HEARING LOSS

M. C. GRAHAM · 2026 · Case ID: A26035282

MIXED

Summary

The Veteran, who served in the U.S. Air Force from May 1977 to May 1997, appeals the denial of service connection for bilateral hearing loss, sinusitis, right elbow scars, kidney conditions, lower back condition, bilateral ankle strains, bilateral knee strains, and bilateral knee extension limitations. The Board denied these claims, finding the evidence persuasively weighed against the Veteran meeting the criteria for a compensable rating for each condition. For bilateral hearing loss, the Board relied on a November 2024 VA audiological examination which indicated a zero percent rating, finding a private chiropractor's opinion lacked probative value due to insufficient qualifications and methodology. For sinusitis, the Board found the Veteran's condition, based on a November 2024 VA examination, met only the criteria for a 10 percent rating, and a private chiropractor's opinion was not persuasive. For right elbow scars, the Board found the evidence weighed against a rating higher than 10 percent, as the scars were not unstable or painful enough to meet higher criteria, and a private chiropractor's assessment was not probative. For kidney conditions, the Board denied a higher rating based on a November 2024 VA examination finding no recurrent stone formation requiring treatment or colic, and a private chiropractor's opinion was not persuasive due to lack of qualifications. For the lower back condition, the Board found the November 2024 VA examination findings more persuasive than a private chiropractor's, indicating the Veteran did not meet the criteria for a higher rating. Similarly, for bilateral ankle strains and knee conditions, the Board found the November 2024 VA examinations more persuasive than a private chiropractor's assessment, concluding the Veteran did not meet the criteria for higher ratings based on limitation of motion or instability. The Board remanded claims for service connection for a right shoulder disability, vertigo, chronic headaches, and an acquired psychiatric disorder due to pre-decisional duty to assist errors, including failure to obtain outstanding private medical records and obtain VA medical opinions addressing the claims on a direct incurrence basis or secondary to service-connected sinusitis.

Rationale

November 2024 VA examination results documented level II hearing impairment in both ears.; Private chiropractor's opinion lacked probative value due to insufficient qualifications and methodology.; Evidence persuasively against a compensable rating.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7804

Docket No.

250502-541335

Full Decision Text

Citation Nr: A26035282
Decision Date: 04/15/26 Archive Date: 04/15/26

DOCKET NO. 250502-541335
DATE: April 15, 2026

ORDER

Entitlement to a compensable rating for bilateral hearing loss is denied.

Entitlement to an initial rating in excess of 10 percent for sinusitis is denied.

Entitlement to a rating in excess of 10 percent for right elbow scars is denied.

Entitlement to an initial compensable rating for kidney conditions is denied.

Entitlement to an initial rating in excess of 10 percent for a lower back condition is denied.

Entitlement to an initial rating in excess of 10 percent for a right ankle strain is denied.

Entitlement to an initial rating in excess of 10 percent for a left ankle strain is denied.

Entitlement to an initial rating in excess of 10 percent for a right knee strain is denied.

Entitlement to an initial compensable rating for limitation of extension, right knee, is denied.

Entitlement to an initial rating in excess of 10 percent for a left knee strain is denied.

Entitlement to an initial compensable rating for limitation of extension, left knee, is denied.

REMANDED

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

Entitlement to service connection for vertigo is remanded.

Entitlement to service connection for chronic headaches is remanded.

Entitlement to service connection for an acquired psychiatric disorder is remanded.

FINDINGS OF FACT

1. Throughout the appeal period, the evidence of record persuasively reflects the Veteran's bilateral hearing loss was manifested by no more than level II hearing impairment in the right ear, and level II hearing impairment in the left ear.

2. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's sinusitis manifested with three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting.

3. Throughout the appeal period, the evidence persuasively reflects the Veteran's right elbow scars were not manifested by three or four scars that were unstable or painful; it is not factually ascertainable that the Veteran's symptoms increased in severity within the applicable look back period.

4. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's kidney conditions manifested with recurrent stone formation; or manifested with only an occasional attack of colic, without infection and without requiring catheter drainage.

5. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's lower back condition manifested with forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

6. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's right ankle strain manifested with marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion).

7. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's left ankle strain manifested with marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion).

8. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's right knee strain manifested with flexion limited to 30 degrees.

9. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's limitation of extension, right knee, manifested with extension limited to 10 degrees.

10. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's left knee strain manifested with flexion limited to 30 degrees.

11. Throughout the initial appeal period, the evidence of record persuasively weighs against finding that the Veteran's limitation of extension, left knee, manifested with extension limited to 10 degrees.

CONCLUSIONS OF LAW

1. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

2. The criteria for an initial rating in excess of 10 percent for sinusitis have not
manifested with flexion limited to 30 degrees.

CONCLUSIONS OF LAW

1. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

2. The criteria for an initial rating in excess of 10 percent for sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.31, 4.97, Diagnostic Code 6512.

3. The criteria for a rating in excess of 10 percent for right elbow scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.118, Diagnostic Code 7804.

4. The criteria for an initial compensable rating for kidney conditions have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.115b, Diagnostic Code 7508.

5. The criteria for an initial rating in excess of 10 percent for a lower back condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.71a, Diagnostic Code 5237.

6. The criteria for an initial rating in excess of 10 percent for a right ankle strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.71a, Diagnostic Code 5271.

7. The criteria for an initial rating in excess of 10 percent for a left ankle strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.71a, Diagnostic Code 5271.

8. The criteria for an initial rating in excess of 10 percent for a right knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.71a, Diagnostic Code 5260.

9. The criteria for an initial compensable rating for limitation of extension, right knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.71a, Diagnostic Code 5261.

10. The criteria for an initial rating in excess of 10 percent for a left knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.71a, Diagnostic Code 5260.

11. The criteria for an initial compensable rating for limitation of extension, left knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.71a, Diagnostic Code 5261.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty, in the United States Air Force, from May 1977 to May 1997. The Board of Veterans' Appeals (Board) thanks the Veteran for his many years of service to our country.

As to the claims for service connection for a right shoulder disability, vertigo, chronic headaches, and an acquired psychiatric disorder, and the claims for a compensable rating for bilateral hearing loss and a rating in excess of 10 percent for right elbow scars, the rating decision on appeal was issued on March 7, 2025 and constitutes an initial decision; therefore, the modern
4.71a, Diagnostic Code 5261.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty, in the United States Air Force, from May 1977 to May 1997. The Board of Veterans' Appeals (Board) thanks the Veteran for his many years of service to our country.

As to the claim for an initial rating in excess of 10 percent for sinusitis, the rating decision on appeal was issued on March 18, 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the AMA, applies.

As to the claims for an initial compensable rating for kidney conditions, an initial rating in excess of 10 percent for a lower back condition, an initial rating in excess of 10 percent for a right ankle strain, an initial rating in excess of 10 percent for a left ankle strain, an initial rating in excess of 10 percent for a right knee strain, an initial compensable rating for limitation of extension, right knee, an initial rating in excess of 10 percent for a left knee strain, and initial compensable rating for limitation of extension, left knee, the rating decision on appeal was issued on April 2, 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the AMA, applies.

In the May 2025 VA Forms 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the applicable agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the applicable AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) 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 claims of entitlement to an initial compensable rating for bilateral hearing loss, entitlement to an initial rating in excess of 10 percent for sinusitis, entitlement to a rating in excess of 10 percent for right elbow scars, entitlement to an initial compensable rating for kidney conditions, entitlement to an initial rating in excess of 10 percent for a lower back condition, entitlement to an initial rating in excess of 10 percent for a right ankle strain, entitlement to an initial rating in excess of 10 percent for a left ankle strain, entitlement to an initial rating in excess of 10 percent for a right knee strain, entitlement to an initial compensable rating for limitation of extension, right knee, entitlement to an initial rating in excess of 10 percent for a left knee strain, and entitlement to an initial compensable rating for limitation of extension, left knee, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims of entitlement to service connection for a right shoulder disability, entitlement to service connection for vertigo, entitlement to service connection for chronic headaches, and entitlement to service connection for an acquired psychiatric disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board has recharacterized the issue of service connection for depressive disorder, also claimed as generalized anxiety disorder, broadly as service connection for an acquired psychiatric disorder. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Similarly, the Board has
However, because the Board is remanding the claims of entitlement to service connection for a right shoulder disability, entitlement to service connection for vertigo, entitlement to service connection for chronic headaches, and entitlement to service connection for an acquired psychiatric disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Also, in his May 2025 VA Forms 10182, the Veteran argued his "Chronic sinusitis - should be 60%", that his "Kidney conditions - Should be 40%" that his "Lower back condition - should be 40%", that his "Right ankle strain - should be 20%", that his "Left ankle strain - should be 20%", that his "Right knee strain - Should be 20%," that his "Limitation of extension, right knee - Should be 20%", that his "Left knee strain - Should be 20%" and that his "Limitation of extension, left knee - should be 20%" While the Veteran's May 2025 VA Forms 10182 did request higher initial ratings for his sinusitis, kidney conditions, lower back condition, right ankle strain, left ankle strain, right knee strain, right knee extension, left knee strain and left knee extension, it did not express any disagreement with the effective dates assigned for his sinusitis, kidney conditions, lower back condition, right ankle strain, left ankle strain, right knee strain, right knee extension, left knee strain and left knee extension. Accordingly, the Veteran limited this appeal, as to these disabilities, to claims for higher initial evaluations for sinusitis, kidney conditions, a lower back condition, right ankle strain, left ankle strain, right knee strain, right knee extension, left knee strain, and left knee extension.

Additionally, the Board notes that it is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). In the present case, the Veteran submitted evidence in support of his appeal with his May 2025 VA Forms 10182, pursuant to 38 C.F.R. § 20.303. As such, a docket switch is no longer possible. See 38 C.F.R. § 20.202(c)(2) ("Requests to modify a Notice of Disagreement will not be granted if the appellant has submitted evidence or testimony as described in 20.302 and 20.303."). Under the circumstances, the Board may proceed with adjudication of the Veteran's appeal without further delay.

As a final preliminary matter, Board acknowledges that on October 28, 2024 VA received from the Veteran information, which contained hyperlinks to content that was not otherwise part of the record on appeal; however, that content was not accessed nor considered as part of the record before the Board. See Bowey v. West, 11 Vet. App. 106, 108-09 (1998) (holding that the mere reference to non-VA documents is insufficient to incorporate them into the record).

Increased Ratings

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

VA must consider whether to "stage" the rating, meaning assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. Consideration of the appropriateness of a staged rating is required for increased rating claims, irrespective of whether it is an initial rating at issue or instead an established rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505
based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

The Board notes that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. See 38 C.F.R. § 4.31.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine at Note 5.

The Court has held that a veteran may be entitled to a rating based on ankylosis if he experiences the functional equivalent of ankylosis when considering the provisions of 38 C.F.R. §§ 4.40 and 4.45. Chavis v. McDonough, 34 Vet. App. 1, 23-24 (2021). Ankylosis is defined in general as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Colayong v. West, 12 Vet. App. 524 (1999) (citing Dorland's Illustrated Medical Dictionary (28th Ed. 1994) at 86).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

1. Entitlement to a compensable rating for bilateral hearing loss
held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

1. Entitlement to a compensable rating for bilateral hearing loss

The Veteran contends that a compensable rating is warranted for his bilateral hearing loss. Specifically, in his October 2024 application for benefits, the Veteran claimed "Ext of sc bilateral hearing loss" and to "See Doctor's Report". In his May 2025 VA Form 10182, the Veteran stated his "Bilateral hearing loss - should be 20%".

Here, this claim stems from an intent to file claim received by VA on December 30, 2023, as an application for benefits with a claim for "Ext of sc bilateral hearing loss" was received within a year thereafter in October 2024. For an increased rating claim, the regulations allow for an effective date up to one year prior to the date of claim or intent to file claim when it is factually ascertainable, based on all evidence of record, that an increase in disability had occurred. 38 C.F.R. § 3.400(o)(2). The appeal period ends March 7, 2025, the date the AOJ decision on appeal was issued.

The assigned evaluation for hearing loss is determined by mechanically applying the rating criteria to certified test results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Under the applicable criteria, ratings for hearing loss are determined in accordance with the findings obtained on audiometric examinations. Evaluations of hearing impairment range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests (Maryland CNC), together with the average hearing threshold level as measured by puretone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz. The rating criteria establish eleven auditory acuity levels designated from I to XI. As set forth in the regulations, Tables VI, VIa, and VII are used to calculate the rating to be assigned. See 38 C.F.R. § 4.85, Diagnostic Code 6100.

Additionally, the regulations allow for evaluating exceptional patterns of hearing impairment. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, Table VI or Table VIa is to be used, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, Table VI or Table VIa is to be used, whichever results in the higher numeral. Thereafter, that numeral will be elevated to the next higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b).

The evidence is persuasively against a compensable evaluation for the Veteran's bilateral hearing loss. A VA audiological examination was afforded to the Veteran in November 2024. The November 2024 VA examination results documented a puretone threshold average of 50 for the right ear and rounded a puretone threshold average of 51 for the left ear, at the relevant frequencies of 1000, 2000, 3000 and 4000 Hertz. The November 2024 VA examination results also revealed Maryland CNC speech recognition scores of 84 percent in each ear. Based on those results with the utilization of Table VI, the Veteran had level II hearing impairment in the right ear, and level II hearing impairment in the left ear. Applying the results to Table VII
for the Veteran's bilateral hearing loss. A VA audiological examination was afforded to the Veteran in November 2024. The November 2024 VA examination results documented a puretone threshold average of 50 for the right ear and rounded a puretone threshold average of 51 for the left ear, at the relevant frequencies of 1000, 2000, 3000 and 4000 Hertz. The November 2024 VA examination results also revealed Maryland CNC speech recognition scores of 84 percent in each ear. Based on those results with the utilization of Table VI, the Veteran had level II hearing impairment in the right ear, and level II hearing impairment in the left ear. Applying the results to Table VII, a zero percent rating is warranted for bilateral hearing loss based on the November 2024 VA audiological examination results. See 38 C.F.R. § 4.85, Diagnostic Code 6100.

Further, an exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown to warrant application of Table VIa based on the November 2024 VA examination results.

Also, in a September 2024 private opinion, Alison Nida, a doctor of chiropractic, stated she tested the Veteran's hearing "in a very quiet room, then again in a room wherein normal day to day noise (air conditioner, computer, and soft background music) is introduced to test functional hearing under normal day to day conditions", that stimuli were employed along with spoken words, and whispered words at a distance of five feet, and this testing revealed the Veteran had "bilateral hearing loss under normal conditions of approximately 40% of the left ear and 50% of the right ear." The September 2024 private opinion noted the Veteran was asked to attend a puretone audiogram and have the results of same sent to this office, and when "received same will be filed in this case as an addendum."

The report includes an unsigned September 26, 2024 private audiogram. The results documented a puretone threshold average of 50 for the right ear and rounded a puretone threshold average of 54 for the left ear, at the relevant frequencies of 1000, 2000, 3000 and 4000 Hertz. Speech discrimination scores were included but did not identify the Maryland CNC test as the test used. This report cannot serve as an examination for hearing impairment for VA purposes as it was unclear whether it was conducted by a state-licensed audiologist and as it did not include the Maryland CNC test.

The September 2024 private chiropractor statement cannot serve as an examination for hearing impairment for VA purposes as it was not conducted by a state-licensed audiologist and as it did not include a controlled speech discrimination (Maryland CNC) test and a puretone audiometry test. Further, the private chiropractor is not competent to evaluate the severity of the Veteran's bilateral hearing loss, as a chiropractor would generally not be qualified through education, training, or experience to offer opinions as to audiological disabilities. See 38 C.F.R. § 3.159(a)(1). The evidence does not establish that this specific private chiropractor has been qualified through education, training, or experience to offer opinions as it relates to sinus disabilities. Therefore, the Board affords the September 2024 private chiropractor opinion no probative weight or persuasiveness. Thus, a higher initial rating is not warranted based on the September 2024 private assessment.

Thus, there is no contrary competent medical evidence of record as to November 2024 VA examination report in terms of audiometric testing that presented the type of specialized findings pertinent to the diagnostic question as to whether the Veteran has compensable hearing loss in either ear for VA purposes. Accordingly, the November 2024 VA examination report is consistent with the other evidence and probative evidence in this matter, and, in the absence of competent evidence to the contrary, persuasive. Thus, based on the evidence above, a compensable rating for the Veteran's bilateral hearing loss is not warranted.

Further, during the November 2024 VA examination the Veteran reported his hearing loss had gotten worse and now needed hearing aids, and he is competent to report difficulty with his hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann, 3 Vet. App. at 349.

The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's main complaint is reduced hearing acuity, which is what is contemplated in the rating assigned.
VA examination the Veteran reported his hearing loss had gotten worse and now needed hearing aids, and he is competent to report difficulty with his hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann, 3 Vet. App. at 349.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and a compensable evaluation for bilateral hearing loss is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

2. Entitlement to an initial rating in excess of 10 percent for sinusitis

The Veteran contends a higher initial rating is warranted for his sinusitis. As discussed above, in his May 2025 VA Form 10182, the Veteran argued his "Chronic sinusitis - should be 60%".

Here, the appeal period for consideration from December 20, 2023, the date service connection was awarded, to March 18, 2025, the AOJ decision on appeal was issued.

Throughout the initial appeal period, the Veteran's sinusitis has been rated under Diagnostic Code 6512, sinusitis, frontal, chronic. See 38 C.F.R. § 4.97, Diagnostic Code 6512.

Under Diagnostic Code 6512, sinusitis is rated pursuant to the General Rating Formula for Sinusitis. This formula provides that a 0 percent rating is warranted when detected by X-ray only. A 10 percent rating is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is warranted for three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A maximum schedular 50 percent rating is warranted following radical sinus surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 38 C.F.R. § 4.97. A note to the General Rating Formula for Sinusitis provides that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. Id.

No other diagnostic codes are relevant to the Veteran's claim for an increased initial rating for sinusitis. See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015).

The evidence is persuasively against an initial rating in excess of 10 percent for the Veteran's sinusitis. During a November 2024 VA examination, the Veteran reported headache, post nasal drip, nasal congestion and pressure, runny nose, watery eyes, and cough. The November 2024 VA examiner documented the Veteran's sinusitis resulted in episodes of sinusitis, headaches, tenderness of affected sinus, and nasal congestion. The November 2024 VA examiner found the Veteran had had three non-incapacitating episodes of sinusitis characterized by headaches, pain and purulent discharge or crusting in the past 12 months but he had not had incapacitating episodes of sinusitis requiring prolonged (4 to 6 weeks) of antibiotics treatment in the past 12 months. The November 2024 VA examiner found the Veteran had not had sinus surgery, including radical, endoscopic or other types of
post nasal drip, nasal congestion and pressure, runny nose, watery eyes, and cough. The November 2024 VA examiner documented the Veteran's sinusitis resulted in episodes of sinusitis, headaches, tenderness of affected sinus, and nasal congestion. The November 2024 VA examiner found the Veteran had had three non-incapacitating episodes of sinusitis characterized by headaches, pain and purulent discharge or crusting in the past 12 months but he had not had incapacitating episodes of sinusitis requiring prolonged (4 to 6 weeks) of antibiotics treatment in the past 12 months. The November 2024 VA examiner found the Veteran had not had sinus surgery, including radical, endoscopic or other types of surgery. The November 2024 VA examiner also found the Veteran did not have repeated sinus-related surgical procedures performed. Thus, an initial rating in excess of 10 percent is not warranted based on the November 2024 VA examiner's findings.

The Board finds that the November 2024 VA examination to be competent because the examiner has specialized medical training and experience. The provider completed the VA curriculum for this exam specialty and had several years of medical experience as a licensed family nurse practitioner. The examination report is credible because it is internally consistent and consistent with the record. Therefore, the Board affords the November 2024 report significant probative weight.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic, did not provide any findings as to the actual rating criteria for Diagnostic Code 6512 but noted the Veteran reported his "symptoms include respiratory deficiency to include congestion of the maxillary and frontal sinuses with difficulty breathing, cough, throat irritation, and facial pain" and that "[a]pproximately twice per year he will develop a sinus infection requiring antibiotics." The Board finds that the private chiropractor is not competent to evaluate the severity of the Veteran's sinusitis, as a chiropractor would generally not be qualified through education, training, or experience to offer opinions as to sinus disabilities. See 38 C.F.R. § 3.159(a)(1). The evidence does not establish that this specific private chiropractor has been qualified through education, training, or experience to offer opinions as it relates to sinus disabilities. Therefore, the Board affords the September 2024 private chiropractor opinion no probative weight or persuasiveness. Thus, an initial rating in excess of 10 percent is not warranted based on the September 2024 private assessment.

The September 2024 private assessment also documented the Veteran reported treatment with "nasal sprays and oral medications" and during the November 2024 VA examination he reported use of nasal spray. However, the "oral medications" documented the September 2024 private assessment appears to be the use of antibiotics as no other medication was actually identified. However, regardless, the Veteran also reported the use of nasal spray. In assigning a disability rating VA may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56 (2012). However, the use of medication is explicitly considered in the rating criteria for Diagnostic Code 6512.

The Board notes that the Veteran's headache symptomatology has been included as part of the separately pending claim for a chronic headache disability, remanded below, to determine whether he has a separate headache disability, including secondary to his service-connected sinusitis. 38 C.F.R. § 4.14.

Further, while the Veteran, as a layperson, is competent to report the symptoms he has experienced, he has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability for his sinusitis according to the rating criteria. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Such competent evidence concerning the nature and extent of the Veteran's sinusitis has been provided by the above discussed evidence, including the November 2024 VA examiner's findings. Moreover, as discussed above, the Veteran has not asserted his sinusitis manifested in three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting.

Additionally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with his respect to his sinusitis. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by
, including the November 2024 VA examiner's findings. Moreover, as discussed above, the Veteran has not asserted his sinusitis manifested in three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an initial evaluation in excess of 10 percent for sinusitis is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

3. Entitlement to a rating in excess of 10 percent for right elbow scars

The Veteran contends that a compensable rating is warranted for his bilateral hearing loss. Specifically, in his October 2024 application for benefits, the Veteran claimed "Ext of sc scar right elbow" and to "See Doctor's Report". In his May 2025 VA Form 10182, the Veteran stated his "Right elbow scars - should be 20%".

Here, this claim stems from an intent to file claim received by VA on December 30, 2023, as an application for benefits with a claim for "Ext of sc scar right elbow" was received within a year thereafter in October 2024. For an increased rating claim, the regulations allow for an effective date up to one year prior to the date of claim or intent to file claim when it is factually ascertainable, based on all evidence of record, that an increase in disability had occurred. 38 C.F.R. § 3.400(o)(2). Thus, the Board has considered the one year period prior the December 20, 2023 intent to file claim to determine whether there was an increase in severity. The appeal period ended March 7, 2025, the date the AOJ decision on appeal was issued. Here, however, there is no medical or lay evidence which can be considered by the Board addressing the severity of the Veteran's right elbow scars during the applicable look back period, and the Veteran has not asserted his right elbow scars increased in severity during the applicable look back period. Accordingly, the Board finds the evidence is persuasively against a finding that it is factually ascertainable, based on all evidence of record, that an increase in disability occurred during the applicable look back period.

Throughout the initial appeal period, the Veteran's right elbow scars have been rated under Diagnostic Code 7804, scar(s), unstable or painful. See 38 C.F.R. § 4.118, Diagnostic Code 7804.

Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id.

The evidence is persuasively against a rating in excess of 10 percent for the Veteran's right elbow scars. Specifically, the Board finds that the evidence of record persuasively weighs against the assignment of a rating in excess of 10 percent under Diagnostic Code 7804 because the Veteran's right elbow scars were not manifest by three or four scars that were unstable or painful. In this regard, a November 2024 VA examiner documented the Veteran reported a twitching sensation, pain, itchiness, and discomfort, and that he had two painful scars of the lateral and medial elbow. However, the November 2024 VA examiner found these scars were not unstable with frequent loss of covering of skin over the scars. The November 2024 VA examiner identified two scars of the Veteran's right elbow, measuring 4.5 cm. by 1 cm. of the lateral elbow, 2.5 cm. by 1 cm. of the medial elbow. The November 2024 VA examiner also identified a scar of the right shoulder, which is not part and parcel of the service-connected right elbow scars at issue here. Thus, a rating in excess of 10 percent is not warranted based on the November 2024 VA examination report.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic, did not provide any findings as to the actual rating criteria for Diagnostic Code 7804 but noted the Veteran had two scars "affiliated with his elbow surgery", that the "first scar is located on the medial elbow and is keloid, while the second scar is located on the lateral elbow area and keloid." Thus, a rating in excess of 10 percent is not warranted based on the September 2024 private assessment.

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's right elbow scars were not of the head, face, or neck, were not deep and nonlinear, and were not associated with underlying soft tissue damage. Indeed, the November 2024 VA examiner found the Veteran's scar of the lateral elbow was tender to palpation, but neither scar was unstable upon inspection and neither scar had underlying soft tissue damage. Thus, although the Veteran's scars were superficial and not associated with underlying soft tissue damage, they did not cover an area or areas of 144 square inches or greater. Therefore, Diagnostic Codes 7800 through 7802, are inapplicable. Finally, the evidence of record shows there are no other disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under Diagnostic Code 7805. Specifically, while the Veteran reported "numbness to fingers", the November 2024 VA examiner found the Veteran's scars did not impact his ability to work.

Moreover, while the Veteran, as a layperson, is competent to report the symptoms he has experienced, he has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability for his right elbow scars according to the rating criteria or whether his reported numbness in his fingers is due to his right elbow scars. Jandreau, 492 F.3d at 1377. For example, the Veteran is also service-connected for a right elbow disability, which is not at issue here, and also has a pending claim for service connection for a right shoulder disability, which is remanded below. Moreover, the competent evidence concerning the nature and extent of the Veteran's right elbow scars has been provided by the above discussed evidence, including the November 2024 VA examiner's findings. Moreover, as discussed above, the Veteran has not asserted his right elbow scars consisted of three or four scars that were unstable or painful scars.

Additionally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with respect to his right elbow scars. See Doucette, 28 Vet. App. at 370.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an evaluation in excess of 10 percent for right elbow scars is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

4. Entitlement to an initial compensable rating for kidney conditions

The Veteran contends a higher initial rating is warranted for his kidney conditions. As discussed above, in his May 2025 VA Form 10182, the Veteran argued his "Kidney conditions - Should be 40%".

persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an evaluation in excess of 10 percent for right elbow scars is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

4. Entitlement to an initial compensable rating for kidney conditions

The Veteran contends a higher initial rating is warranted for his kidney conditions. As discussed above, in his May 2025 VA Form 10182, the Veteran argued his "Kidney conditions - Should be 40%".

Here, the appeal period for consideration from December 20, 2023, the date service connection was awarded, to April 2, 2025, the date the AOJ decision on appeal was issued.

Under the AMA, the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104. The April 2025 AOJ decision on appeal, issued on April 2, 2025, did not provide any favorable findings as to this claim.

Throughout the initial appeal period, the Veteran's kidney conditions have been rated under Diagnostic Code 7508, nephrolithiasis/ureterolithiasis/ nephrocalcinosis. See 38 C.F.R. § 4.115b, Diagnostic Code 7508.

Under Diagnostic Code 7508, nephrolithiasis (kidney stones) is rated as hydronephrosis under Diagnostic Code 7509, except where there is recurrent stone formation requiring one or more of the following: (1) diet therapy; (2) drug therapy; or (3) invasive or noninvasive procedures more than two times per year. If evaluated under this code, the rating assigned will be 30 percent.

Under Diagnostic Code 7509, hydronephrosis warrants a 10 percent rating when there is only an occasional attack of colic, without infection and without requiring catheter drainage. A 20 percent disability rating is warranted for frequent attacks of colic requiring catheter drainage. A 30 percent disability rating is warranted where there are frequent attacks of colic with infection (pyonephrosis) and impaired kidney function. If hydronephrosis is severe, it is rated as renal dysfunction. 38 C.F.R. § 4.115b, Diagnostic Code 7509.

No other diagnostic codes are relevant to the Veteran's claim for an increased initial rating for kidney conditions as a sole diagnosis of nephrolithiasis (kidney stones) was endorsed by the November 2024 VA examiner. See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015).

For the following reasons, the evidence is persuasively against an initial compensable rating for the Veteran's kidney condition. In this regard, during a November 2024 VA examination, the Veteran reported he had kidney stones in the military, and had five episodes since then, that as to current symptoms, he had flank pain and painful urination sometimes, and that he had no treatment. The November 2024 VA examiner documented the Veteran had, now or in the past, a kidney calculus but the stone formation did not cause stricture of the ureter. The November 2024 VA examiner also found that the Veteran had not had treatment for recurrent stone formation in the kidney or ureter. The November 2024 VA examiner also found the Veteran did not have any signs or symptoms due to upper urinary tract urolithiasis, and that he did not have attacks of colic due to upper urinary tract urolithiasis. The November 2024 VA examiner also found the Veteran did not have a history of recurrent symptomatic urinary tract or kidney infections and he did not have renal dysfunction. Thus, an initial compensable rating is not warranted based on the November 2024 VA examiner's findings.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic, did not provide any findings as to the actual rating criteria for Diagnostic Code 7508 but noted the Veteran reported during service, he diagnosed with kidney stones, that he "was able to pass that stone on his own", that he "has continued to suffer from ongoing kidney stones over the years" and he "reports he has passed approximately 4 stones over the years, with the one being in 2022." However, 2022 is not proximate to the appeal period at issue here. The September 2024 private assessment also documented the Veteran reported he "
not warranted based on the November 2024 VA examiner's findings.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic, did not provide any findings as to the actual rating criteria for Diagnostic Code 7508 but noted the Veteran reported during service, he diagnosed with kidney stones, that he "was able to pass that stone on his own", that he "has continued to suffer from ongoing kidney stones over the years" and he "reports he has passed approximately 4 stones over the years, with the one being in 2022." However, 2022 is not proximate to the appeal period at issue here. The September 2024 private assessment also documented the Veteran reported he "had to undergo surgery intervention approximately 10 years ago for a large stone" and he "is now using a medication to assist in reduction of stone formation." However, again, a kidney stone 10 years from the September 2024 private assessment, in approximately 2014, is not proximate to the appeal period at issue here.

The Board finds that the private chiropractor is not competent to evaluate the severity of the Veteran's service-connected kidney disorder, as a chiropractor would generally not be qualified through education, training, or experience to offer opinions as to kidney disabilities. See 38 C.F.R. § 3.159(a)(1). The evidence does not establish that this specific private chiropractor has been qualified through education, training, or experience to offer opinions as it relates to kidney disabilities. Therefore, to the extent that there is a medical assessment contained in the September 2024 private chiropractor statement (as opposed to a recitation of lay statements), the report has no probative weight or persuasiveness. Thus, an initial compensable rating is not warranted based on the September 2024 private assessment.

Moreover, contrary to the Veteran's report during the September 2024 private assessment that he "is now using a medication to assist in reduction of stone formation", as discussed above, during the November 2024 VA examination the Veteran reported he had no treatment and, specifically, the examination report noted "no" to a question as to whether the Veteran takes medication for the kidney condition. There is no medical evidence, dated proximate to or during the appeal period, of any treatment for kidney stones. The use of medication is explicitly considered in the rating criteria for Diagnostic Code 7508. Jones, 26 Vet. App. at 63. However, the Board finds that the evidence is persuasively against finding recurrent stone formation requiring one or more of the following: (1) diet therapy; (2) drug therapy; or (3) invasive or noninvasive procedures more than two times per year at any time during the appeal period. Accordingly, the Board finds that the evidence is persuasively against a higher rating.

Moreover, while the Veteran, as a layperson, is competent to report the symptoms he has experienced, he has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability for his kidney conditions according to the rating criteria. Jandreau, 492 F.3d at 1377. Such competent evidence concerning the nature and extent of the kidney conditions has been provided by the above discussed evidence, including the November 2024 VA examiner's findings. Moreover, as discussed above, the Veteran has not asserted, nor does the evidence show, that his kidney condition manifested with occasional attacks of colic, without infection and without requiring catheter drainage. In fact, the VA examination report clearly found that the Veteran did not have attacks of colic.

Additionally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with respect to his kidney conditions. See Doucette, 28 Vet. App. at 370.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an initial compensable evaluation for kidney conditions is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

5. Entitlement to an initial rating in excess of 10 percent for a lower back condition

The Veteran contends a higher initial rating is warranted for his lower back condition. As discussed above, in his May 2025 VA Form 10182, the Veteran argued his "Lower back condition - should be 40%".

Here, the appeal period for consideration from December 20, 2023, the date service connection was awarded, to April 2, 2025, the AOJ decision on appeal was
not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

5. Entitlement to an initial rating in excess of 10 percent for a lower back condition

Here, the appeal period for consideration from December 20, 2023, the date service connection was awarded, to April 2, 2025, the AOJ decision on appeal was issued.

Throughout the initial appeal period, the Veteran's lower back condition has been rated under Diagnostic Code 5237, lumbosacral or cervical strain. See 38 C.F.R. § 4.71a, Diagnostic Code 5237.

Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1.

For the following reasons, the evidence is persuasively against an initial rating in excess of 10 percent for the Veteran's low back condition under the General Rating Criteria. In this regard, a November 2024 VA examiner found the Veteran had, as to active and passive range of motion, forward flexion of the thoracolumbar spine to 80 degrees and combined range of motion of the thoracolumbar spine to 180 degrees, even with pain and repetitive testing. The November 2024 VA examiner also found the Veteran had pain with weight-bearing. The November 2024 VA examiner also found the Veteran did not have localized tenderness, guarding or muscle spasm of the thoracolumbar spine. Also, during the November 2024 examination, the Veteran reported "PULLING PAIN" but he did not report flare-ups of the thoracolumbar spine, and he did not report any functional loss or functional impairment, including but not limited to after repeated use over time.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic, noted the Veteran reported his "progressive low back pain in varying degrees and intensified with standing, sitting, and walking" and that "[o]n examination his true lumbar ranges of motion (hips immobilized) are: flexion 25 degrees, extension 10 degrees, right rotation 10 degrees, left rotation 10 degrees, right lateral flexion 10 degrees, and left lateral flexion 5 degrees" and that "[t]here is fixation from L4-S1 with moderate hypertonicity of the superficial and deep musculature at that level."

Greater weight may be placed on one medical provider's opinion over another's depending on factors such as reasoning employed by the provider, and whether or
a doctor of chiropractic, noted the Veteran reported his "progressive low back pain in varying degrees and intensified with standing, sitting, and walking" and that "[o]n examination his true lumbar ranges of motion (hips immobilized) are: flexion 25 degrees, extension 10 degrees, right rotation 10 degrees, left rotation 10 degrees, right lateral flexion 10 degrees, and left lateral flexion 5 degrees" and that "[t]here is fixation from L4-S1 with moderate hypertonicity of the superficial and deep musculature at that level."

Moreover, the September 2024 private assessment did not explicitly identify ankylosis as to a lumbar spine disability. However, September 2024 private assessment noted "[t]here is fixation from L4-S1 with moderate hypertonicity of the superficial and deep musculature at that level". First, to the extent the notation of fixation at L4-S1 suggests ankylosis or its functional equivalent, the Board finds that the evidence is persuasively against such a finding as the chiropractor noted some range of motion in all planes of the lumbar spine and as the November 2024 VA examination did not find ankylosis and the findings of the November 2024 examination also did not suggest the functional equivalent of ankylosis. The November 2024 VA examination reports found there was no ankylosis of the spine, specifically the Veteran did not have unfavorable ankylosis of the entire spine, unfavorable ankylosis of the entire thoracolumbar spine or favorable ankylosis of the entire thoracolumbar spine. Further, to the extent the September 2024 private assessment referenced hypertonicity, suggesting tight muscles in the lumbar spine, the Board also finds that this language, when taken with the other evidence of record clearly showing no ankylosis or its functional equivalent, does not support a finding of ankylosis such that a higher rating is warranted.

Thus, even considering the Veteran's lay reports of symptoms and noted functional loss, to include pulling pain, progressive low back pain in varying degrees and intensified with standing, sitting, and walking, and resulting in limitation of motion, the degree of additional limitation reflected by his statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

Specifically, as noted above, during the November 2024 VA examination, the Veteran did not report flare-ups of the thoracolumbar spine and he did not report any functional loss or functional impairment, including but not limited to after repeated use over time. Nonetheless, after reviewing the record, which was specifically documented by the November 2024 VA examiner, the November 2024 VA examiner found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups. Similarly, the November 2024 VA examiner also found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time.

Further, while the Veteran, as a layperson
he did not report any functional loss or functional impairment, including but not limited to after repeated use over time. Nonetheless, after reviewing the record, which was specifically documented by the November 2024 VA examiner, the November 2024 VA examiner found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups. Similarly, the November 2024 VA examiner also found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time.

Further, while the Veteran, as a layperson, is competent to report the symptoms he has while the Veteran, as a layperson, is competent to report the symptoms he has experienced, he has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability for his lower back condition according to the rating criteria. Jandreau, 492 F.3d at 1377. Such competent evidence concerning the nature and extent of the lower back condition has been provided by the above discussed evidence, including the November 2024 VA examiner's findings. Moreover, as discussed above, the Veteran has not asserted his lower back condition manifested with limitation of motion more nearly approximating forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

Thus, the most persuasive evidence of record, reflects the Veteran's lower back condition was manifested by pain and other symptoms productive of limitation of forward flexion of the thoracolumbar spine to 80 degrees, and combined range of motion of 180 degrees, based on the November 2024 VA examination report, but not forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

Also, during the November 2024 VA examination, the Veteran reported he used Tylenol. The use of medication is not explicitly considered in the rating criteria for Diagnostic Code 5237. Jones, 26 Vet. App. at 63. However, there is nothing in the record, to include the Veteran's own statements, to suggest that he would otherwise have the functional equivalent of thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, but for the use of Tylenol. Further, the record does not reflect the Veteran was examined after having taken Tylenol, or that this over the counter pain medication masked his thoracolumbar spine impairment during the November 2024 VA examination. Indeed, during the November 2024 VA examination, the Veteran reported pulling pain, and the November 2024 VA examination report itself documented the Veteran exhibited pain with forward flexion, extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation. Thus, when considering any possible ameliorative effects of over the counter Tylenol, the criteria for an initial rating higher than 10 percent have still not been met.

Consideration has also been given to assigning a higher rating under Diagnostic Code 5243, defined disc herniation with compression and/or irritation of the adjacent nerve root, under the formula for rating intervertebral disc syndrome (IVDS) based on incapacitating episodes. In this regard, the November 2024 VA examiner found the Veteran did have IVDS of the thoracolumbar spine. Moreover, the Veteran has not asserted he has IVDS of his thoracolumbar spine or that he was prescribed bed rest by a physician for his lumbosacral strain proximate to or during the appeal period at issue. Thus, the evidence of record is persuasively against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating proximate to or during the appeal period at issue as explicitly required by the rating criteria. See 38 C.F.R. § 4
(IVDS) based on incapacitating episodes. In this regard, the November 2024 VA examiner found the Veteran did have IVDS of the thoracolumbar spine. Moreover, the Veteran has not asserted he has IVDS of his thoracolumbar spine or that he was prescribed bed rest by a physician for his lumbosacral strain proximate to or during the appeal period at issue. Thus, the evidence of record is persuasively against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating proximate to or during the appeal period at issue as explicitly required by the rating criteria. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

Regarding neurological impairment, the lay and medical evidence of record is against a finding that the Veteran has any neurological abnormality associated with his spine disability. In this regard, the November 2024 VA examiner found the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy, nor has the Veteran asserted such. Also, the November 2024 VA examiner found the Veteran did not have any other neurologic abnormalities or findings related to a thoracolumbar spine condition (such as bowel or bladder problems/pathologic reflexes), nor has the Veteran asserted such.

Additionally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with respect to his lower back condition. See Doucette, 28 Vet. App. at 370.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an initial evaluation in excess of 10 percent for a lower back condition is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

6. Entitlement to an initial rating in excess of 10 percent for a right ankle strain

7. Entitlement to an initial rating in excess of 10 percent for a left ankle strain

The Veteran contends higher initial rating are warranted for his right ankle strain and left ankle strain. As discussed above, in his May 2025 VA Form 10182, the Veteran argued his "Right ankle strain - should be 20%", that his "Left ankle strain - should be 20%".

Here, the appeal period for consideration for each claim is from December 20, 2023, the date service connection was awarded, to April 2, 2025, the AOJ decision on appeal was issued.

Throughout the initial appeal period, the Veteran's right ankle strain and left ankle strain have each been rated under Diagnostic Code 5271, ankle, limited motion of. See 38 C.F.R. § 4.71a, Diagnostic Code 5271.

Under Diagnostic Code 5271, a 10 percent rating is warranted for moderate limited motion of the ankle (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion.) A 20 percent rating is warranted for marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion).

For the following reasons, the evidence is persuasively against an initial rating in excess of 10 percent for the Veteran's right ankle strain and an initial rating in excess of 10 percent for his left ankle strain. In this regard, a November 2024 VA examiner found the Veteran had, as to active and passive range of motion, as to his right ankle, plantar flexion to 35 degrees and dorsiflexion to 15 degrees, even with pain and repetitive testing. The November 2024 VA examiner found the Veteran had, as to active and passive range of motion, as to his left ankle, plantar flexion to 35 degrees and dorsiflexion to 15 degrees, even with pain and repetitive testing. The November 2024 VA examiner also found the Veteran had pain with weight-bearing as to each ankle. Also, during the November 2024 examination, the Veteran reported "TIGHTNESS AND SWELLING" but he did not report flare-ups
examiner found the Veteran had, as to active and passive range of motion, as to his right ankle, plantar flexion to 35 degrees and dorsiflexion to 15 degrees, even with pain and repetitive testing. The November 2024 VA examiner found the Veteran had, as to active and passive range of motion, as to his left ankle, plantar flexion to 35 degrees and dorsiflexion to 15 degrees, even with pain and repetitive testing. The November 2024 VA examiner also found the Veteran had pain with weight-bearing as to each ankle. Also, during the November 2024 examination, the Veteran reported "TIGHTNESS AND SWELLING" but he did not report flare-ups of either ankle, and he did not report any functional loss or functional impairment, including but not limited to after repeated use over time, of either ankle.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic, did not provide any numerical findings with respect to limitation of motion. The assessment noted the Veteran had "right ankle pain of varying degrees intensified by all weight bearing activities" that "[o]n examination dorsiflexion and plantarflexion are mildly decreased with pain" that "[i]nversion and eversion are severely decreased with pain" and "[j]oint grinding is noted on motion." The September 2024 private assessment provided identical findings as to the Veteran's left ankle, specifically, the Veteran had "left ankle pain of varying degrees intensified by all weight bearing activities" that "[o]n examination dorsiflexion and plantarflexion are mildly decreased with pain" that "[i]nversion and eversion are severely decreased with pain" and "[j]oint grinding is noted on motion." Absent any findings that address the criteria in the relevant diagnostic code, the Board is unable to reach findings of fact with respect to the private assessment from which legal conclusions about entitlement to benefits may be drawn. As a result, the private assessment has very limited probative value.

Thus, even considering the Veteran's lay reports of symptoms and noted functional loss, to include tightness, swelling, pain, and grinding, and resulting in limitation of motion, the degree of additional limitation reflected by his statements would not result in limitation of motion more nearly approximating marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). Specifically, as noted above, during the November 2024 VA examination, the Veteran did not report flare-ups of either ankle and he did not report any functional loss or functional impairment, including but not limited to after repeated use over time, of either ankle. Nonetheless, after review of the record, which was specifically documented by the November 2024 VA examiner, the November 2024 VA examiner found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups as to his right ankle or his left ankle. Similarly, the November 2024 VA examiner also found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time, as to his right ankle or his left ankle.

Further, while the Veteran, as a layperson, is competent to report the symptoms he has experienced, he has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability for his right ankle or his left ankle according to the rating criteria. Jandreau, 492 F.3d at 1377. Such competent evidence concerning the nature and extent of right ankle and his left ankle has been provided by the above discussed evidence, including the November 2024 VA examiner's findings. Moreover, as discussed above, the Veteran has not asserted his right ankle or his left ankle manifested with limitation of motion more nearly approximating marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion).

Thus, the most persuasive evidence of record, reflects the Veteran's right ankle strain and left ankle strain were manifested by pain and other symptoms productive of limitation of dorsiflexion to 35 degrees, bilaterally, and plantar flexion to 15 degrees, bilaterally, based on the November 2024 VA examination report, but not limitation of motion more nearly approximating marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). Accordingly, the Board finds that the evidence of record persuasively weighs against initial ratings in excess of 10 percent for each ankle.

Also, during the November
than 10 degrees plantar flexion).

Also, during the November 2024 VA examination, the Veteran reported he used Tylenol or Motrin. The use of medication is not explicitly considered in the rating criteria for Diagnostic Code 5271. Jones, 26 Vet. App. at 63. However, there is nothing in the record, to include the Veteran's own statements, to suggest that he would have the functional equivalent of marked limited motion of either ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion) if any improvement due to the use of Tylenol or Motrin was not considered. Further, the record does not reflect the Veteran was examined after having taken Tylenol or Motrin, or that this over the counter pain medication masked his impairment of either ankle during the November 2024 VA examination. Indeed, during the November 2024 VA examination, the Veteran reported tightness and swelling, and the November 2024 VA examination report itself documented the Veteran exhibited pain with plantar flexion and dorsiflexion, bilaterally. Thus, even without consideration of any possible ameliorative effects of over the counter Tylenol or Motrin, the criteria for an initial ratings higher than 10 percent have still not been met for either ankle.

The Board has considered whether any other Diagnostic Codes related to disabilities of the ankle would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. As there is no lay or medical evidence of ankylosis, the Board finds that Diagnostic Code 5270 does not apply, and thus, cannot provide for a higher rating for either ankle. Specifically, November VA examiner did not endorse a finding of ankylosis for either ankle, nor is ankylosis or its functional equivalent otherwise reflected in the other evidence of record. As there is no lay or medical evidence of subastragalar or tarsal joint, ankylosis of, the Board finds that Diagnostic Code 5272, does not apply, and thus, cannot provide for a higher rating for either ankle. Specifically, November 2024 VA examiner found Veteran did not have, as to either ankle, ankylosis of the subastragalar or tarsal joint, nor is such otherwise reflected in the other evidence of record. Additionally, as there is no lay or medical evidence of os calcis or astragalus, malunion of, or astragalectomy, the Board finds that Diagnostic Codes 5273 and 5274, do not apply, and thus, cannot provide for a higher rating for either ankle. Specifically, November 2024 VA examiner found Veteran did not now have or had not ever had had shin splints (medial tibial stress syndrome), stress fractures, Achilles tendonitis, Achilles tendon rupture, malunion of calcaneus (os calcis) or talus (astragalus), and he had not had a talectomy (astragalectomy).

Additionally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with respect to his bilateral ankle strains. See Doucette, 28 Vet. App. at 370.

Accordingly, the evidence is persuasively against the claims. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an initial evaluation in excess of 10 percent for a right ankle strain and an initial evaluation in excess of 10 percent for a left ankle strain are not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

8. Entitlement to an initial rating in excess of 10 percent for a right knee strain

9. Entitlement to an initial compensable rating for limitation of extension, right knee

10. Entitlement to an initial rating
asively against the claims. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an initial evaluation in excess of 10 percent for a right ankle strain and an initial evaluation in excess of 10 percent for a left ankle strain are not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

8. Entitlement to an initial rating in excess of 10 percent for a right knee strain

9. Entitlement to an initial compensable rating for limitation of extension, right knee

10. Entitlement to an initial rating in excess of 10 percent for a left knee strain

11. Entitlement to an initial compensable rating for limitation of extension, left knee

The Veteran contends higher initial ratings are warranted for his bilateral knee disabilities. As discussed above, in his May 2025 VA Form 10182, the Veteran argued his "Right knee strain - Should be 20%," that his "Limitation of extension, right knee - Should be 20%", that his "Left knee strain - Should be 20%" and that his "Limitation of extension, left knee - should be 20%".

Here, the appeal period for consideration for each claim from December 20, 2023, the date service connection was awarded, to April 2, 2025, the AOJ decision on appeal was issued.

Throughout the initial appeal period, the Veteran's right knee strain and left knee strain have each been rated under Diagnostic Code 5260, leg, limitation of flexion of. See 38 C.F.R. § 4.71a, Diagnostic Code 5260. Throughout the initial appeal period, the Veteran's limitation of extension, right knee, and limitation of extension, left knee, have each been rated under Diagnostic Code 5261,leg, limitation of extension of. See 38 C.F.R. § 4.71a, Diagnostic Code 5261.

Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

For the following reasons, for the Veteran's right knee and left knee disabilities, the evidence of record persuasively weighs against initial ratings in excess of 10 percent based on limitation of flexion under Diagnostic Code 5260 and initial compensable ratings based on limitation of extension under Diagnostic Code 5261. In this regard, a November 2024 VA examiner found the Veteran had, as to active and passive range of motion, as to his right knee, flexion to 110 degrees and extension to 5 degrees, even with pain and repetitive testing. The November 2024 VA examiner found the Veteran had, as to active and passive range of motion, as to his left knee, flexion to 110 degrees and extension to 5 degrees, even with pain and repetitive testing. The November 2024 VA examiner also found the Veteran had pain with weight-bearing as to each knee. Also, during the November 2024 examination, the Veteran reported "KNEE SWELLING AND PAIN" but he did not report flare-ups of either knee, and he did not report any functional loss or functional impairment, including but not limited to after repeated use over time, of either knee.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic,
2024 VA examiner found the Veteran had, as to active and passive range of motion, as to his left knee, flexion to 110 degrees and extension to 5 degrees, even with pain and repetitive testing. The November 2024 VA examiner also found the Veteran had pain with weight-bearing as to each knee. Also, during the November 2024 examination, the Veteran reported "KNEE SWELLING AND PAIN" but he did not report flare-ups of either knee, and he did not report any functional loss or functional impairment, including but not limited to after repeated use over time, of either knee.

Also, a September 2024 private assessment from Alison Nida, a doctor of chiropractic, did not provide any findings as to the actual rating criteria for Diagnostic Codes 5260 or 5261 but noted the Veteran had as to each knee "flexion is performed with pain to 40 degrees" and "[e]xtension is adequate."

Thus, even considering the Veteran's lay reports of symptoms and noted functional loss, to include popping, clicking, swelling, crepitus, pain, including pain varying degrees and intensified with sitting, walking, standing, stairs, transition to other positions, and arising from a seated position, the degree of additional limitation reflected by his statements would not result in limitation of motion more nearly approximating flexion limited to 30 degrees and extension limited to 10 degrees as to either knee. Specifically, as noted above, during the November 2024 VA examination, the Veteran did not report flare-ups of either knee and he did not report any functional loss or functional impairment, including but not limited to after repeated use over time, of either knee. Nonetheless, after review of the record, which was specifically documented by the November 2024 VA examiner, the November 2024 VA examiner found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups as to his right knee or his left knee. Similarly, the November 2024 VA examiner also found the procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time, as to his right knee or his left knee.

Further, while the Veteran, as a layperson, is competent to report the symptoms he has experienced, he has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability for his right knee or his left knee disabilities according to the rating criteria. Jandreau, 492 F.3d at 1377. Such competent evidence concerning the nature and extent of his right knee and his left knee disabilities has been provided by the above discussed evidence, including the November 2024 VA examiner's findings. Moreover, as discussed above, the Veteran has not asserted his right knee or his left knee disabilities manifested with limitation of motion more nearly approximating flexion limited to 30 degrees and extension limited to 10 degrees.

Thus, the most persuasive evidence of record, reflects the Veteran's right and left knee disabilities were manifested by pain and other symptoms productive of limitation of flexion to 40 degrees, bilaterally, and extension to 5 degrees, bilaterally, based above discussed evidence, but not limitation of motion more nearly approximating flexion limited to 30 degrees and extension limited to 10 degrees as to either knee.

Also, during the November 2024 VA examination, the Veteran reported he used Ibuprofen as need. The use of medication is not explicitly considered in the rating criteria for Diagnostic Codes 5260 or 5261. Jones, 26 Vet. App. at 63. However, there is nothing in the record, to include the Veteran's own statements, to suggest that he would otherwise have the functional equivalent of flexion limited to 30 degrees, and extension limited to 10 degrees, as to either knee, but for the use of Ibuprofen. Further, the record does not reflect the Veteran was examined after having taken Ibuprofen, or that this over the counter pain medication masked his impairment of either knee during the November 2024 VA examination. Indeed, during the November 2024 VA examination, the Veteran reported knee pain and swelling, and the November 2024 VA examination report itself documented the Veteran exhibited pain with flexion and extension, bilaterally. Thus, without considering any possible ameliorative effects of over the counter Ibuprofen, the criteria for higher initial ratings have not been met for either knee.

The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a
Further, the record does not reflect the Veteran was examined after having taken Ibuprofen, or that this over the counter pain medication masked his impairment of either knee during the November 2024 VA examination. Indeed, during the November 2024 VA examination, the Veteran reported knee pain and swelling, and the November 2024 VA examination report itself documented the Veteran exhibited pain with flexion and extension, bilaterally. Thus, without considering any possible ameliorative effects of over the counter Ibuprofen, the criteria for higher initial ratings have not been met for either knee.

The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment).

As there is no lay or medical evidence of ankylosis, the Board finds that Diagnostic Code 5256 does not apply, and thus, cannot provide for a higher rating for either knee. Specifically, the November 2024 VA examiner did not endorse a finding of ankylosis for either knee, nor is ankylosis or its functional equivalent otherwise reflected in the other evidence of record.

As there is no lay or medical evidence of dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint, or removal of symptomatic semilunar cartilage, the Board finds that Diagnostic Codes 5258 and 5259, respectively, do not apply, and thus, cannot provide for a higher rating for either knee. Specifically, the November 2024 VA examiner found Veteran did not now have or had not ever had a meniscus (semilunar cartilage) condition of either knee, nor is such otherwise reflected in the other evidence of record.

As there is no lay or medical evidence of impairment of the tibia and fibula, the Board finds that Diagnostic Code 5262 does not apply, and thus, cannot provide for a higher rating for either knee. Specifically, the November 2024 VA examiner found Veteran did not now have or had not ever had been diagnosed with a recurrent patellar dislocation, shin splints (medial tibial stress syndrome), stress fractures, or any other tibial or fibular impairment.

As there is no lay or medical evidence of impairment of the genu recurvatum, the Board finds that Diagnostic Code 5263 does not apply, and thus, cannot provide for a higher rating for the right knee. Specifically, the November 2024 VA examiner did not endorse a finding of acquired and/or traumatic genu recurvatum with objective demonstrated weakness and insecurity in weight-bearing of either knee, nor is such otherwise reflected in the other evidence of record.

Diagnostic Code 5257 provides ratings for other impairment of the knee based recurrent subluxation or instability. Under Diagnostic Code 5257, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription from a medical provider for one
for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription from a medical provider for one of the following: a brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription from a medical provider for a brace and either a cane or a walker. The patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). 38 C.F.R. § 4.71a, Diagnostic Code 5257.

Under the version of Diagnostic Code 5257 in effect prior to the current appeal period, and thus, not for application here, objective medical evidence was not required to establish lateral knee instability, so objective medical evidence could not be categorically found more probative than lay evidence. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). However, since English was decided, the amended regulations have further refined the requirements for a compensable rating for instability, including more clearly defining instability for VA compensation purposes.

Because the appeal period for these claims is after February 7, 2021, a compensable rating under Diagnostic Code 5257 requires either a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability or a diagnosed condition involving the patellofemoral complex (consisting of the quadriceps tendon, the patella, and the patellar tendon) with recurrent instability. Here, as to the Veteran's right knee, the September 2024 private assessment stated the "[o]rthopedic examination reveals lateral instability" provided a diagnosis of"[r]ight knee pain with instability" and also stated that "[d]ue to the instability...[the Veteran] would benefit from further evaluation by an Orthopedist to include imaging to further diagnose the knee condition and discuss treatment options including surgical intervention." However, no further private evaluation as to right knee instability was documented.

Rather, a few months later, in November 2024, the November 2024 VA examiner found the Veteran did not report or have a history of instability or recurrent subluxation of the knee. The November 2024 VA examiner also found, as to each knee, the Veteran did not have recurrent subluxation or persistent instability. Also, as to each knee, the November 2024 VA examiner did not endorse a symptom of instability of station. The November 2024 VA examiner also found as to each knee, the Veteran did not have or had not had a ligament tear or knee sprain and did not have recurrent patellar instability. Further, no condition involving the patellofemoral complex was diagnosed. The November 2024 VA examiner did not endorse a diagnosis of knee instability or patellar instability as to either knee.

Greater weight may be placed on one medical provider's opinion over another's depending on factors such as reasoning employed by the provider, and whether or not, and to what extent, they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994). Here, in weighing the respective medical assessments and opinions, the November 2024 VA clinician's examination reflects a full review of all medical evidence of record, including the clinical records. In contrast, chiropractor Nida did not indicate any medical records had been reviewed and only relayed statements provided by the Veteran. The VA examiner's clinical assessment was detailed in a 19-page examination report. Chiropractor Nida's assessment of each knee consisted of one paragraph. Further, the instability findings provided by chiropractor Nida were markedly inconsistent with the findings noted in the VA examination report less than two months later. In contrast to the statement proffered by Dr. Nida, the VA clinician's assessment was more thorough
(1994). Here, in weighing the respective medical assessments and opinions, the November 2024 VA clinician's examination reflects a full review of all medical evidence of record, including the clinical records. In contrast, chiropractor Nida did not indicate any medical records had been reviewed and only relayed statements provided by the Veteran. The VA examiner's clinical assessment was detailed in a 19-page examination report. Chiropractor Nida's assessment of each knee consisted of one paragraph. Further, the instability findings provided by chiropractor Nida were markedly inconsistent with the findings noted in the VA examination report less than two months later. In contrast to the statement proffered by Dr. Nida, the VA clinician's assessment was more thorough, reporting the Veteran's statements as well as making a more detailed assessment of the Veteran's knee disability. Accordingly, the Board finds that the statement of chiropractor Nida is of less probative value than the opinion by the VA clinician.

Thus, the evidence of record is persuasively against finding that a separate rating for right knee instability is warranted. The evidence of record is also persuasively against the Veteran's left knee strain caused persistent instability as there is no medical or lay evidence of left knee instability.

Accordingly, the evidence is persuasively against the claims. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an initial rating in excess of 10 percent for a right knee strain, an initial compensable rating for limitation of extension, right knee, an initial rating in excess of 10 percent for a left knee strain, and an initial compensable rating for limitation of extension, left knee, are not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch, 21 F.4th at 781-82.

REASONS FOR REMAND

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

Here, the appeal period for consideration is from December 30, 2023, the date VA received an intent to file claim, with application for benefits with a claim for right shoulder pain received thereafter in October 2024.

Under the AMA, the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104. The March 2025 AOJ decision on appeal, issued on March 7, 2025, provided a favorable finding as to this claim. Specifically, a November 2024 examination report confirmed a diagnosis of a right shoulder strain.

This claim is remanded to correct the following two pre-decisional duty to assist errors.

First, the record reflects the existence of relevant outstanding private medical records prior to the March 2025 AOJ decision on appeal. Specifically, during the November 2024 VA examination, the Veteran reported he had surgery to his right shoulder in 2014. Also, a September 2024 private opinion documented the Veteran underwent surgical intervention in 2014 to repair the shoulder. However, no private treatment records from right shoulder surgery dated in 2014 are of record. Thus, failure of the AOJ to request these identified private treatment records is a pre-decisional duty to assist error and a remand is required to allow VA to obtain authorization and request these records. The Veteran is also advised he may add these records to his VA benefits file himself.

Second, as discussed above, a November 2024 examination report endorsed current a diagnosis of a right shoulder strain. Also, during the November 2024 VA examination, the Veteran reported his right shoulder disability started with pain due to injury of his right shoulder while he was in the military, specifically when stationed in New Mexico. However, the November 2024 VA examiner did not provide a medical opinion addressing the claim on a direct incurrence basis. Thus, the AOJ's failure to obtain an opinion addressing the claim on a direct incurrence basis is a pre-decisional error and remand is warranted. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 C.F.R. § 3.159(c)(4).

Also, in a September 2024 private opinion, Alison Nida, a doctor of chiropractic, found the onset of the Veteran's right shoulder pain, which persisted to the present, was during active duty military service, which should qualify said condition for service connection, and it was as likely as not that the condition was directly and causally related to the Veteran's military service. However, the Board does not find that chiropractor Nida's opinion is adequate to support a grant of benefits at this time because there was little to no rationale provided for the opinion. Further, the September 2024 private opinion did not address relevant evidence that conflicted with the proffered opinion, including the Veteran's service treatment records which did not document any chronic right shoulder complaints. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993).

The Board also advises that, at this time, it intimates no opinion as to the credibility or probative value of any lay statements in relation to the Veteran's claim for service connection for a right shoulder disability and defers any credibility determinations until final adjudication of the claim.

2. Entitlement to service connection for vertigo is remanded.

Here, the appeal period for consideration is from December 30, 2023, the date VA received an intent to file claim, with application for benefits with a claim for vertigo received thereafter in October 2024.

This claim is remanded to correct the following two pre-decisional duty to assist errors.

First, the record reflects the existence of relevant outstanding private medical records prior to the March 2025 AOJ decision on appeal. Specifically, during the November 2024 VA examination, the Veteran reported he had treatment with Zofran and Meclizine. Also, a September 2024 private opinion documented the Veteran "has been assessed for this condition with both an ENT and Neurologist" and that he "has also been seen several times at his local ER due to the condition." However, no private treatment records documenting vertigo related treatment with Zofran and Meclizine, treatment from an ear nose and throat specialist, treatment from a neurologist, and treatment emergency room are of record. Thus, failure of the AOJ to request these identified private treatment records is a pre-decisional duty to assist error and a remand is required to allow VA to obtain authorization and request these records. The Veteran is also advised he may add these records to his VA benefits file himself.

Second, remand is warranted to obtain a VA medical opinion addressing the claim on the basis of the Veteran's TERAs. In this regard, discussed above, prior to the March 2025 AOJ decision on appeal, a November 2024 examination report endorsed current a diagnosis of a vertigo. Also, prior to the March 2025 AOJ decision on appeal, while in March 2025 VA issued memorandum, which found the Veteran did not have participation in a TERA, in November 2024, VA issued memorandum, which found the Veteran did have participation in a TERA, as due to his military occupational specialty as an avionic systems craftsman, he had exposure to jet engine exhaust, hazardous chemicals (JP-8, toluene, phenol, lead, formaldehyde, asbestos, methanol), and radio frequency radiation. However, no VA medical opinion addressing the claim on the basis of the Veteran's TERAs has been obtained. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, 20 Vet. App. at 81-82. Thus, failure of the AOJ to obtain a VA medical opinion addressing the claim on the basis of the Veteran
participation in a TERA, as due to his military occupational specialty as an avionic systems craftsman, he had exposure to jet engine exhaust, hazardous chemicals (JP-8, toluene, phenol, lead, formaldehyde, asbestos, methanol), and radio frequency radiation. However, no VA medical opinion addressing the claim on the basis of the Veteran's TERAs has been obtained. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, 20 Vet. App. at 81-82. Thus, failure of the AOJ to obtain a VA medical opinion addressing the claim on the basis of the Veteran's TERAs is a pre-decisional duty to assist error and a remand is required.

Also, in a September 2024 private opinion, Alison Nida, a doctor of chiropractic, documented the Veteran reported his vertigo began shortly after exiting the military and "[i]t is as likely as not that same is directly and causally related to his military service." However, September 2024 private opinion did provide any rationale. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Thus, the Board finds the September 2024 private opinion lacks probative value and is not sufficient to grant the claim at this time.

The Board also recognizes during the November 2024 VA examination, the Veteran reported his vertigo began progressively due to tinnitus. However, because at this juncture, there is no competent and credible evidence which reflects his vertigo may be secondary to service-connected tinnitus, remand for VA opinions addressing the claim on a secondary basis is not warranted. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, 20 Vet. App. at 81-82

The Board also advises that, at this time, it intimates no opinion as to the credibility or probative value of any lay statements in relation to the Veteran's claim for service connection for vertigo and defers any credibility determinations until final adjudication of the claim.

3. Entitlement to service connection for chronic headaches is remanded.

Here, the appeal period for consideration is from December 30, 2023, the date VA received an intent to file claim, with application for benefits with a claim for chronic headaches received thereafter in October 2024.

This claim is remanded to correct the following two pre-decisional duty to assist errors.

First, remand is warranted to obtain a VA medical opinion addressing the claim on the basis of the Veteran's TERAs. In this regard, as discussed above, prior to the March 2025 AOJ decision on appeal, a November 2024 examination report endorsed current a diagnosis of migraines. Also, prior to the March 2025 AOJ decision on appeal, in November 2024 VA issued memorandum, which found the Veteran did have participation in a TERA, as due to his military occupational specialty as an avionic systems craftsman, he had exposure to jet engine exhaust, hazardous chemicals (JP-8, toluene, phenol, lead, formaldehyde, asbestos, methanol), and radio frequency radiation. However, no VA medical opinion addressing the claim on the basis of the Veteran's TERAs has been obtained. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, 20 Vet. App. at 81-82. Thus, failure of the AOJ to obtain a VA medical opinion addressing the claim on the basis of the Veteran's TERAs is a pre-decisional duty to assist error and a remand is required.

Second, remand is warranted for opinions addressing the claim on a secondary basis. In this regard, as discussed above, as a November 2024 VA examiner endorsed a symptom of headaches as related to the Veteran's service-connected sinusitis, secondary opinions on this basis are warranted. 38 C.F.R. § 3.310. The AOJ's failure to obtain VA opinions addressing the claim as secondary to service-connected sinusitis is a pre-decisional error, and remand is warranted for supplemental
82. Thus, failure of the AOJ to obtain a VA medical opinion addressing the claim on the basis of the Veteran's TERAs is a pre-decisional duty to assist error and a remand is required.

Second, remand is warranted for opinions addressing the claim on a secondary basis. In this regard, as discussed above, as a November 2024 VA examiner endorsed a symptom of headaches as related to the Veteran's service-connected sinusitis, secondary opinions on this basis are warranted. 38 C.F.R. § 3.310. The AOJ's failure to obtain VA opinions addressing the claim as secondary to service-connected sinusitis is a pre-decisional error, and remand is warranted for supplemental opinions on this basis. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, 20 Vet. App. at 81-82.

Also, in a September 2024 private opinion, Alison Nida, a doctor of chiropractic, endorsed a diagnosis of chronic headaches and found it was as "likely as not that the aforementioned is directly and causally related to Gulf War Syndrome (undiagnosed illness) per the presumptions published in Gulf War." However, the record does not refect, nor does the Veteran assert, he is a Persian Gulf veteran. Nieves-Rodriguez, 22 Vet. App. at 304. The term "Persian Gulf veteran" means a veteran who served on active duty in the Armed Forces in the Southwest Asia theater of operations, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, during the Persian Gulf War. 38 U.S.C. § 1117(f). The "Southwest Asia theater of operations" refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(2). The Persian Gulf War means the period beginning on August 2, 1990, through the present. 38 U.S.C. § 101(33); 38 C.F.R. § 3.317(a)(i). Thus, the Board finds the September 2024 private opinion lacks probative value as it is based on an inaccurate factual premise and is not sufficient to grant the claim.

The Board also advises that, at this time, it intimates no opinion as to the credibility or probative value of any lay statements in relation to the Veteran's claim for service connection for chronic headaches and defers any credibility determinations until final adjudication of the claim.

4. Entitlement to service connection for an acquired psychiatric disorder is remanded.

Here, the appeal period for consideration is from December 30, 2023, the date VA received an intent to file claim, with application for benefits with claims for generalized anxiety disorder and depressive disorder received thereafter in October 2024.

This claim is remanded to correct the following pre-decisional duty to assist error.

Specifically, remand is warranted to obtain a VA medical opinion addressing the claim on a direct incurrence basis. In this regard, as discussed above, prior to the March 2025 AOJ decision on appeal, a November 2024 examination report endorsed current a diagnosis of major depressive disorder, recurrent, moderate with anxious distress. Also, in September 2024 private assessment, Martha Phelps, a Licensed Clinical Social Worker (LCSW), found the Veteran's "faced a life -threatening situation when he was injured and trapped inside an aircraft while working on a brake switch" and his "injury contributed to depressive feelings related to physical limitations." In this regard, a March 1980 service treatment record documented the Veteran was working on an air brake on an F4 with his arm extended fully into the air brake, had the door close on both upper extremities, that there was a small 1 cm wound over the right medial distal epicondyle, that he was prepared for surgery for de
disorder, recurrent, moderate with anxious distress. Also, in September 2024 private assessment, Martha Phelps, a Licensed Clinical Social Worker (LCSW), found the Veteran's "faced a life -threatening situation when he was injured and trapped inside an aircraft while working on a brake switch" and his "injury contributed to depressive feelings related to physical limitations." In this regard, a March 1980 service treatment record documented the Veteran was working on an air brake on an F4 with his arm extended fully into the air brake, had the door close on both upper extremities, that there was a small 1 cm wound over the right medial distal epicondyle, that he was prepared for surgery for debridement of an open fracture of the right distal humerus, and provided final diagnoses of open fracture, right distal lateral humerus, and soft tissue wound, right distal medial humerus. However, no VA medical opinion addressing the claim on a direct incurrence basis has been obtained. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, 20 Vet. App. at 81-82. Thus, failure of the AOJ to obtain a VA medical opinion addressing the claim on a direct incurrence basis, with consideration of the March 1980 service treatment record, is pre-decisional duty to assist error and a remand is required.

In a September 2024 private assessment, Martha Phelps, a LCSW, endorsed diagnoses generalized anxiety disorder and depressive disorder due to another medical condition with depressive features. However, the September 2024 private assessment also found the Veteran's "anxiety began while he was engaged in avionics maintenance", that "since leaving the military ...[he] has continued to experience anxiety" and that he "also faced a life -threatening situation when he was injured and trapped inside an aircraft while working on a brake switch" and his "injury contributed to depressive feelings related to physical limitations." The September 2024 private assessment found it was "as likely as not that he has developed anxiety and depressive symptoms related to his service-connected experiences which resulted in limitations on his functioning." However, the September 2024 private assessment did not address relevant evidence that conflicted with the proffered opinion, including the Veteran's service treatment records, which did not demonstrate chronic psychiatric symptomology. Thus, the Board finds the September 2024 private assessment lacks probative value and is not sufficient to grant the claim. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993).

The Board also advises that, at this time, it intimates no opinion as to the credibility or probative value of any lay statements in relation to the Veteran's claim for service connection for an acquired psychiatric disorder and defers any credibility determinations until final adjudication of the claim.

The matters are REMANDED for the following actions:

1. After obtaining any necessary authorization from the Veteran and advising him that he may alternatively add the records to his VA benefits file himself, please make necessary efforts to obtain the following outstanding non-VA records:

(a.) records pertaining to right shoulder surgery in 2014,

(b.) records pertaining to vertigo treatment with Zofran and Meclizine,

(c.) records pertaining to vertigo treatment by an ear nose and throat specialist,

(d.) records pertaining to vertigo treatment by a neurologist,

(e.) records pertaining to vertigo treatment at emergency room(s).

2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for a right shoulder disability. The clinician is asked to provide a response, with a rationale, to the following:

Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher), the Veteran's right shoulder strain, as diagnosed by the November 2024 VA examiner, is related to service, including with consideration of the Veteran's contention, during the November 2024 VA examination, that his right shoulder disability started with pain due to injury in right shoulder while he was in the military, specifically when stationed in New Mexico? Please explain why or why not.

3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for vertigo. The clinician is asked to provide a response, with a rationale, to the following:

Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher), the Veteran's vertigo, as diagnosed by a November 2024 VA examiner, is related to his TERAs during his active service, specifically exposure to jet engine exhaust, hazardous chemicals (JP-8, toluene, phenol, lead
that his right shoulder disability started with pain due to injury in right shoulder while he was in the military, specifically when stationed in New Mexico? Please explain why or why not.

3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for vertigo. The clinician is asked to provide a response, with a rationale, to the following:

Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher), the Veteran's vertigo, as diagnosed by a November 2024 VA examiner, is related to his TERAs during his active service, specifically exposure to jet engine exhaust, hazardous chemicals (JP-8, toluene, phenol, lead, formaldehyde, asbestos, methanol), and radio frequency radiation, as documented in November 2024 VA memorandum? In rendering this opinion, the clinician is asked to consider and discuss the Veteran's total potential exposure through all applicable military deployments and the synergistic, combined effect of all TERAs. Please explain why or why not.

4. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for chronic headaches. The clinician is asked to provide a response, with a rationale, to the following:

(a.) Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher), the Veteran's migraines, as diagnosed by a November 2024 VA examiner, are related to his TERAs during his active service, specifically exposure to jet engine exhaust, hazardous chemicals (JP-8, toluene, phenol, lead, formaldehyde, asbestos, methanol), and radio frequency radiation, as documented in November 2024 VA memorandum? In rendering this opinion, the clinician is asked to consider and discuss the Veteran's total potential exposure through all applicable military deployments and the synergistic, combined effect of all TERAs. Please explain why or why not.

(b.) Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher), the Veteran's migraines, as diagnosed by a November 2024 VA examiner, are proximately due to his service-connected sinusitis? Please explain why or why not.

(c.) Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher), the Veteran's migraines, as diagnosed by a November 2024 VA examiner, are aggravated (any increase in disability without consideration of what might be the natural progress of the disease) by his service-connected sinusitis? Please note permanent increase is not required. Please explain why or why not.

5. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for an acquired psychiatric disorder. The clinician is asked to provide a response, with a rationale, to the following:

Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher), the Veteran's major depressive disorder, recurrent, moderate with anxious distress, as diagnosed by a November 2024 VA examiner, is related to his active service, to include with consideration of a March 1980 service treatment record, which documented the Veteran was working on an air brake on an F4 with his arm extended fully into the air brake, had the door close on both upper extremities, that there was a small 1 cm wound over the right medial distal epicondyle, that he was prepared for surgery for debridement of an open fracture of the right distal humerus, and provided final diagnoses of open fracture, right distal lateral humerus, and soft tissue wound, right distal medial humerus? Please explain why or why not.

M. C. GRAHAM

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Espinoza, Counsel

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

.F.R. § 20.1303.

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