HEARING LOSS

R. BISIGNANI · 2026 · Case ID: A26035113

MIXED

Summary

The veteran, who served in the Army from July 2001 to September 2004, appeals the denial of service connection for bilateral hearing loss, right ankle condition, right trigger finger condition, sleep apnea, bilateral tinnitus, bilateral chronic dry eye, and PTSD. The Board denied service connection for bilateral hearing loss, finding the veteran did not have a current hearing loss disability as defined by VA regulations, despite conceding in-service noise exposure. The Board denied service connection for a right ankle condition, noting that while an in-service ankle sprain occurred, the evidence indicated full resolution of symptoms and no current disability, with the VA examiner finding no current pathology. The claim for a right trigger finger condition was denied as the evidence showed no complaint, treatment, or diagnosis of any finger condition in service or during the period of appeal, and the VA examiner found no current pathology. Service connection for sleep apnea was denied, as the veteran's STRs were silent regarding sleep issues, and while TERA exposure was conceded, the VA examiner opined the sleep apnea was less likely than not caused by service due to other risk factors. The veteran sought increased ratings for bilateral tinnitus, bilateral chronic dry eye, and PTSD, but the Board denied these claims, finding the current ratings adequately contemplated the veteran's symptoms and that the evidence did not support higher evaluations. The claim for a right knee condition, including arthritis, was remanded for correction of pre-decisional errors, including the failure to obtain relevant community care records and the inadequacy of the VA examination.

Rationale

No current hearing loss disability per 38 C.F.R. § 3.385; No audiometric tests in VA treatment records; Weight of evidence against claim

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250903-586024

Full Decision Text

Citation Nr: A26035113
Decision Date: 04/15/26 Archive Date: 04/15/26

DOCKET NO. 250903-586024
DATE: April 15, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

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

Entitlement to service connection for a right trigger finger condition is denied.

Entitlement to service connection for sleep apnea, to include as secondary to toxic exposure risk activities (TERA), is denied.

Entitlement to an evaluation in excess of 10 percent disabling for service-connected bilateral tinnitus is denied.

Entitlement to an evaluation in excess of 20 percent disabling for service-connected bilateral chronic dry eye is denied.

Entitlement to an evaluation in excess of 50 percent disabling for service-connected posttraumatic stress disorder (PTSD) is denied.

REMANDED

Entitlement to service connection for a right knee condition, to include arthritis, is remanded.

FINDINGS OF FACT

1. The probative evidence of record does not show that the Veteran has a hearing loss disability for VA compensation purposes.

2. The probative evidence of record does not show that the Veteran has a right ankle disability that is related to his active-duty service.

3. The probative evidence of record does not show that the Veteran has a right trigger finger condition that is related to his active-duty service.

4. The probative evidence of record does not show that the Veteran's obstructive sleep apnea is related to his active-duty service.

5. For the entire period of appeal, the Veteran has had the maximum permissible schedular rating for tinnitus and the Veteran's tinnitus symptoms are adequately contemplated by the schedular rating criteria.

6. For the entire period of appeal, the Veteran's service-connected bilateral chronic dry eye manifested as a bilateral disorder of the lacrimal apparatus, the Veeran's symptoms are adequately contemplated by the schedular rating criteria for disorders of the lacrimal apparatus, and no other evaluative criteria in the rating schedule better describe the Veteran's chronic dry-eye symptoms than the criteria for disorders of the lacrimal apparatus.

7. The probative evidence of record shows that for the entire period of appeal the Veteran's service-connected PTSD manifested as occupational and social impairment with reduced reliability and productivity and did not manifest as occupational and social impairment with deficiencies in most areas, such as work; school; family relations; judgment; thinking; or mood.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385.

2. The criteria for entitlement to service connection for a right ankle condition have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for a right trigger finger condition have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for entitlement to an evaluation in excess of 10 percent disabling for service-connected bilateral tinnitus have not been met. 8 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (b)(1), 4.87, DC 6260.

6. The criteria for entitlement to an evaluation in excess of 20 percent disabling for service-connected bilateral chronic dry eye have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.304, 4.1, 4.3, 4.7, 4.79 DC 6099-6025.

7. The criteria for entitlement to an evaluation in excess of 50 percent disabling for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.304, 4
1), 4.87, DC 6260.

7. The criteria for entitlement to an evaluation in excess of 50 percent disabling for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.304, 4.1, 4.3, 4.7, 4.130 DC 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Army from July 2001 to September 2004.

In September 2025, the Board of Veterans' Appeals (Board) received a VA Form 10182, Decision Review Request: Board Appeal electing the Direct Review docket to review a March 2025 rating decision issued by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38?C.F.R. § 20.301.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the all issues on appeal as described on the title page except for the issue of entitlement to service connection for a right knee condition, it may not consider this evidence in its decision on these issues. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Only evidence received within those time periods will be considered by the Board as it remands entitlement to service connection for a right knee condition. Evidence added to the claims file outside of those submission periods will be considered by the AOJ in the adjudication of the claims. 38 C.F.R. § 20.802(c).

Service Connection

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. 38 C.F.R. § 3.303; see Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. §§ 1113 (b); 38 C.F.R. §§ 3.303 (d).

Additionally, certain chronic diseases, including arthritis and hearing loss, will be presumed related to service if it was noted as chronic in service; or if it manifested to a compensable degree within a presumptive period (usually one year) following separation from active duty; or if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a)(3).

VA must consider the competency of the lay evidence and
; or if it manifested to a compensable degree within a presumptive period (usually one year) following separation from active duty; or if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a)(3).

VA must consider the competency of the lay evidence and cannot outright reject such evidence on the basis that such evidence can never establish a medical diagnosis or nexus. However, this does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the lay person is competent and does not otherwise require specialized medical training and expertise to do so; i.e., the Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for the evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b). This benefit-of-the-doubt rule applies if the competing evidence is nearly equal but does not apply when the evidence persuasively favors one side or the other. See Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).

1. Entitlement to service connection for bilateral hearing loss.

The Veteran contends that he has a bilateral hearing loss disability that is related to his active-duty service.

For the purpose of applying the laws administered by VA, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels (dB) or greater; or when the auditory threshold for at least three of the frequencies 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 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. When audiometric test results at separation from service do not meet the regulatory requirements for establishing a "disability" at that time, a veteran may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 160 (1993). The threshold for normal hearing is from 0 to 20 decibels. Id. at 157.

As an initial matter, the Board observes that in the rating decision on appeal, in-service hazardous noise exposure was conceded as a favorable finding. See March 2025 Rating Decision - Narrative at 7. The Board is bound by this favorable finding. 38 C.F.R. § 3.104 (c). As such, the Board is satisfied that the Veteran experienced an in-service injury consisting of exposure to hazardous levels of noise. See Shedden, supra.

The Veteran was afforded a VA examination of his hearing loss in November 2024. See November 2024 C&P Exam. The examiner reviewed the claims file, examined the Veteran, and performed audiometric testing. Id at 1-3. The results of audiometric testing from that exam are below:

HERTZ

500 1000 2000 3000 4000

RIGHT 25 20 10 10 10

LEFT 20 15 10 10 20

Id at 3.

The Veteran's speech discrimination scores were 96% for the right ear and 96% for the left ear. Id.

The Board
.

HERTZ

500 1000 2000 3000 4000

RIGHT 25 20 10 10 10

LEFT 20 15 10 10 20

Id at 3.

The Veteran's speech discrimination scores were 96% for the right ear and 96% for the left ear. Id.

The Board has reviewed the Veteran's VA treatment records and notes that they contain no audiometric tests. The Board further observes that based on the evidence of record the Veteran does not have a hearing loss disability as defined by 38 C.F.R. § 3.385.

Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1110. Because the Veteran does not have a hearing loss disability under applicable VA regulations, his claim for service connection for bilateral hearing loss must be denied. 38 U.S.C. § 1110; 38 C.F.R. § 3.385.

With respect to chronicity, the Board notes that a present disability is still required to establish entitlement to service connection. Id. The Board thus finds that the Veteran is not entitled to presumptive service connection for hearing loss as a chronic disease. See 38 C.F.R. §§ 3.303 (b) and 3.309(a).

In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

2. Entitlement to service connection for a right ankle condition.

The Veteran contends that he has a right ankle condition that is related to his active-duty service.

The Board has reviewed the Veteran's service treatment records (STR). See October 2004 STR - Medical. These records show that the Veteran experienced an ankle sprain during active-duty service around August 2002. Id at 59. The Veteran reported swelling for 7 days and "much" improvement with range of motion exercises, ice, and an air splint. Id. There are no subsequent entries discussing treatment for this condition. At a 2004 physical examination near in time to the Veteran's separation from active-duty service, the Veteran's ankle injury was not mentioned either by the Veteran or by the examiner. Id at 40-47.

The Board has reviewed the Veteran's VA treatment records. These show that the Veteran reported bilateral ankle pain in November 2017. See November 2024 CAPRI at 504. The Veteran was prescribed a course of physical therapy in 2019. Id at 391. By September of that year, his ankle pain improved from 10/10 at worst to 3/10 at worst, and the Veteran reported being able to run with his horses. Id at 382. In November of 2019 the Veteran reported further improvement and that he was happy with home life tending to dogs, horses, and garden. Id at 376. At more recent primary care appointments, the Veteran denied pain and did not mention any issue with his right ankle. See February 2026 CAPRI at 98 (denying any pain at November 2024 appointment). The November 2019 note concerning continued improvement is the most recent treatment record concerning right ankle pain that the Board can locate in the Veteran's treatment records, with subsequent treatment records either silent or denying pain.

The Veteran was afforded a VA examination during the period of appeal to determine the nature and etiology of any right ankle disability the Veteran may have. See November 2024 C&P Exam. The examiner reviewed the claims file and examined the Veteran. Id at 1. The Veteran reported no flare-ups of his right ankle, no additional functional loss after repetitive use over time, and no history of instability. Id at 3. The Veteran reported that his right ankle "gets uncomfortable with standing (6 hours max), requires periodic rotation with rest." Id at 3. The examiner performed range of motion (ROM) testing and noted normal ROM. Id at 3-4. The Veteran's passive ROM was the same as his active ROM and no
The Veteran was afforded a VA examination during the period of appeal to determine the nature and etiology of any right ankle disability the Veteran may have. See November 2024 C&P Exam. The examiner reviewed the claims file and examined the Veteran. Id at 1. The Veteran reported no flare-ups of his right ankle, no additional functional loss after repetitive use over time, and no history of instability. Id at 3. The Veteran reported that his right ankle "gets uncomfortable with standing (6 hours max), requires periodic rotation with rest." Id at 3. The examiner performed range of motion (ROM) testing and noted normal ROM. Id at 3-4. The Veteran's passive ROM was the same as his active ROM and no pain was evident. Id at 4. The Veteran was able to perform 3 repetitions of ROM testing with the same results. Id at 5. No additional factors were noted to contribute to disability. Id at 7. No muscle atrophy, ankylosis, or instability were noted. Id at 7-8. The examiner noted no functional impairment produced by the Veteran's claimed ankle condition. Id at 10-11. The examiner diagnosed the Veteran with no current right ankle disability. Id at 2. The examiner opined that there was no current pathology to warrant a diagnosis. See December 2024 C&P Exam at 2. The examiner explained that prior injuries to the Veteran's right ankle fully resolved by the time the Veteran filed his claim for entitlement to service connection. See December 2024 C&P Exam at 11. Noting that this examination is consistent with the Veteran's treatment records and reports of improvement and a resumption of normal activities in 2019, the Board finds this examination adequate for rating purposes and assigns it high probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. At 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion ... that contributes probative value to a medical opinion.")

Based on the above, the Board finds the Veteran does not have a current diagnosis of any ankle condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). To the extent the Veteran's STR and VA treatment records show injuries to the Veteran's ankle, they also show recovery with no residual symptoms evident. see Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (affirming the Secretary's interpretation of 38 U.S.C. § 1110 to require current symptomatology; "current disability" requirement is not satisfied at all when the weight of the probative evidence shows that a disability that might have one time existed fully resolved prior to the date the claim was filed.)

In reaching this decision the Board acknowledges Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, the Board does not find that the Veteran's reported symptoms, described only as "gets uncomfortable with standing," reached any level of functional impairment of earning capacity. Despite the Veteran's reported symptoms, the medical evidence of record contains no suggestion that the Veteran currently experiences symptoms resulting in functional impairment of earning capacity. Id.

While the Veteran believes he has a current diagnosis of an ankle condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

Thus, the weight of the competent and probative evidence does not establish the first element of service connection, a present disability. See Shedden, supra. As such, the Board need not proceed with analysis of the remaining elements, and the veteran's claim is denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 136
Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

Thus, the weight of the competent and probative evidence does not establish the first element of service connection, a present disability. See Shedden, supra. As such, the Board need not proceed with analysis of the remaining elements, and the veteran's claim is denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

3. Entitlement to service connection for a right trigger finger condition.

The Veteran contends that he has a right trigger finger condition that is related to his active-duty service.

The Board has reviewed the Veteran's VA treatment records and notes that they contain no complaint, treatment, or diagnosis for any finger condition or problem.

The Board has also reviewed the Veteran's STR. These records, inclusive of a physical exam conducted near in time to the Veteran's separation from active-duty service, show no complaint, treatment, or diagnosis for any finger condition or problem. See generally October 2004 STR - Medical.

The Veteran was afforded a VA examination during the period of appeal to determine the nature and etiology of any finger condition he might have. See December 2024 C&P Exam. The examiner reviewed the claims file and examined the Veteran. Id at 1. The Veteran described only a "sticking sensation with use," which "[...] required manual manipulation during the winter months." Id at 2. The Veteran reported no flare ups nor any additional functional impairment after repetitive use over time. Id at 2-3. The examiner performed range of motion (ROM) testing and noted that it was normal. Id at 3. Passive ROM was the same as active ROM. Id at 4. The examiner reported no evidence of pain. Id at 5. The Veteran was able to perform three repetitions of ROM testing with no change in the results. Id at 6. No additional factors were noted to contribute to the condition. Id at 8. The Veteran's strength was normal. Id at 9. No atrophy or ankylosis were noted. Id at 10-11. The examiner reviewed a 2009 imaging report which noted evidence of a healed laceration. Id at 12. The examiner noted no functional impact. Id at 12. The examiner further opined that there is no current pathology to diagnose. See December 2024 C&P Exam at 2. Noting that this conclusion is consistent with the Veteran's VA treatment records and is not contradicted by any other medical evidence, the Board finds this examination adequate for rating purposes and assigns it high probative weight. See Nieves-Rodriguez, supra.

Based on the above, the Board finds the Veteran does not have a current diagnosis of any finger condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See Romanowsky supra; McClain supra. In reaching this decision the Board acknowledges Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, the Board does not find that the Veteran's reported symptoms, described only as "sticking sensation with use; required manual manipulation during the winter months," reached any level of functional impairment of earning capacity. Moreover, the Veteran did not explicitly mention pain or any particular functional impact, only a "sensation." Despite the Veteran's reported symptoms, the medical evidence of record contains no suggestion that the Veteran currently experiences symptoms which result in functional impairment of earning capacity. Id.

While the Veteran believes he has a current diagnosis of a right trigger finger condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

Thus, the weight of the competent and probative evidence does not establish the first element of service connection, a present disability.
medical evidence of record contains no suggestion that the Veteran currently experiences symptoms which result in functional impairment of earning capacity. Id.

Thus, the weight of the competent and probative evidence does not establish the first element of service connection, a present disability. See Shedden, supra. As such, the Board need not proceed with analysis of the remaining elements, and the veteran's claim is denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

4. Entitlement to service connection for sleep apnea, to include as secondary to TERA.

The Veteran contends that his sleep apnea is related to his active-duty service.

As an initial matter, an August 2019 VA treatment record shows that the Veteran was diagnosed with sleep apnea after a polysomnogram at a VA facility. See November 2024 CAPRI at 388-9. As such, the Board finds the current disability element is established. See Shedden v. Principi, 381 F.3d 1163, 1167.

With respect to in-service injury, event, or illness, the Board has reviewed the Veteran's STR and notes that they are silent for any complaint, treatment, or diagnosis for a sleep problem of any kind. See generally October 2004 STR - Medical. The Veteran's VA treatment records suggest that the Veteran first inquired about a sleep apnea evaluation in May 2019. See November 2024 CAPRI at 423. The Veteran then noted that his spouse was concerned about the Veteran's snoring and the Veteran reported poor sleep. Id. The Board can locate no assertion by the Veteran that his symptoms began during or near in time to his active-duty service.

The Board notes that in a November 2024 memo, VA conceded that the Veteran participated in a TERA based on service in Afghanistan in 2004 and occupational exposure due to the Veteran's Military Occupational Specialty as a petroleum supply specialist. See November 2024 other. Based on this evidence, the Board finds that the element of in-service injury is satisfied only by the Veteran's conceded TERA. See Shedden, supra.

Turning to the element of nexus, the Veteran was afforded a VA examination and opinion during the period of appeal to determine the nature and etiology of his sleep apnea. See December 2024 C&P Exam. The examiner reviewed the claims file and examined the Veteran. Id at 1. The examiner cited to medical literature explaining risk factors for the development of sleep apnea including body weight, age, male sex, and tobacco use. Id at 4, 5. The examiner explained that these risk factors are present in the Veteran's case and placed him at high risk for the development of sleep apnea. Id. The examiner opined that the Veteran's sleep apnea is less likely than not caused by the Veteran's toxic exposure risk activities during active-duty service. Id. Noting that this opinion is not contradicted by any other evidence of record, the Board finds it adequate for rating purposes and assigns it high probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. At 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion ... that contributes probative value to a medical opinion.")

The Board notes that the December 2024 VA examiner also opined with respect to direct service connection without regard to TERA. See December 2024 C&P Exam. As discussed above, the Board finds that there is no evidence in the record of an in-service injury, event, or illness other than the Veteran's TERA that is rationally related to the Veteran's sleep apnea. However, the Board notes that in this opinion, the examiner further discussed the Veteran's risk factors for sleep apnea, including smoking, age, gender, body mass index, alcohol use, and comorbidities including hypertension, diabetes
factually accurate, fully articulated, sound reasoning for the conclusion ... that contributes probative value to a medical opinion.")

The Board notes that the December 2024 VA examiner also opined with respect to direct service connection without regard to TERA. See December 2024 C&P Exam. As discussed above, the Board finds that there is no evidence in the record of an in-service injury, event, or illness other than the Veteran's TERA that is rationally related to the Veteran's sleep apnea. However, the Board notes that in this opinion, the examiner further discussed the Veteran's risk factors for sleep apnea, including smoking, age, gender, body mass index, alcohol use, and comorbidities including hypertension, diabetes, and cardiovascular disease. The examiner opined that addressing these risk factors would alleviate the risk of sleep apnea. Id at 3. The Board finds that this opinion complements and supports the examiner's TERA opinion in that it finds other risk factors to be a more likely cause of the Veteran's sleep apnea than the events of his active-duty service.

Based on the foregoing, the Board finds that the weight of the probative evidence of record does not show that the Veteran's sleep apnea is related to the Veteran's active-duty service, to include as secondary to his conceded TERA. Accordingly, the Veteran's claim is denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

Increased Rating

Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Ch. I, Part 4. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509.

1. Entitlement to an evaluation in excess of 10 percent disabling for service-connected bilateral tinnitus.

The Veteran contends that his service-connected tinnitus symptoms are more severe than contemplated by his current 10 percent evaluation.

The Veteran's service-connected bilateral tinnitus is assigned a 10 percent evaluation from August 13, 2024, under 38 C.F.R. § 4.87, DC 6260. See February 2026 Rating Decision - Codesheet.

A. Schedular Rating Criteria for Tinnitus

Under Diagnostic Code 6260, a single 10 percent evaluation is assigned for "recurrent" tinnitus, whether the sound is perceived as being in one ear,
App. at 509.

1. Entitlement to an evaluation in excess of 10 percent disabling for service-connected bilateral tinnitus.

The Veteran contends that his service-connected tinnitus symptoms are more severe than contemplated by his current 10 percent evaluation.

The Veteran's service-connected bilateral tinnitus is assigned a 10 percent evaluation from August 13, 2024, under 38 C.F.R. § 4.87, DC 6260. See February 2026 Rating Decision - Codesheet.

A. Schedular Rating Criteria for Tinnitus

Under Diagnostic Code 6260, a single 10 percent evaluation is assigned for "recurrent" tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note (2).

B. Facts and Analysis

The Board notes that for the entire period of appeal, the Veteran has been assigned the maximum schedular rating allowed for tinnitus under DC 6260. Therefore, further relief on a schedular basis is not available, and the only consideration for the Board is whether the evidence above shows that referral for extraschedular consideration under 38 C.F.R. § 3.321 (b)(1) is appropriate. The Board notes that extraschedular consideration has not been expressly raised by the Veteran. The Board further finds, based on the evidence of record, that extraschedular consideration has not been reasonably raised by the record. Specifically, the Board notes that the only symptoms of tinnitus reported by the Veteran occur 1-5 times per month and last 10 minutes. See, e.g, November 2024 C&P Exam at 2. The Board notes that this description is consistent with the schedular criteria set forth in DC 6260, and that there is no contradictory evidence of record suggesting that the Veteran's tinnitus manifests differently or more severely. As such, the Veteran's tinnitus symptoms and manifestations are adequately contemplated by diagnostic code 6260, which expressly considers symptoms of recurring tinnitus. Therefore, the Board will not further discuss extraschedular consideration. See Thun v. Peake, 22 Vet. App. 111, 114 (2008), aff'd, 572 F.3d 1366 (Fed. Cir. 2009); Johnson v. Shinseki, 26 Vet. App. 237, 244 (2013), rev'd on other grounds by Johnson v. McDonald, 762 F.3d 1362 (Fed. Cir. 2014); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016).

Accordingly, the Veteran's claim for an evaluation in excess of 10 percent disabling for service-connected tinnitus is denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

2. Entitlement to an evaluation in excess of 20 percent disabling for service-connected bilateral chronic dry eye.

The Veteran contends that the symptoms of his chronic dry eye condition are more severe than contemplated by his current 20 percent evaluation.

The Veteran's service-connected bilateral chronic dry eye condition is assigned a 20 percent rating from August 13, 2024, under 38 C.F.R. § 4.79, DC 6099-6025. See February 2026 Rating Decision - Codesheet.

A. Schedular Ratings for Chronic Dry Eyes

When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. When rating by analogy, the diagnostic code number will be "built-up" as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be "99" for all unlisted conditions. 38 C.F.R. § 4.28.

Hyphenated diagnostic codes are
atology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. When rating by analogy, the diagnostic code number will be "built-up" as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be "99" for all unlisted conditions. 38 C.F.R. § 4.28.

Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27.

Diagnostic Code 6099 thus indicates that the part or system of the body involved is the eyes. Diagnostic code 6025 indicates that the Veteran's condition has been rated analogously to a disorder of the lacrimal apparatus (epiphora, dacryocystitis, etc.)

Under DC 6025 for disorders of the lacrimal apparatus, a 10 percent evaluation is assigned when the condition is unilateral. A maximum 20 percent evaluation is assigned when the condition is bilateral. 38 C.F.R. § 4.79 DC 6025.

B. Facts and Analysis

The Board has reviewed the Veteran's VA treatment records. These show that the Veteran has been assessed as having "nonfunctioning tear ducts" since at least as far back in time as 2009. See November 2024 CAPRI at 766. These records show that at times the Veteran has described the condition as "dry, irritating, feel[ing] like sand." Id at 496. During the period of appeal, the Veteran had an active prescription for eye drops to treat this condition. Id at 43. The Veteran's treatment records do not suggest that the Veteran's dry eye condition impairs his visual acuity and contain few descriptions of the condition's symptoms and manifestations.

The Veteran was afforded a VA examination during the period of appeal to assess the severity of the Veteran's dry eye condition. See December 2024 C&P Exam. The examiner reviewed the claims file and examined the Veteran. Id at 1. The examiner diagnosed the Veteran with bilateral dry eye syndrome and bilateral arcus senilis. Id at 1. The Veteran reported symptoms of itching, redness, a burning sensation, and a feeling "like sand in eyes." Id at 2. The Veteran reported treatment with steroid eye drops and a stint in his tear ducts. Id. Current treatment consisted of lubricant eye drops. Id. The Veteran's uncorrected distance visual acuity was normal and his uncorrected near visual acuity was 20/100, with correction to 20/20. Id. No defect of the pupils, anatomical loss, light perception only, or extremely poor vision or blindness were noted. Id at 3. No astigmatism or diplopia were noted. Id. Slit lamp examination revealed bilateral dry patches and bilateral arcus senilis. Id at 4. Internal examination was normal bilaterally and no field of vision defect was diagnosed. Id. The examiner opined that the Veteran's dry eye syndrome did not decrease his visual acuity or cause other visual impairment. Id at 6. No other eye conditions were noted and no incapacitating episodes were noted over the last 12 months. Id at 7-10. Noting that there is no contradictory evidence in the claims file, the Board finds the December 2024 VA examination report adequate for rating purposes and assigns it high probative weight. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (adequate medical examination is one that is based on consideration of veteran's prior medical history and describes his or her condition with a level of detail sufficient to allow the Board to make a fully informed decision on the relevant medical question).

Based on the foregoing, the Board notes that for the entire period of appeal, the Veteran has been assigned the maximum schedular rating allowed for tinnitus under DC 6025. Therefore, further relief on a schedular basis is not available under this diagnostic code.

The Board has considered whether any other diagnostic code more accurately describes the manifestations of the Veteran's bilateral chronic dry eye condition. However, based on the lack of any documented symptoms other than itching, redness, a burning sensation, and a feeling "like sand in eyes;" and the non-functionality of the Veteran's tear ducts, the Board finds that DC 6025 is the best of the available
to allow the Board to make a fully informed decision on the relevant medical question).

The Board has considered whether any other diagnostic code more accurately describes the manifestations of the Veteran's bilateral chronic dry eye condition. However, based on the lack of any documented symptoms other than itching, redness, a burning sensation, and a feeling "like sand in eyes;" and the non-functionality of the Veteran's tear ducts, the Board finds that DC 6025 is the best of the available DC's, because it contemplates disorders of the lacrimal (tear) system. See Butts v. Brown, 5 Vet. App. 532, 539 (1993) (Board's selection of the appropriate code under which to rate a veteran's disability is subject to deferential review under the "arbitrary and capricious" standard.)

Thus, the only remaining consideration for the Board is whether the evidence above shows that referral for extraschedular consideration under 38 C.F.R. § 3.321 (b)(1) is appropriate. The Board notes that extraschedular consideration has not been expressly raised by the Veteran. The Board further finds, based on the evidence of record, that extraschedular consideration has not been reasonably raised by the record. Specifically, the Board notes that only symptoms of dry eyes reported by the Veteran are itching, redness, a burning sensation, and a feeling "like sand in eyes," relieved by application of artificial tears. The Board notes that this description is consistent with the schedular criteria set forth in DC 6025 which contemplates a non-functioning lacrimal (tear) system, and that there is no contradictory evidence of record suggesting that the Veteran's chronic dry eye syndrome manifests differently or more severely than would generally be expected for such a condition. As such, the Veteran's chronic dry eye symptoms and manifestations are adequately contemplated by diagnostic code 6025, which expressly considers symptoms of a non-functional lacrimal system. Therefore, the Board will not further discuss extraschedular consideration. See Thun v. Peake, 22 Vet. App. 111, 114 (2008), aff'd, 572 F.3d 1366 (Fed. Cir. 2009); Johnson v. Shinseki, 26 Vet. App. 237, 244 (2013), rev'd on other grounds by Johnson v. McDonald, 762 F.3d 1362 (Fed. Cir. 2014); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016).

Accordingly, the Veteran's claim for an evaluation in excess of 20 percent disabling for service-connected bilateral chronic dry eyes is denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

3. Entitlement to an evaluation in excess of 50 percent disabling for service-connected PTSD.

The Veteran contends that during the period of appeal, his service-connected PTSD manifested as symptoms more disabling than those contemplated by his initial 50 percent evaluation.

The Veteran's service-connected PTSD is assigned a 50 percent evaluation from August 13, 2024, under 38 C.F.R. § 4.130, DC 9411, applying the General Formula for Mental Disorders. See February 2026 Rating Decision - Codesheet.

A. Schedular Rating Criteria Under the General Formula for Mental Disorders

A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms 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; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id.

A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech;
percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms 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; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id.

A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms 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 work-like setting); and inability to establish and maintain effective relationships. Id.

A 100 percent evaluation is assignable where there is 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); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126 (a). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment, but it shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2.

B. Facts and Analysis

The Board has reviewed the Veteran's VA treatment records for the period of appeal. An October 2024 mental health social work note shows that the Veteran was alert and oriented across all domains. See November 2024 CAPRI at 1-3. His speech was fluent and within normal limits for rate, volume, and prosody. No psychomotor agitation or retardation was noted. The Veteran's mood was euthymic and his affect was mood-congruent. Id. The Veteran's thought process was logical, organized, and goal-directed. Id. The Veteran displayed no suicidal or homicidal ideation, delusional constructs, or hallucinations and his judgment and insight were assessed a within normal limits. Id. Also, in October 2024, the Veteran began a prescription for fluoxetine, an antidepressant. Id at 7.

The Veteran was afforded one VA examination during the period of appeal to determine the severity and functional impact of the Veteran's service-connected PTSD. See November 2024 C&P Exam. The examiner reviewed the claims file and examined the Veteran. Id at 1. The examiner diagnosed the Veteran with PTSD. Id. The examiner observed that the Veteran was appropriately dressed and groomed, made good eye contact, and spoke within a normal range. Id at 7. The Veteran's thought process was linear and his mood was stable with congruent affect. Id. The Veteran reported persistent anxiety, particularly before sleep, and restlessness at night. The Veteran reported watchfulness and anxiety in crowds and public situations. Id The Veteran noted intermittent periods of depression and loneliness. The Veteran reported spending time with his spouse and his spouse's friends, and that he tended not to have meaningful friendships of his own. Id. The Veteran reported struggling at times with declining motivation and mood. The Veteran denied suicidal ideation, homicidal ideation, hallucinations, and delusions and was oriented across all domains. Id. His short-term and long-term memory were intact and his judgment and insight were assessed as good. Id. The examiner checked boxes noting symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and difficulty establishing and maintaining effective work and social relationships. Id. The examiner checked a box noting that overall, the Veteran's symptoms were best described as productive of reduced reliability and productivity. Id at 2. Noting that this examination report appears complete and is consistent with the Veteran's contemporaneous treatment records, the Board finds it adequate
reported struggling at times with declining motivation and mood. The Veteran denied suicidal ideation, homicidal ideation, hallucinations, and delusions and was oriented across all domains. Id. His short-term and long-term memory were intact and his judgment and insight were assessed as good. Id. The examiner checked boxes noting symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and difficulty establishing and maintaining effective work and social relationships. Id. The examiner checked a box noting that overall, the Veteran's symptoms were best described as productive of reduced reliability and productivity. Id at 2. Noting that this examination report appears complete and is consistent with the Veteran's contemporaneous treatment records, the Board finds it adequate for rating purposes and assigns it high probative weight. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (adequate medical examination is one that is based on consideration of veteran's prior medical history and describes his or her condition with a level of detail sufficient to allow the Board to make a fully informed decision on the relevant medical question).

Based on the foregoing, the Board finds that for the entire period of appeal, the Veteran's PTSD manifested as reduced reliability and productivity and did not manifest as occupational and social impairment with deficiencies in most areas, such as work; school; family relations; judgment; thinking; or mood. Specifically, the Board notes that there is no evidence that during the period of appeal the Veteran experienced suicidal ideation; obsessional rituals that interfere with routine activities; illogical, obscure, or irrelevant speech; near continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty adapting to stressful circumstances; or inability to establish and maintain effective relationships. As such, none of the criteria for the next higher evaluation are present in the medical and lay evidence for any of the period of appeal.

Thus, the weight of the competent and probative evidence does not support entitlement to an evaluation in excess of 50 percent disabling for service-connected PTSD. Accordingly, the Veteran's claim is denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990).

REASONS FOR REMAND

One of the effects of the Appeals Modernization Act (AMA) is to narrow the set of circumstances in which the Board must remand appeals to the AOJ for further development instead of immediately deciding them directly. Nevertheless, even under the AMA, the Board still has the duty to remand issues when necessary to correct a pre-decisional duty-to-assist error. See Pub L. No. 115-55 section (2)(d); 38 C.F.R. § 20.802 (a).

1. Entitlement to service connection for a right knee condition, to include arthritis is remanded.

The Veteran contends that he has a right knee condition that is related to his active-duty service.

A December 2024 VA examination report shows that the Veteran was diagnosed with right knee degenerative arthritis. See December 2024 C&P Exam at 2. VA community care treatment records further show that the Veteran has undergone surgery to replace his right knee joint with a prosthesis to treat this arthritis. See, e.g., November 2024 CAPRI at 239. Although the Veteran's VA-generated records contain reference to these community care records, the Board can locate no evidence that the AOJ attempted to obtain these records prior to the date of the March 2025 rating decision on appeal and were not considered. See March 2025 Rating Decision - Narrative at 2. These records appear to have been added to the claims file after the date of the rating decision on appeal. See, e.g., February 2026 VAMC Other Output / Reports.

On his claim form, the Veteran stated: "BUSTED KNEE WHILE DEPLOYED; STILL HAS ISSUES WITH PAIN AND HAD IT REPLACED TWICE." See October 2024 VA 21-526EZ, Fully Developed Claim (Compensation) at 5. The Veteran has also described symptoms of pain and discomfort in his right knee for treatment purposes as early as June 2009. See November 2024 CAPRI at 744 (Veteran reported in 2009 that he injured his knee 4 years ago during active-duty service and occasionally gets
the claims file after the date of the rating decision on appeal. See, e.g., February 2026 VAMC Other Output / Reports.

The Veteran was afforded a VA examination and opinion during the period of appeal to determine the nature and etiology of his right knee arthritis. See December 2024 C&P Exam. The examiner reviewed the claims folder and noted that "All pertinent records were reviewed and findings considered when completing this IMO." However, as noted above, relevant surgical and other treatment record do not appear to have been present in the claims file at the time of the Veteran's examination and the examiner does not appear to have listed them as records that she reviewed. Id at 2-4. The examiner opined as follows:

"I opine that the Veteran's alleged condition of right knee arthritis s/p TKR (claimed as right knee pain), which WAS NOT noted to have occurred during service as there is no mention of a right knee injury until 2009, post-service therefore, IS NOT directly linked to the diagnosis of right knee arthritis s/p TKR (claimed as right knee pain). The Veterans condition IS NOT a direct result of the veteran's service, and a nexus IS NOT established." Id at 5.

The Board finds this examination inadequate first because it appears to be based entirely on the lack of a notation of injury during service to the Veteran's right knee. Such notation is not required to establish that an event or injury occurred. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (noting that an examination was found inadequate where the examiner did not comment on the Veteran's report of in-service injury and relied on the lack of evidence in the service treatment records to provide a negative opinion). Particularly where, as here, a Veteran states that an injury occurred during a deployment where medical care is likely to have been more difficult to obtain, consideration must be given to the Veteran's competent lay reporting. Moreover, for the Veteran to be entitled to service connection for arthritis based on a presumptive basis based on chronicity, the Veteran's symptoms need not to have manifested during service, but only within 1 year of discharge. See Walker, supra; Fountain, supra.

Here, the Veteran had a diagnosis of right knee arthritis near in time to the expiration of the presumptive period and has competently reported "occasional flares." Based on this evidence, the Board finds that entitlement to service connection based on chronicity has been raised by the record and it was thus necessary for the examiner not to merely comment on whether records show that the Veteran's arthritis was or was not diagnosed or manifested during service; but whether all of the evidence, including the lay evidence, show that it is at least as likely as not that the Veteran's arthritis symptoms manifested within one year of discharge from active-duty service (in this case, by September 2005).

The Board finds that the AOJ's failure to attempt to obtain relevant treatment records and reliance upon an inadequate medical opinion are pre-decisional duty-to-assist errors. Remand is required to correct these errors.

The matter is REMANDED for the following actions:

1. First, verify that all records from VA community care providers have been added to the claims file. For any community care records that are referenced in the Veteran's VA treatment records but are not yet present in the claims file, ask the Veteran to complete a VA Form 21-4142. Make two requests for the authorized records from any provider for which the Veteran completes a VA Form 21-4142, unless it is clear after the first request that a second request would be futile.

2. Then, obtain an addendum opinion from an appropriate clinician. The examiner must review the claims file but only needs to examine the Veteran in person if the examiner determines that doing so is necessary to answer and adequately explain the following questions:

(a) Is it at least as likely as not that the Veteran's right knee arthritis (1) began during active service, (2) manifested within 1 year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service?

(Continued on the next page)

(b) Regardless of the answers to (a), above, is it at least as likely
it is clear after the first request that a second request would be futile.

(Continued on the next page)

(b) Regardless of the answers to (a), above, is it at least as likely as not that the Veteran's later-diagnosed right knee arthritis is related to the Veteran's reported in-service knee injury?

The examiner must supply an adequate rationale and is reminded that the Veteran is competent to report the circumstances of his service and the symptoms he has experienced. In providing the requested opinion, consider the Veteran's description of the in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of the current disability, this should be noted. Stated another way, do the Veteran's reports about the symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Divis, Robert A.

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.

Analyze in VA Law Explorer