiner acknowledged the Veteran's reports of flare-ups and difficulty performing daily tasks due to pain.

From the foregoing, the Board finds that the VA examination is incomplete. Specifically, the examiner did not adequately comply with Saunders v. Wilkie, which held that pain causing functional impairment can constitute a current disability. 886 F.3d 1356 (Fed. Cir. 2018). The examiner also failed to address or discuss the Veteran's assertion of bilateral carpal tunnel syndrome. Such constitutes a DTA error, and remand is necessary to obtain an adequate VA examination and medical opinion.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination with a different examiner from December 2019 to evaluate the nature and etiology of his left hip pain. Specifically, the examiner should state whether there is a left hip disability, to include pain. The record, to include a copy of this remand, must be made available to and be reviewed by the examiner.

If a diagnosis is present, the examiner should then provide the following opinion:

(a.) Whether it is approximately as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any current left hip disability is related to active service.

If no diagnosis is present, the examiner must determine whether any pain reaches the level of a functional impairment of earning capacity. Notably, evidence of pain alone that causes functional impairment, even without a specific diagnosis or identifiable disease, may constitute a
hip pain. Specifically, the examiner should state whether there is a left hip disability, to include pain. The record, to include a copy of this remand, must be made available to and be reviewed by the examiner.

If a diagnosis is present, the examiner should then provide the following opinion:

(a.) Whether it is approximately as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any current left hip disability is related to active service.

If no diagnosis is present, the examiner must determine whether any pain reaches the level of a functional impairment of earning capacity. Notably, evidence of pain alone that causes functional impairment, even without a specific diagnosis or identifiable disease, may constitute a disability for VA purposes. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

(a.) Whether it is approximately as likely as not that any diagnosed pain disability, to include any finding of pain that results in functional impairment of earning capacity, had onset in, or is otherwise related to, active military service.

Assuming a current disability is found, the examiner must then provide the following opinions:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left hip disability is caused by his service-connected disabilities (particularly his right hip strain)? In this regard, please state what facts and medical principles and/or medical literature you base this opinion on.

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left hip disability is aggravated by his service-connected disabilities (particularly his right hip strain)? In this regard, please state what facts and medical principles and/or medical literature you base this opinion on.

In providing the above opinions, the examiner should fully review and address the relevant lay and medical evidence of record, including the December 2019 Separation Exam; December 2019 VA Hip Examination; and March 2020 STRs.

The examiner is also advised that lay statements are competent to establish the presence of observable symptomatology and may provide sufficient support for a claim of service connection. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Moreover, lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). If the Veteran's reports are discounted, the examiner should provide a reason for doing so.

Further, please state upon what facts, medical principles, and/or medical literature the requested opinion is based. Note that a complete rationale must be provided for the requested opinion. If the examiner cannot provide said opinion 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 speculation.

2. Schedule the Veteran for medical opinions by a qualified VA examiner regarding the Veteran's claim of entitlement to service connection for a digestive disability, to include pain and diarrhea. The entire claims file, including a copy of this Remand, must be made available to, and be reviewed by the examiner in conjunction with the requested opinions, and should the examiner require an additional examination to render the requested opinions, such examination should be scheduled.

Following a review of the claims file and examination, if necessary, the examiner shall address the following:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's abdominal pain and diarrhea had their onset in service or are otherwise related to his military service, to include exposure to explosives, weaponry, fuels, fumes, fluids, and other toxins.

In so opining, the examiner should address 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.

In providing the above opinion, the examiner must specifically consider and discuss the relevant lay and medical evidence of record, including the December 2019 Separation Exam and December 2019 VA Intestinal Examination.

The examiner's review of the record is NOT restricted to the evidence listed above. This list is provided to assist the examiner in locating potentially relevant evidence.

3. Schedule the Veteran for an examination with a different examiner from December 2019 to evaluate the nature and etiology of his bilateral wrist pain. Specifically, the examiner should state whether there is a bilateral wrist disability, to include pain. The record, to include a copy of this remand, must be made available to and be reviewed by the examiner.

If a diagnosis is present, the examiner should then provide the following opinion:

relevant lay and medical evidence of record, including the December 2019 Separation Exam and December 2019 VA Intestinal Examination.

The examiner's review of the record is NOT restricted to the evidence listed above. This list is provided to assist the examiner in locating potentially relevant evidence.

If a diagnosis is present, the examiner should then provide the following opinion:

(a.) Whether it is approximately as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any current bilateral wrist disability is related to active service.

If no diagnosis is present, the examiner must determine whether any pain reaches the level of a functional impairment of earning capacity. Notably, evidence of pain alone that causes functional impairment, even without a specific diagnosis or identifiable disease, may constitute a disability for VA purposes. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

4. Schedule the Veteran for an examination and medical opinion by a qualified VA examiner regarding the Veteran's claim of entitlement to service connection for his bilateral carpal tunnel syndrome. The entire claims file, including a copy of this Remand, must be made available to, and be reviewed by the examiner in conjunction with the requested examination and opinions.

Following a review of the claims file and examination, the examiner shall address the following:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any diagnosed neurological disability is directly related to service? Please state the facts and medical principles and/or medical literature on which you base this opinion.

Further, in providing the above opinion, the examiner must specifically consider and discuss the relevant lay and medical evidence of record, including the December 2019 Separation Exam; December 2019 VA Wrist Examination; March 2020 STRs; and August 2024 Hearing Transcript.

The examiner's review of the record is NOT restricted to the evidence listed above. This list is provided to assist the examiner in locating potentially relevant evidence.

5. Readjudicate the Veteran's claims.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Alexander, Lasheyna T.

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

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