HEARING LOSS

JENNIFER WHITE · 2026 · Case ID: A26033718

MIXED

Summary

The veteran, who served from February 2011 to July 2014 and in the Reserves from July 2014 to April 2021, appeals the denial of service connection for bilateral hearing loss, fracture of the right lower leg, residuals of a right leg fracture, right foot fracture, right fifth finger fracture, and an increased rating for generalized anxiety disorder. The Board found new and relevant evidence for the bilateral hearing loss claim, including an article on noise exposure, but ultimately denied service connection due to a lack of current disability. For the right lower leg and foot fracture claims, the Board found no evidence of an in-service injury or nexus to current residuals, despite the veteran's contentions and some VA examination findings. The Board also denied a compensable rating for the right fifth finger fracture, finding the veteran's symptoms did not meet criteria for a higher rating or extraschedular consideration. The claim for an increased rating for generalized anxiety disorder was denied, as the Board found the veteran's symptoms, while present, did not rise to the level required for a 70 percent rating, aligning more closely with the 50 percent criteria. The Board remanded claims for right and left knee disabilities due to inadequate VA examinations that failed to address the veteran's contentions of ongoing pain since service and specific service treatment record findings.

Rationale

No current disability of hearing loss established for VA purposes.; March 2022 VA examination showed normal puretone thresholds.; Veteran's lay opinion on hearing loss not considered probative due to lack of required training/experience.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251010-597517

Full Decision Text

Citation Nr: A26033718
Decision Date: 04/13/26 Archive Date: 04/13/26

DOCKET NO. 251010-597517
DATE: April 13, 2026

ORDER

New and relevant evidence has been received to readjudicate the claim of entitlement to service connection for bilateral hearing loss.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for fracture lower right leg is denied.

Entitlement to service connection for right foot fracture is denied.

Entitlement to a compensable rating for status post fracture of fifth digit, right hand is denied.

Entitlement to a rating in excess of 50 percent for generalized anxiety disorder is denied.

REMANDED

Entitlement to service connection for right knee pain is remanded.

Entitlement to service connection for left knee strain is remanded.

FINDINGS OF FACT

1. Evidence received in connection with the Veteran's May 2023 supplemental claim for entitlement to service connection for bilateral hearing loss is new and relevant, readjudication of the claim is warranted.

2. The evidence of record does not establish that the Veteran has hearing loss for VA purposes.

3. The evidence of record persuasively weighs against finding that the Veteran has a right leg fracture or residuals thereof that began during active service or is otherwise related to an in-service injury or disease.

4. The evidence of record persuasively weighs against finding that the Veteran has a right foot disability that began during active service or is otherwise related to an in-service injury or disease.

5. For the entire period on appeal, the Veteran's fifth finger disability does not warrant a compensable rating.

6. For the entire period on appeal, the Veteran's generalized anxiety disorder demonstrated no more than occupational and social impairment with reduced reliability and productivity.

CONCLUSIONS OF LAW

1. The additional evidence received with the May 2023 supplemental claim for entitlement to service connection for bilateral hearing loss is new and relevant; readjudication of the claim for entitlement to service connection for bilateral hearing loss is warranted. 38 U.S.C §5108; 38 C.F.R. §§ 3.2501(a)(1).

2. The criteria for entitlement to service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for fracture lower right leg are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for right foot are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to a compensable rating for status post fracture of fifth digit, right hand are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5230.

6. The criteria for entitlement to a rating in excess of 50 percent for generalized anxiety disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9400.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had confirmed service from February 2011 to July 2014 and additional Reserve service from July 2014 to April 2021.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the July 2023 and September 2023 agency of original jurisdiction (AOJ) decisions, which were subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

The Board notes that the AOJ
2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

The Board notes that the AOJ requested the Veteran submit any relevant private treatment records or submit information with which VA can assist the Veteran in obtaining private treatment records. Required notice and information were provided in the claim form which the Veteran signed, certifying to the fact that such notice was received and further than they have included or identified relevant evidence. VA requested records for which the Veteran submitted a proper release and/or adequately identified. The duty to assist is not a one-way street. If a Veteran desires help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991). Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002).

The standard set forth in 38 C.F.R. § 3.103(c)(2)(iii) only permits constructive receipt of Veterans Health Administration (VHA) records that not only existed prior to the issuance of the AOJ decision on appeal, but also for which the claimant furnished sufficient information to make the Veterans Benefits Administration (VBA) aware of the existence of those records. Thus, the Board's consideration of VHA records is limited to the same. Here, the Board finds that VA treatment records were obtained and reviewed consistent with 38 C.F.R. § 3.103(c)(2)(iii) and the AMA framework.

The Board notes that the Veteran's claims for entitlement to service connection for fracture of the right lower leg, entitlement to service connection for fracture of the right foot, entitlement to service connection for left knee strain, entitlement to service connection for right knee pain and entitlement to service connection for hearing loss were previously denied in a June 2022 rating decision. The February 2025 higher level review rating decision found that new and relevant evidence has been received in support of the Veteran's claims for entitlement to service connection for fracture of the right lower leg, entitlement to service connection for fracture of the right foot, entitlement to service connection for left knee strain, and entitlement to service connection for right knee pain. The determination that new and relevant evidence has been received is a finding favorable to the claimant and is binding on the Board unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. 38 C.F.R. §§ 3.104(c), 20.801(a). With respect to hearing loss, the October 2024 rating decision on appeal found that new and relevant evidence has not been received to adjudicate the claim. The issue of readjudication of the claim for entitlement to service connection for hearing loss is addressed below.

READJUDICATION

1. New and relevant evidence having been received, the claim for entitlement to service connection for bilateral hearing loss is readjudicated.

To readjudicate a claim which has been previously denied, the claimant must present new and material evidence. 38 U.S.C. § § 5108. New evidence means existing evidence not previously part of the record before agency adjudicators. Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed. 38 C.F.R. § 3.2501(a)(1).

The Veteran filed a claim for entitlement to service connection for hearing loss in February 2022. The claim was denied in a June 2022 rating decision. The Veteran filed the current supplemental claim in May 2023 which was denied in a July 2023 rating decision. In July 2024 the Veteran filed a request for higher level review. An October 2024 higher level review rating decision denied the claim for entitlement to service connection for hearing loss based on no new
Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed. 38 C.F.R. § 3.2501(a)(1).

The Board finds that new and relevant evidence has been received to readjudicate the Veteran's claim for entitlement to service connection for bilateral hearing loss. Along with his supplemental claim the Veteran submitted an article regarding the long term effects of noise exposure during military service in South Korea. This evidence is both new and relevant. Accordingly, readjudication of the claim for entitlement to service connection for hearing loss is warranted.

SERVICE CONNECTION

Generally, to establish a right to compensation for a present disability a veteran must show: (1) a present disability; (2) an 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 be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

2. Entitlement to service connection for bilateral hearing loss.

The Veteran contends that he is entitled to service connection for bilateral hearing loss because it developed as a result of military service. In his March 2022 fully developed claim the Veteran asserted that his hearing loss developed as a result of noise from using heavy weapons.

Service connection can only be granted if it is established that the Veteran has a current disability. Here, despite the Veteran's contentions, the record does not establish that the Veteran has a current disability of hearing loss for VA purposes.

Sensorineural hearing loss is recognized by VA as chronic diseases under 38 C.F.R. § 3.303(b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, Vet. App. 258 (2015). Where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b).

For the purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000 or 4000 hertz ae 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

Here, the record does not establish that the Veteran has a current disability of hearing loss for VA purposes.

The Veteran was afforded a VA examination for hearing loss in March 2022. Results were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 15 20 15 25 10

LEFT 10 10 10 5 15

Puretone thresholds were 100 percent in the right ear and 98 percent in the left ear.

Based on the evidence of record a current disability is not established.

The Board notes that the Veteran believes that he has a current disability of hearing loss. However, the Veteran has not been shown to have the experience, training, or education necessary to diagnose hearing loss as defined in 38 C.F.R. § 3.385. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of hearing loss to include as due to remote trauma and/or aging. See Kahana v. Shinseki, 24 Vet. App.
the evidence of record a current disability is not established.

The Board notes that the Veteran believes that he has a current disability of hearing loss. However, the Veteran has not been shown to have the experience, training, or education necessary to diagnose hearing loss as defined in 38 C.F.R. § 3.385. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of hearing loss to include as due to remote trauma and/or aging. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).

Absent a current disability, service connection cannot be established. Entitlement to service connection for bilateral hearing loss is denied.

3. Entitlement to service connection for fracture lower right extremity and residuals.

The Veteran contends that he is entitled to service connection for right leg fracture to include residuals of a right leg fracture. In a May 2023 statement in support of claim the Veteran states that he fractured his right leg running in service during a PT test.

The evidence of record does not establish that the Veteran has a current disability of right leg fracture or residuals thereof.

First, service treatment records do not note complaints of or treatment for a right leg fracture during the Veteran's October 2010 enlistment exam nor an April 2013 periodic exam. While service treatment records note a left leg fracture in service in June 2013, there is no evidence of a right leg fracture.

Post service the record contains no complaints of or treatment for right leg fracture.

The Veteran was afforded a VA examination for his right knee and lower leg in March 2022. With respect to the right leg, no disabilities were noted. The Veteran endorsed a left tibial stress fracture in service. Other than knee pain (remanded herein), the Veteran did not report any right lower extremity symptoms. Imaging showed a normal right tibia and fibula. The VA opinion opined a negative nexus for right lower extremity disability noting no evidence of an in-service injury. The Board affords probative weight to this opinion as it is consistent with and supported with the evidence of record which shows no right lower extremity fracture.

The Veteran was afforded another VA examination in November 2024. The examiner noted a left tibia and or fibia fracture diagnosed in August 2024. Subjectively the Veteran reported that pain began after the fracture in his right lower leg after the injury. The Veteran reported that he does not run now or hike due to his bilateral knee pain. The examiner noted that the Veteran's main complaint is bilateral knee pain (remanded herein). The Veteran reported that his right lower leg from claimed fracture does not cause functional impact, but bilateral knee (remanded herein) pain impacts his ability to tolerate prolonged walking and needs to take frequent breaks to complete tasks.

The Board affords probative weight to these opinions because they are consistent with and supported by the evidence of record which shows no complaints of or treatment for a right lower extremity fracture in service.

Despite his contentions, the Veteran has not been shown to have the experience, training, or education necessary to give a probative etiology opinion on these claimed disabilities. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of the musculoskeletal system, to include as due to remote trauma and/or aging. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran's contentions are outweighed by the more probative VA examinations of record.

In a brief attached to the Veteran's May 2023 supplemental claim, the Veteran's representative argues that the examiner administering the Veteran's March 2022 knee/lower leg examination presented several contradictory statements regarding the Veteran's disability which were not clarified, making the examination and associated opinion inadequate at best. The examiner claimed the Veteran did not experience flare-ups however, the examiner went on to note the Veteran reporting he "no longer runs, he has pain with stairs, hiking" and that created functional loss. This also suggests scenarios of flare-ups, such as after stair climbing or walking long distances, which needed to be pursued by the examiner
2007). The Veteran's contentions are outweighed by the more probative VA examinations of record.

The Board has considered the arguments of the Veteran's representative; however, the Board finds that any contradictions in the March 2022 VA examination are clarified by the subsequent November 2024 VA examination in which the examiner specifically notes that the Veteran attributes his symptoms to the right knee and denies any symptoms of right tibular/fibular fracture.

Ultimately the record does not establish a current disability of right lower extremity fracture or residuals thereof. While the record notes a left lower extremity fracture in service, there is no evidence of a right lower extremity fracture in service or post service. The Board notes that pain can constitute a disability if it results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (2018). Here, the Veteran has reported some right knee pain, however, the Veteran has separate claims for service connection for left knee pain and right knee pain (remanded herein); therefore, the Board will address functional impairment of the knees in connection with those claims. The Veteran has not reported any additional symptoms related to the right lower leg other than his right knee. With respect to right lower extremity fracture there is no evidence of an in-service right lower extremity fracture which resulted in current residuals.

Entitlement to service connection for right lower extremity fracture is denied.

4. Entitlement to service connection for right foot fracture is denied.

The Veteran contends that he is entitled to service connection for a right foot fracture because it developed as a result of military service. The Veteran submitted a statement in support of claim in May 2023 asserting that he injured his foot in basic training and was placed on crutches. He also asserted that he was subject to constant physical training which included running long distances, sprints, carrying other soldiers and high weight ruck marches.

The Veteran was afforded a VA examination for his right foot in March 2022. The Veteran reported that his right foot injury began in service after jumping off of a truck and injuring his foot. He reports going to sick call, being placed in a boot and sent on leave for 30 days. With respect to current symptoms the Veteran reported right foot aches occurring three times a month while hiking. The examiner noted that the Veteran denied flare ups or functional loss. An x-ray of the right foot was normal. The examiner opined that the Veterans right foot disability was less likely than not related to military service because service treatment records note injury of the left foot in service, with no documentations of problems with the right foot in service or on separation examination.

The Veteran was afforded another VA examination for his right foot in November 2024. The Veteran reports that his right foot pain began in military service and noted that he needs to pop or flex his right foot. He reported that his pain is constant but mainly associated with overuse and reports that due to his right foot pain he would need to take frequent breaks to finish work shifts. The examiner noted that the Veteran's right foot pain results in functional loss. The examiner opined that the Veteran's right foot disability is less likely than not related to military service, noting that without chronicity during service or after service a post service event or injury is considered to be a more likely etiology.

The Board notes that pain can constitute a disability if it results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (2018). Here, based on the Veteran's right foot pain with noted functional impairment the Board finds that the Veteran has a current disability of right foot pain.

However, the Board does not find that there is evidence of an in-service injury or a nexus between the Veteran's right foot pain and military service.

With respect to an in-service injury, April 2011 service treatment records note that the Veteran injured his left foot in service, not his right foot. Post service, treatment records note no complaints of right foot pain prior to the March 2022 VA examination.

The Veteran has not been shown to have the experience, training, or education necessary to give a probative etiology opinion on these claimed disabilities.
6 (2018). Here, based on the Veteran's right foot pain with noted functional impairment the Board finds that the Veteran has a current disability of right foot pain.

However, the Board does not find that there is evidence of an in-service injury or a nexus between the Veteran's right foot pain and military service.

The Veteran has not been shown to have the experience, training, or education necessary to give a probative etiology opinion on these claimed disabilities. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of the musculoskeletal system, to include as due to remote trauma and/or aging. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).

The Board notes that the Veteran's representative asserts that the Veteran's valorous award for his service in Afghanistan was not taken into consideration. Specifically, the representative asserts that "The veteran's Valorous Unit Award was given "based upon "extraordinary heroism against an armed enemy" in the Paktika Province, Afghanistan from August 2011 to November 2011. VA not developing this evidence as an origin of disability, especially taking into consideration the veteran's MOS [infantryman], is a failure of VA's Duty to Assist, 38 U.S.C. § 5103A(d)(1); 38 C.F.R. § 3.159(c) (2007); Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1998), and must be corrected."

While the evidence notes that the Veteran's service includes service in Afghanistan and the Veteran received a Valorous unit award, the Board does not find that in the instant case this establish an "origin of disability" or an in-service incident/injury.

As to claims made by combat veterans, VA shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. The combat presumption may be rebutted by clear and convincing evidence to the contrary. 38 U.S.C. § 1154 (b); 38 C.F.R. § 3.304 (d).

The combat presumption must be applied to two questions: (1) whether the claimed in-service injurious event occurred and (2) whether the claimed disability itself occurred while in service. Reeves v. Shinseki, 682 F.3d 988, 999 (Fed. Cir. 2012). In other words, the combat presumption relieves the veteran of having to establish that the injurious event suffered while in service led to disability following service, thereby permitting the veteran to have to show only that the injury or disease incurred in service was a chronic condition that persisted in the years following service. Id. at 999-1000.

Here, the Veteran does not attribute a right foot disability to combat and does not even indicate that it happened while he was deployed. The Veteran specifically reports that he sustained a foot injury in service which required treatment with a boot and the use of crutches in service and that his right foot disability is a result of this direct injury. Service treatment records confirm that the Veteran did in fact sustain a foot fracture in service in April 2011, but it was to the left foot, not the right foot. As the Veteran reported and was treated for his left foot injury in service, it stands to reason that if he also had a right foot injury, he would have reported it.

The Board finds that the evidence of record is persuasively against a finding that there is in-service injury to the right foot or a nexus between military service and his current right foot pain and thus entitlement to service connection for right foot pain is denied.

INCREASED RATING

General Rating Principles

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability
the Veteran did in fact sustain a foot fracture in service in April 2011, but it was to the left foot, not the right foot. As the Veteran reported and was treated for his left foot injury in service, it stands to reason that if he also had a right foot injury, he would have reported it.

INCREASED RATING

General Rating Principles

Disability evaluations 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 Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations.

Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.59 (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Excess fatigability and incoordination should be considered in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45.

In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40.

The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

The Board will consider not only the criteria of the currently assigned diagnostic code, but also the criteria of other potentially applicable diagnostic codes.

5. Entitlement to a compensable rating for status post fracture of fifth digit, right hand.

The Veteran contends that he is entitled to a compensable rating for his fracture of the fifth digit right hand.

Procedurally the Veteran filed
.F.R. § § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

The Board will consider not only the criteria of the currently assigned diagnostic code, but also the criteria of other potentially applicable diagnostic codes.

5. Entitlement to a compensable rating for status post fracture of fifth digit, right hand.

The Veteran contends that he is entitled to a compensable rating for his fracture of the fifth digit right hand.

Procedurally the Veteran filed a claim for service connection of the fifth digit right hand fracture in February 2022. A June 2022 rating decision granted service connection with a noncompensable rating effective February 15, 2022. The Veteran filed an increased rating claim in May 2023 and perfected his appeal with an October 2025 VA Form 10182.

The Veteran's fracture of the fifth finger right hand is rated under diagnostic code 5230. Under diagnostic code 5230, a noncompensable rating is the only rating warranted for the ring or little finger.

Notes to diagnostic code 5230 state:

(1) For the index, long, ring, and little fingers (digits II, III, IV, and V), zero degrees of flexion represents the fingers fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the wrist dorsiflexed 20 to 30 degrees, the metacarpophalangeal and proximal interphalangeal joints flexed to 30 degrees, and the thumb (digit I) abducted and rotated so that the thumb pad faces the finger pads. Only joints in these positions are considered to be in favorable position. For digits II through V, the metacarpophalangeal joint has a range of zero to 90 degrees of flexion, the proximal interphalangeal joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal joint has a range of zero to 70 or 80 degrees of flexion.

(2) When two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level

(3) Evaluation of ankylosis of the index, long, ring, and little fingers: (i) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, evaluate as amputation without metacarpal resection, at proximal interphalangeal joint or proximal thereto (ii) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position (iii) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of more than two inches (5.1 cm.) between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as unfavorable ankylosis (iv) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as favorable ankylosis.

The Veteran was afforded a VA examination for his right fifth finger in April 2022. The Veteran reported current symptoms of soreness of the medial with grasping tightly. The Veteran denied flare-ups. On examination, range of motion was normal with no gap between the finger and proximal transverse crease of the hand on maximal finger flexion. There was no evidence of localized tenderness or pain on palpation of the joint. There was also no evidence of pain. The Veteran was able to perform repetitive use testing with at least three repetitions and no additional loss of function or range of motion after three repetitions. There was no evidence of pain, fatigability, weakness, lack of endurance or incoordination which significantly limits functional ability with repeated use over time or with flare ups. The Veteran maintained 5/5 hand grip with no muscle atrophy and no ankylosis. The examiner noted that the Veteran had slight angulation of the right fifth digit, nontender and normal range of motion. March 2022 imaging noted mild deformity from previous fracture, well healed. Comparatively, the examiner noted that the previous August 2013 imaging from the Veteran's initial fracture noted fracture with approximately 50 degree dorsal angulation.

Based on the evidence of record the Veteran does not meet criteria for a compensable rating under diagnostic code 5230; similarly, the Veteran does not meet criteria for a compensable rating under any other diagnostic code for the hand. There is no evidence of limitation of motion, a gap between the fingers, or ankylosis.

The issue of consideration of an extraschedular rating was raised by the Veteran's representative in a brief attached to the May 2023 supplemental claim. The representative argued "In the March 2022 examination, the examiner claimed that the veteran's hand fracture residuals had "improved" however, this is another example of a factually inaccurate premise, Monzingo supra, as nowhere in the examination is it documented that the veteran stated that. Moreover, the veteran actually indicated that he continued to have "trouble grasping, tightening" his grip, Daves supra. The examiner also stated, erroneously, that the veteran didn't suffer flare-ups but again, nowhere in the examination did the veteran state that. Because the veteran's statement about difficulty with fine motor skills like grasping or tightening his grip, suggests functional impairment which warrants a holistic evaluation of extraschedular rating entitlement, we ask that an addendum opinion be obtained, Thun v. Peake, 22 Vet. App. 111 (2008). If the examination was too inadequately administered and lacks the necessary information for an addendum opinion, we ask another examination be scheduled for the veteran that focuses on the veteran's functional limitations."

Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran's disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant's symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111.

The Court revisited the meaning of Thun's first element, holding that it is not "a mechanical test that is satisfied whenever a veteran presents a symptom not expressly listed in the [DC]." Long v. Wilkie, 33 Vet. App. 167. The key to the first Thun element is exceptionality and requires a "totality of the factors" inquiry into whether the veteran's disability picture as a whole (i.e., full symptomatology) presents an impairment that is so exceptional that the rating schedule is not capable of assessing it in the first instance. Id. The Court held that "the sole focus of Thun's first step is on the ability of the ratings schedule to evaluate any impairment manifested by the veteran's symptomology" and that symptomology "is exceptional... when it is of such nature or severity that conventional
test that is satisfied whenever a veteran presents a symptom not expressly listed in the [DC]." Long v. Wilkie, 33 Vet. App. 167. The key to the first Thun element is exceptionality and requires a "totality of the factors" inquiry into whether the veteran's disability picture as a whole (i.e., full symptomatology) presents an impairment that is so exceptional that the rating schedule is not capable of assessing it in the first instance. Id. The Court held that "the sole focus of Thun's first step is on the ability of the ratings schedule to evaluate any impairment manifested by the veteran's symptomology" and that symptomology "is exceptional... when it is of such nature or severity that conventional ratings tools are not adequate to evaluate it properly." Id. at 10. The Court further noted that "functional effects" are relevant to Thun's second step, while symptoms and functional impairments are the "operative focus" of Thun's first step. Id. at 12.

First, the Board must determine whether the schedular rating criteria adequately contemplates the Veteran's disability picture. Treatment records during the period on appeal do not note complaints of or treatment for the Veteran's right hand disability. However, in his March 2022 VA examination the Veteran reports symptoms of soreness of the medial hand with grasping tightly. No other symptoms are noted. Diagnostic code 5230 only considers limitation of motion. However, the Board notes that the first step of the extraschedular analysis focuses on the ability of the rating schedule to evaluate any impairment manifested by the veteran's symptomology. Long v. Wilkie, 33 Vet. App. 167, 174 (U.S. 2020). A symptom of soreness when grasping would be manifested by limitations of motion, which is contemplated by the rating criteria of diagnostic code 5230. As such, the Veteran's disability is not exceptional.

The Board further notes that the Veteran's disability does not meet the second step in the extraschedular evaluation: whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). During a May 2023 VA examination for his acquired psychiatric disorder the Veteran reported a history of working as a mechanic and meeting or exceeding performance standards. The Veteran also reported obtaining a new job as a housekeeper. June 2024 VA treatment records note that the Veteran reports that he is right handed and participates in archery hunting during the season. The record shows that the Veteran has a history of employment and hobbies which require use of his hand to include hand grasping. Despite his contentions of right hand soreness, the record indicates that the Veteran has been able to perform tasks without interference from right hand symptoms. Further, there is no evidence of hospitalizations as a result of his right fifth finger disability.

As the Veteran's right fifth finger disability does not satisfy the first two steps of the extraschedular analysis, a further analysis is not necessary and referral for extraschedular consideration is not warranted.

Entitlement to a compensable rating for right fifth finger is denied.

6. Entitlement to a rating in excess of 50 percent for generalized anxiety disorder.

The Veteran contends that he is entitled to a rating in excess of 50 percent for generalized anxiety disorder.

Procedurally, the Veteran filed a claim for entitlement to service connection for an acquired psychiatric disorder in May 2023. A September 2023 rating decision granted entitlement to service connection for generalized anxiety disorder with a 50 percent rating effective February 2, 2023. The Veteran filed a request for higher level review in July 2024. Following a February 2025 higher level review rating decision which denied entitlement to a rating in excess of 50 percent for generalized anxiety disorder, the Veteran submitted an October 2025 VA Form 10182.

The Veteran's generalized anxiety disorder is rated under diagnostic code 9400 with the general rating formula for mental disorders.

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir
General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

The Veteran submitted lay testimony, dated April 30, 2023 in which he described avoidance of crowded sparces and large numbers of people. He described significant anxiety associated with these environments, and playing out worst case scenarios in his mind. He expressed great frustration in communicating with civilians. He also remarked that his irritability had caused him issues securing employment and due to his irritability, his family largely avoids him.

The Veteran was afforded a VA examination for PTSD in May 2023. The examiner noted diagnosis of adjustment disorder with mixed anxiety and depressed mood. The examiner also noted occupational and social impairment due to mild or transient symptoms. The Veteran reported that he lives in a home with his partner and their two children. He was employed as mechanic and the Veteran reported that he was very focused at work, he has a high level of skill and meets or exceeds all standards of performance, and the enjoyed his work. Symptoms were noted to include depressed mood and disturbance of motivation and mood.

The Veteran was afforded another PTSD examination in August 2023. The examiner noted a diagnosis of generalized anxiety disorder. The examiner reported the Veteran had occupational and social impairment with reduced reliability and productivity. The Veteran reported that he still lives with his fiancée and their two sons and he shares 50/50 custody with his 2 older sons from his ex-wife. Veteran stated they now have good communication and co-parenting. He still has a conflictual relationship with his mother due to her drug use when he was a child. When feeling anxious, the Veteran loses motivation to be around others. Sometimes he has to force himself to interact with his kids. Veteran described himself as mostly an extrovert, yet crowds make him anxious. He denied significant issues with initiating and maintaining relationships and has two close friends he sees on a daily basis. When anxious, the Veteran reported he can become irritable. He described himself as not being fully present at times due to anxiety. The Veteran reported that he recently stopped working as a mechanic due to not getting along with his boss and started working at a resort doing housekeeping. The Veteran reported being excited about his job and denied significant conflict with coworkers or superiors. The Veteran denied current mental health counseling or psychotropic medications. He denied suicide attempts or psychiatric hospitalizations since his last exam. Veteran reported worrying over multiple areas such as his health and safety, family health and safety, finances, job security and the general state of the world. He has difficulty controlling his worry and imagines worst case scenarios. Veteran becomes restless, irritable and experiences muscle tension in his jaw when anxious. He has five hours
. He described himself as not being fully present at times due to anxiety. The Veteran reported that he recently stopped working as a mechanic due to not getting along with his boss and started working at a resort doing housekeeping. The Veteran reported being excited about his job and denied significant conflict with coworkers or superiors. The Veteran denied current mental health counseling or psychotropic medications. He denied suicide attempts or psychiatric hospitalizations since his last exam. Veteran reported worrying over multiple areas such as his health and safety, family health and safety, finances, job security and the general state of the world. He has difficulty controlling his worry and imagines worst case scenarios. Veteran becomes restless, irritable and experiences muscle tension in his jaw when anxious. He has five hours of interrupted sleep per night with difficulty staying asleep. He is unsure of what wakes him at night. The examiner noted that the Veteran's symptoms include depressed mood, anxiety, chronic sleep impairment and disturbance of motivation and mood.

With respect to VA treatment records, June 2024 treatment records note a brief mental health assessment. The Veteran reported that his initial response to things is always negative and he doesn't like how he responds to it. He noted that he is very reactive to small responses. He also reported bad anxiety being in public places.

July 2024 mental health notes symptoms of depression. The Veteran reported that over a two week period he had little interest or pleasure nearly every day; felt down, depressed or hopeless more than half the days; trouble sleeping several days; tired with low energy nearly every day; feelings of failure, guilt more than half the days. The Veteran's symptoms were noted to be moderate in severity. The Veteran reported that his symptoms make it difficult to work, take care of things at home or get along with others.

August 2024 VA mental health records note the Veteran reported over the prior two weeks having little interest or pleasure nearly every day; feeling down, depressed or hopeless nearly every day; trouble sleeping nearly every day; tired, low energy nearly every day; feelings of failure, guilt on several days; and trouble concentrating: several days. While the Veteran's symptoms were noted to have increased, they were still characterized as moderate.

A September 2024 psychotherapy consult notes that the Veteran reported "With certain situations I get overwhelmed, and I react instead of really processing things. I raise my voice over and I can hurt other people's feelings. Frustration when little things happen." Veteran reported persistent depressive and anxiety symptoms "never go away since COVID". Veteran reported symptoms that include lack of motivation, low energy, irritability, tendency to be reactive, emotional numbness, and a lack of sense of accomplishment that made his daily functioning difficult. A mental status examination noted the Veteran seemed oriented to time, place, person and situation, euthymic, cooperative and communicative. Veteran thoughts were logical and goal oriented. Veteran seemed to have appropriate insight into presenting problems and symptoms. During the session Veteran maintained a conversational normal rate, tone volume and articulation. Veteran denied auditory, visual or tactile hallucinations. No perceptual disturbance or disruptive behavior was noted during the session. Veteran denied suicidal, homicidal, self-harm thoughts, plans, preparatory behaviors or intent.

The Board finds the severity, frequency, and duration of the Veteran's symptoms more closely approximate the symptoms contemplated by a 50 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 70 percent rating. See 38 C.F.R. § 4.126. Further, despite the Veteran's symptoms he has been able to maintain a relationship with his fiancé and children and reports having at least two close friends. During his August 2023 examination while the Veteran reported leaving his job as a mechanic, he also reported starting work doing housekeeping and denied any conflicts with coworkers or superiors. The Veteran reported being excited about his housekeeping job.

After review of the entirety of the evidence of record, the Board finds that evidence is persuasively against a finding that the Veteran has symptoms consistent with the 70 percent rating to include suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

The Board observes that the Veteran's representative argues in the letter attached to the VA Form 10182 that "Impaired impulse control (irritability) and difficulty adapting to stressful situations are symptoms VA has assigned to
activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

The Board observes that the Veteran's representative argues in the letter attached to the VA Form 10182 that "Impaired impulse control (irritability) and difficulty adapting to stressful situations are symptoms VA has assigned to the 70% rating criteria." However, the Board notes that the evidence is persuasively against a finding that the Veteran had impaired impulse control (such as unprovoked irritability with periods of violence); but instead, described irritability when his anxiety increases without periods of violence. Additionally, the Veteran is compensated under the 50 percent criteria for symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. Here, the Board finds the description of irritability and anxiety with regards to stressful situations to be included under disturbances of motivation and mood which cause occupational and social impairment with reduced reliability and productivity as contemplated by the 50 percent criteria.

In short, the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 70 percent rating. A 70 percent rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Here, although the Veteran reported some difficulty with motivation and mood, evidence showing good relationships with his fiancé and children. While the Veteran reported an issue with his prior boss (when he was working as a mechanic) he reported being excited about his housekeeping job and denied conflict with coworkers and superiors. This does not support a 70 percent rating criteria.

In an October 2025 brief included in the VA Form 10182 the Veteran's representative argued the examiners failed in asking all of the necessary questions to fully evaluate the severity of the Veteran's symptoms and, basically, failed to elicit the Veteran's symptomatology from him during the encounter. While the Board has considered the representative's arguments, the Board does not agree with these contentions. The VA examinations of record fully contemplate and address the Veteran's symptoms based on the in person examination, the Veteran's lay statements, and the evidence of record. While the Veteran's representative contends that the examiner failed to elicit information from the Veteran, the Board notes that in section 2A of the examination the examiner elicited information regarding the Veteran's current social/marital family history. The Veteran reported he "still lives with his fiancée and their 2 sons and he shares 50/50 custody with his 2 older sons from his ex-wife. [Veteran] stated they now have good communication and co-parenting. He still has a conflictual relationship with his mother due to her drug use when he was a child. When feeling anxious, vet loses motivation to be around others. Sometimes he has to force himself to interact with his kids. Vet described himself as mostly an extrovert, yet crowds make him anxious. He denied significant issues with initiating and maintaining relationships and has 2 close friends he sees on a daily basis. When anxious, vet can become irritable. He described himself as not being fully present at times due to anxiety. In question 2C for relevant mental health history the examiner noted that the Veteran "denied current [mental health] counseling or psychotropic medications. He denied suicide attempts or psychiatric hospitalizations since his last exam. [Veteran] reported worrying over multiple areas such as his health and safety, family health and safety, finances, job security and the general state of the world. He has difficulty controlling his worry and imagines worst case scenarios. Vet becomes restless, irritable and experiences muscle tension in his jaw when anxious. He has 5 hrs of interrupted sleep per night with difficulty staying asleep. He is unsure of what wakes him at night. [Symptoms] have been present since 2019 after discharge from service." These statements are consistent with the contentions that the Veteran noted in his April 2023 statement in support of claim (which the representative identifies as the
psychotropic medications. He denied suicide attempts or psychiatric hospitalizations since his last exam. [Veteran] reported worrying over multiple areas such as his health and safety, family health and safety, finances, job security and the general state of the world. He has difficulty controlling his worry and imagines worst case scenarios. Vet becomes restless, irritable and experiences muscle tension in his jaw when anxious. He has 5 hrs of interrupted sleep per night with difficulty staying asleep. He is unsure of what wakes him at night. [Symptoms] have been present since 2019 after discharge from service." These statements are consistent with the contentions that the Veteran noted in his April 2023 statement in support of claim (which the representative identifies as the Veterans April 2023 SISC, although the Board was previously unaware of this acronym). Further the symptom inventory list in the May 2023 examination notes depressed mood and disturbance of motivation and mood.

With regard to the argument that the examiners failed to use the Beck Anxiety Inventory (BAI), this is not a requirement in assessing an acquired psychiatric disorder for rating purposes. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). In evaluation, an examiner is required to assess the disability in accordance with the DSM-5, which does not require the use of the BAI. A medical examination is adequate where it is based upon consideration of the Veteran's medical information and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one...An examiner is tasked with thoroughly describing a claimant's current disability to allow an adjudicator to assign the appropriate rating and must consider the current disability." Golden v. Shulkin, 29 Vet. App. 221, 226 (2018). Here, the Board finds that the examiner adequately elicited information that described the Veterans symptoms.

Assigning a rating for the Veteran's acquired psychiatric disability is the job of the rating agency, not the examiner. While an examiner's opinion must be adequate, ultimately a disability rating is based on all of the evidence of record, not solely the VA examinations. See 38 C.F.R. § 4.126. Here, the Board finds that the VA examinations of record are adequate and the evidence of record, when taken as a whole does not substantiate entitlement to a rating in excess of 50 percent for the period on appeal.

Based on the evidence of record, and for the aforementioned reasons, entitlement to a rating in excess of 50 percent for generalized anxiety disorder is denied.

REASONS FOR REMAND

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

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

The matters are REMANDED for the following action:

1. BACKGROUND INFORMATION FOR THE REGIONAL OFFICE ADJUDICATOR.

This is a remand to cure a predecisional duty to assist error. The Veteran contends that he is entitled to service connection for a bilateral knee disability. Service treatment records include a December 2016 periodic health assessment in which the Veteran reports that he has knee pain on and off. June 2022 VA treatment records note complaints of ongoing knee pain. June 2024 VA treatment records note complaints of bilateral knee pain since military service. In his May 2023 statement in support of claim the Veteran reported constant knee pain since service. August 2024 VA treatment records note a diagnosis of left knee meniscal tear and right knee meniscal tear. The Veteran was afforded VA examinations for his knee disabilities in April 2022 and December 2024. The examiners failed to consider the Veterans contentions of ongoing knee pain since service and the December 2016 service treatment record which notes knee pain. Remand is warranted for an addendum opinion.

THE REMAND DIRECTIVES FOLLOW.

2. Obtain an addendum opinion for the Veteran's left knee disability from an appropriate clinician. The examiner is asked to address the following:

(a.) Identify any left knee and/or right knee disability, to include osteoarthritis and/or pain amounting to functional impairment of earning capacity (which is deemed a disability for VA purposes).

(b.) For all disabilities found, as defined in (a) above, opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that such disability/disabilities had its onset in, or is otherwise etiologically related to active service. Why or why not?

The examiner must review the entire record in conjunction with rendering the
.

2. Obtain an addendum opinion for the Veteran's left knee disability from an appropriate clinician. The examiner is asked to address the following:

(a.) Identify any left knee and/or right knee disability, to include osteoarthritis and/or pain amounting to functional impairment of earning capacity (which is deemed a disability for VA purposes).

The examiner must review the entire record in conjunction with rendering the requested opinions.? The examiner's attention is drawn, but not limited to, the following evidence:?? December 2016 periodic health assessment in which the Veteran reports that he has knee pain on and off;?June 2022 VA treatment records noting complaints of ongoing knee pain; June 2024 VA treatment records noting complaints of bilateral knee pain since military service; May 2023 statement in support of claim in which the Veteran reports constant knee pain since service; August 2024 VA treatment records which note a diagnosis of left knee meniscal tear and right knee meniscal tear.

The Board notes that the claims folder must be provided to and reviewed by the examiner for all post-remand cases per AOJ policy. See VBA Manual M21-1, Part IV.i.2.A.8.b. Thus, the examiner must specifically note that the claims folder was received and reviewed in the body of the examination report.

The examiner is informed by the Board that chronicity is not required to find a nexus to service or for service connection to be granted.

The examiner is informed that a positive opinion indicating a nexus to service does not require certainty. Rather, if the weight of the evidence is in approximate balance for and against a nexus to service, the examiner should make a determination favorable to the Veteran.

All requested opinions must be supported with a rationale based on generally accepted medical principles and the examiner's medical training and expertise.

3. Readjudicate.

Jennifer White

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Wimbish, Alicia

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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