KNEE IMPAIRMENT OF

Summary

The Veteran served from February 2007 to February 2012. This case comes before the Board of Veterans' Appeals (Board) following a May 2021 supplemental claim rating decision that denied service connection for a left knee disability, hypertension, and otitis externa, finding no new and relevant evidence. The Veteran appealed, electing a Board hearing. The Board reviewed evidence submitted up to the hearing and within 90 days following it. The Veteran sought readjudication of service connection for a left knee disability, hypertension, and otitis externa. For the left knee, service treatment records were negative, but a May 2021 VA exam diagnosed degenerative arthritis, with the examiner initially opining a positive nexus, later retracting it in an addendum. A July 2025 private opinion from Dr. A. K. found the left knee disability more likely than not due to service, citing overuse injuries from service and disagreeing with the VA's negative addendum. The Board found the evidence nearly balanced and applied the benefit of the doubt, granting service connection for the left knee disability. For hypertension, service treatment records showed elevated blood pressure at entry, with a waiver granted. A May 2008 diagnosis and prescription of medication occurred during service. A September 2020 VA exam opined a positive nexus, but a November 2020 addendum found hypertension clearly pre-existing and not aggravated by service. Dr. K.'s July 2025 private opinion agreed with the positive VA opinion and disagreed with the negative addendum, finding hypertension more likely than not due to service. The Board again applied the benefit of the doubt, granting service connection for hypertension. For otitis externa, service treatment records noted scarred tympanic membranes (TMAS) at entry, and a later October 2009 visit noted infective otitis externa. A January 2021 VA exam diagnosed chronic otitis externa, with the examiner initially finding no nexus due to lack of in-service records, but later concluding it was less likely than not related to service due to lack of records. Dr. K.'s July 2025 private opinion found chronic otitis externa more likely than not due to service, citing the Veteran's use of earpieces and disagreeing with the VA's assessment of no in-service evidence. The Board found the evidence nearly balanced and applied the benefit of the doubt, granting service connection for otitis externa. The Board declined to consider claims for hearing loss, tinnitus, headaches, and right knee disability as they were not part of the issues on appeal.

Rationale

New and relevant evidence received after prior denial.; Positive opinions from VA examiner (initial) and private physician.; Nearly balanced evidence, benefit of doubt applied.

Full Decision Text

Citation Nr: A26035351
Decision Date: 04/15/26	Archive Date: 04/15/26

DOCKET NO. 210726-174338
DATE: April 15, 2026

ORDER

Readjudication of the claim for entitlement to service connection for a left knee disability is granted. 

Readjudication of the claim for entitlement to service connection for otitis externa (claimed as ear infection) is granted.

Readjudication of the claim for entitlement to service connection for hypertension is granted.

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

Entitlement to service connection for otitis externa is granted. 

Entitlement to service connection for hypertension.

FINDINGS OF FACT

1. New and relevant evidence was received following the most recent prior denial of the claim for a left knee disability.

2.  New and relevant evidence was received following the most recent prior denial of the claim for service connection for hypertension.

3.  New and relevant evidence was received following the most recent prior denial of the claim for service connection for otitis externa.

4. Resolving reasonable doubt in favor of the Veteran, his left knee disability is etiologically related to service.

5. Resolving reasonable doubt in favor of the Veteran, his otitis externa is etiologically related to service.

6. Resolving reasonable doubt in favor of the Veteran, his hypertension is etiologically related to service.

CONCLUSIONS OF LAW

1. The criteria for readjudicating the claim for service connection for a left knee disability have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156 (d), 3.2501(a)(1).

2. The criteria for readjudicating the claim for service connection for otitis externa have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156 (d), 3.2501(a)(1).

3. The criteria for readjudicating the claim for service connection for hypertension have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156 (d), 3.2501(a)(1).

4. The criteria for entitlement to service connection for a left knee disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 

5. The criteria for entitlement to service connection for otitis externa have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served from February 2007 to February 2012.  This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2021 supplemental claim rating decision by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).   The AOJ found that the Veteran did not submit new and relevant evidence. 

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 21, 2025.

Therefore, the Board may only consider the evidence of record at the time of the May 2021 agency of original jurisdiction (AOJ) supplemental claim decision on appeal, as well as any evidence submitted by the Veteran, or representative, at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302.  If evidence was submitted either (1) during the period after the AOJ issued the supplemental claim decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

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 claim, considering the new evidence in addition to the evidence previously considered. Id.  Specific instructions for filing a Supplemental
 and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

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 claim, considering the new evidence in addition to the evidence previously considered. Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

1. Readjudication of entitlement to service connection for a left knee disability. 

2. Readjudication of entitlement to service connection for otitis externa. 

3. Readjudication of entitlement to service connection for hypertension. 

38 U.S.C. § 5108(a) provides: "If new and relevant evidence is presented or secured with respect to a supplemental claim, the Secretary shall readjudicate the claim taking into consideration all of the evidence of record."  The implementing regulation clarifies that "a claimant may file a supplemental claim and... [i]f new and relevant evidence... is presented or secured with respect to the supplemental claim, the agency of original jurisdiction will readjudicate the claim taking into consideration all of the evidence of record." 38 C.F.R. § 3.156(d).

VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156 (d)). "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501 (a)(1).

In a February 2021 decision, the AOJ denied service connection for a left knee disability, and in a March 2021 decision the AOJ denied service connection for hypertension and otitis externa.  The Veteran submitted a supplemental claim, and in a July 2021 decision, the AOJ determined new and relevant evidence had not been received. 

The questions with regard to these matters are whether there is new evidence after the most recent denial of the Veteran's claims of service connection for left knee disability (February 2021), hypertension (March 2021), and chronic otitis externa (March 2021), and if so, whether that new evidence is relevant to his claims (tends to prove or disprove a matter at issue).  In this case, the AOJ denied service connection for left knee disability, hypertension, and chronic otitis externa in the February 2021 and March 2021 rating decisions on the basis that service treatment records (STRs) do not contain complaints, treatment, or diagnoses for these conditions.

The evidence received between the February and March 2021 decisions, and the May 2021 rating decision on appeal tends to prove an element of these claims.  Specifically, VA and private examinations contain diagnoses of and discussion of the Veteran's conditions.  In this regard, "[n]ew evidence that affirms findings previously deemed favorable to the claimant is still relevant.  There is no requirement that relevant evidence prove a previously unsubstantiated matter."  

As new and relevant evidence has been received, readjudication of the claims for service connection for a left knee disability, hypertension, and otitis externa, is warranted.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a).  To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.  See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).  Service connection may be granted for any disease initially diagnosed after discharge when the evidence, including that pertinent to service, establishes the disease was incurred in service.  38 C.F.R. § 3.303 (d).

The Board must fully consider the lay evidence of record.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir.
 injury incurred or aggravated during service.  See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).  Service connection may be granted for any disease initially diagnosed after discharge when the evidence, including that pertinent to service, establishes the disease was incurred in service.  38 C.F.R. § 3.303 (d).

The Board must fully consider the lay evidence of record.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).  A layperson is competent to report on the onset of disability and, when applicable, continuity of his or her current symptomatology.  See Layno v. Brown, 6 Vet. App. 465, 470 (1994).  Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007).  When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, supra.

4. Entitlement to service connection for a left knee disability. 

Service treatment records (STRs) do not contain reports of left knee pain or disability.  

Private treatment records from Performance Rehabilitation in May 2018, note treatment for left knee pain, and patellofemoral disorders.  

The Veteran underwent a VA examination in May 2021.  He reported left knee pain and swelling.  The examiner diagnosed him with left knee degenerative arthritis.  He had limited, and painful motion.  In May 2021 radiology reports, the findings were normal.  The examiner opined that the claimed condition was at least as likely as not incurred in or caused by the claimed in service injury, event, or illness.  The Veteran had no issues related to the left knee prior to service.  During service the Veteran was required to run and perform calisthenics several days a week, to include rucking.  He began to experience left knee pain towards the end of 2017, which gradually worsened affecting his normal daily functions.  In May 2018 an x-ray revealed mild patellofemoral degenerative changes.  He received physical therapy, however his pain persisted.  Though the May 2021 x-ray was negative for arthritis the May 2018 x-ray results documented arthritis.  Aging, joint injury and obesity are risk factors for the development of arthritis.  The examiner explained that the only identifiable risk factor for the Veteran is a joint injury.  The constant running, rucking and physical activities during service has directly impacted his left knee resulting in arthritis.  

In a May 2021 addendum opinion, the examining provider indicated the positive nexus opinion issued in May 2021, was erroneous, as there is no nexus.  In support of the rationale, the examiner explained STRs do not identify a nexus.  

At the April 2025 Board hearing, the Veteran reported due to the circumstances of his service, his left knee developed degenerative arthritis.  

In an April 2025 statement the Veteran reiterated that during service he engaged in repeated bending, lifting, climbing, walking, and running.  He reported working long days, and wearing heavy gear, all of which took a heavy toll on his joints.  

In July 2025, Dr. A. K., provided a private medical opinion.  Dr. K. concluded that a left knee disability is more likely than not due to service.  Dr. K. explained osteoarthritis in the knee arises primarily from the failure of normal transmission of forces across the knee.  The musculoskeletal system if subjected to excess stress can suffer from overuse injuries which may affect the bone, muscle, tendons, and ligaments.  Training and general activities are known to increase the risk of knee overuse injuries.  Dr. K. cited agreement with the VA examiner who found the circumstances of the Veteran's service to have contributed to the arthritic degenerative of his knees.  In contrast, Dr. K. cited disagreement with the addendum opinion findings, noting the provider relied solely on
 K. concluded that a left knee disability is more likely than not due to service.  Dr. K. explained osteoarthritis in the knee arises primarily from the failure of normal transmission of forces across the knee.  The musculoskeletal system if subjected to excess stress can suffer from overuse injuries which may affect the bone, muscle, tendons, and ligaments.  Training and general activities are known to increase the risk of knee overuse injuries.  Dr. K. cited agreement with the VA examiner who found the circumstances of the Veteran's service to have contributed to the arthritic degenerative of his knees.  In contrast, Dr. K. cited disagreement with the addendum opinion findings, noting the provider relied solely on a lack of treatment during service to find a negative nexus.  Dr. K. noted the Veteran suffered from overuse and trauma to the knee related to his normal job duties.  

The Veteran reported experiencing knee pain during service that has continued to present.  The Veteran is also competent to testify regarding facts or circumstances that can be observed and described by a layperson.

There are positive and negative opinions of record.  A VA examiner provided a positive medical opinion, explaining the sole indicator of the knee pain and disability was joint impairment during service.  Though a later opinion determined a negative nexus, the sole rationale being a lack of evidence during service of an injury.  Further, there is an additional positive opinion from July 2025, linking his left knee disability to the circumstances of service. 

Thus, the Board will resolve reasonable doubt in the Veteran's favor, and conclude the evidence is nearly balanced as to whether his left knee disability is attributable to active service.

In light of the foregoing, the Board finds that service connection for a left knee  disability is warranted.  See 38 C.F.R. § 3.310 (a).  The benefit of the doubt doctrine applies. 38 U.S.C. §5107 (b), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

5. Entitlement to service connection for hypertension. 

STRs reveal upon entrance examination in August 2006, the Veteran had 3 elevated blood pressure readings.  A waiver of physical standards was recommended and approved in August 2006.  In support of the request for a waiver 3 separate blood pressure readings were obtained, all of which were within normal limits.  The Veteran provided a statement explaining his physical aptitude noting he plays recreational basketball, football, runs, and does weight training on a regular basis.  At an August 2007 examination the Veteran reported his recent blood pressure readings were in the 130s.  At a May 2008 visit the Veteran was diagnosed with hypertension and prescribed anti-hypertensive medication. 

In September 2020 the Veteran underwent a VA examination.  He reported the approximate onset of hypertension as being in 2007.  He reported going to a base medical provider due to chest pain after a routine physical training session.  He reported being told his chest pain was due to a pulled muscle, but his blood pressure was elevated.  He came in 2 times daily for a week to have his pressure check and was subsequently prescribed anti-hypertensive medication.  The examiner concluded hypertension was at least as likely as not incurred in or caused by an in service injury, event or illness.  The examiner noted that while on entrance examination in August 2006, the Veteran was noted to have elevated blood pressure, he was not formally diagnosed with hypertension until approximately May 2008.   

In November 2020 an addendum opinion was rendered.  The examiner concluded that hypertension clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by an in service injury, event, or illness.  The examiner indicated that the Veteran had elevated blood pressure since enlistment, which indicates it was a preexisting condition.  

At the April 2025 Board hearing, the Veteran reported at the time of his August 2006 entrance examination he had elevated blood pressure readings.  He then obtained a waiver as to the elevated blood pressure readings, as he was then assessed with normal blood pressure.  The Veteran's representative reiterated that the Veteran was not diagnosed and treated for hypertension until May 2008. 

In an April 2025 statement, the Veteran reiterated that he developed hypertension during service.

In July 2025, Dr. A. K., provided a private medical opinion. Dr. K. concluded that the Veteran's hypertension is more likely than not due to service.  Dr. K. concluded it is more likely than not that headaches are due to the Veteran's hypertension.  Dr. K. concluded tinnitus is more likely than not due to service, and is aggravated by hypertension. 

Dr. K. noted the Veteran did not
 to the elevated blood pressure readings, as he was then assessed with normal blood pressure.  The Veteran's representative reiterated that the Veteran was not diagnosed and treated for hypertension until May 2008. 

In an April 2025 statement, the Veteran reiterated that he developed hypertension during service.

In July 2025, Dr. A. K., provided a private medical opinion. Dr. K. concluded that the Veteran's hypertension is more likely than not due to service.  Dr. K. concluded it is more likely than not that headaches are due to the Veteran's hypertension.  Dr. K. concluded tinnitus is more likely than not due to service, and is aggravated by hypertension. 

Dr. K. noted the Veteran did not have a diagnosis of hypertension at the time of entrance into service.  To meet the requirement for a diagnosis of hypertension, the Veteran would have had to have been tested over a period of 1 to 4 weeks, or in the alternative 2 measurements per hour, during waking hours over 14 hours.  The Veteran was evaluated and 3 readings were taken, which does not meet the medical communities standards for diagnosing hypertension.  Further, just 5 days later his blood pressure measured normotensive.  The evidence does indicate the Veteran was diagnosed with hypertension approximately 2 years later in 2008.  Dr. K. noted agreement with the positive VA opinion.  Dr. K. noted the negative opinion, is based on a false premise as the Veteran did not have hypertension prior to service.  Further, Dr. K. noted the Veteran to have headaches are known to be caused by hypertension, as are vision disturbances and tinnitus.  Further the Veteran has tinnitus due to loud noise exposure.   

Typically, a veteran who is not noted to have a preexisting condition upon entrance into service is presumed to have entered service in sound condition.  38 U.S.C. § 1111.  There is no indication prior to entry to service of a diagnosis of hypertension.  Though the Veteran had elevated blood pressure in early August 2006, a physical standards waiver was approved as to hypertension.  The Veteran was not formally diagnosed with hypertension or prescribed medication until May 2008.  As such, the presumption of soundness has not been rebutted. 

The Veteran was first diagnosed with hypertension during service.  The Veteran reported an onset of symptoms during service that has continued to present.  The Veteran is also competent to testify regarding facts or circumstances that can be observed and described by a layperson.

There are positive and negative opinions of record.  A VA examiner provided a positive medical opinion, explaining the onset of hypertension as being in 2008, with no indication of hypertension prior to service.  Additionally, there is a positive opinion from July 2025, linking his hypertension to service. 

Thus, the Board will resolve reasonable doubt in the Veteran's favor and conclude that the evidence is nearly balanced as to whether hypertension is attributable to active service.

In light of the foregoing, the Board finds that service connection for hypertension is warranted.  See 38 C.F.R. § 3.310 (a).  The benefit of the doubt doctrine applies. 38 U.S.C. §5107 (b), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Additionally, the Board notes the Veteran's assertion that the Board should take jurisdiction over issues of entitlement to service connection for hearing loss, tinnitus, headaches, and right knee disability. See April 2025 Attorney Brief.  The Court of Appeals for Veterans Claims (Court) held that VA is obligated to develop and adjudicate a claim for secondary service connection that is reasonably raised during the processing of a properly initiated claim as to the primary service-connected disability's evaluation level.  Wilson v. McDonough, 35 Vet. App. 103 (2022); see also Bailey v. Wilkie, 33 Vet. App. 188, 201 (2021) (emphasis added).   

Given that the issues on appeal pertain to grants of service connection and not increased ratings, Bailey does not apply.  VA is not required to develop and adjudicate claims for secondary service connected disabilities unless it is in the context of adjudication of a claim for the proper evaluation level of the primary service connected disability.  Again, in this appeal, the issues on appeal are not as to entitlement to the appropriate levels of disability, but as to entitlement to service connection. 

The Board will not apply Bailey to the facts of this case.  The Veteran is free to file a claim in the first instance for secondary hearing loss, tinnitus, headaches, and right knee disability, at any time, and those claims may be developed once those claims are received; however, the Board determines that there is no jurisdiction to address those claims never filed
 Bailey does not apply.  VA is not required to develop and adjudicate claims for secondary service connected disabilities unless it is in the context of adjudication of a claim for the proper evaluation level of the primary service connected disability.  Again, in this appeal, the issues on appeal are not as to entitlement to the appropriate levels of disability, but as to entitlement to service connection. 

The Board will not apply Bailey to the facts of this case.  The Veteran is free to file a claim in the first instance for secondary hearing loss, tinnitus, headaches, and right knee disability, at any time, and those claims may be developed once those claims are received; however, the Board determines that there is no jurisdiction to address those claims never filed nor ever adjudicated by the AOJ.

6. Entitlement to service connection for otitis externa.

In July 2020, the Veteran submitted a claim for service connection for ear infections.  He reported the infections started during service and continued to present. 

STRs reveal upon examination in August 2006, the examiner noted the Veteran to have scarred "TMAS."  In October 2009 the Veteran seen with reports of ear pain and was assessed with infective otitis externa.  

In January 2021 the Veteran underwent a VA examination and was assessed with chronic otitis externa.  The Veteran reported during service wearing a radio earpiece device and developing ear infections.  The AOJ asked the examiner to opine as to whether the ear condition, which clearly and unmistakably existed prior to service was aggravated during service.  The examiner explained that at the time of the August 2006 enlistment examination, there was no mention of ear infections, and therefore the chronic otitis externa did not exist prior to service. 

In a February 2021 addendum opinion, the examiner concluded that otitis externa was less likely than not incurred in or caused by the claimed in service injury, event or illness.  As rationale, the examiner noted the Veteran's reports of in-service otitis externa during his time in Guantanamo Bay.  The examiner explained there are no records of this occurrence, therefore no evidence of recurrent ear infections during service. 

The Board notes that both January and February 2021 examiners made no mention of the Veteran's in service ear infection.  

At the Board hearing the Veteran noted the August 2006 entry of "TMAS," and noted the possibility of meaning being a scarred tympanic membrane.  The Board notes, a definition was not rendered as to TMAS, nor was it documented again during service.  The Veteran reiterated that upon entry to service he did not have tympanic membrane scarring.  He further stated that even if he had scarring of the tympanic membrane, there is no indication of a relation to external ear infections.  The Veteran reports he initially had ear infections related to wearing a radio earpiece, and ever since then began experiencing frequent ear infections.  He reported the onset of chronic otitis externa during service.  His representative further raised the issue of entitlement to tinnitus or hearing loss, asserting these issues had been reasonably raised.  As noted above, the Veteran is free to file a claim of service connection for tinnitus and hearing loss, on a secondary basis, with the AOJ.

In an April 2025 statement, the Veteran reiterated that he began experiencing recurrent ear infections during service.

In July 2025, Dr. A. K., provided a private medical opinion.  Dr. K. concluded chronic otitis externa is more likely than not due to service.  The Veteran utilized ear plugs during service, and developed otitis externa during service, and is corroborated by the Veteran's statements.  Dr. K. explained otitis externa pertains to an infection of the outer ear, and otitis media is an infection of the middle ear.  Dr. K. explained that the presence of scarring of the tympanic membrane is indicative of otitis media not otitis externa.  Dr. K. noted the entrance examination notes tympanic scarring, however, scarring is not noted at any other point throughout service, or post service.  Therefore, Dr. K. concluded, it is more likely than not that the scarring noted on entry was done in error.  Dr. K. noted the Veteran's use of earpieces would likely cause otitis externa, as the use is consistent with transmitting bacteria into the ear canal.  Dr. K. noted the VA examiner's finding of no evidence during service, which is in error as there is clear treatment of otitis externa during service.

There is no indication prior to entry to service of a diagnosis of ear infections, to include otitis externa.  As such the presumption of soundness has not been rebutted. 

There is a report of an ear infection
 other point throughout service, or post service.  Therefore, Dr. K. concluded, it is more likely than not that the scarring noted on entry was done in error.  Dr. K. noted the Veteran's use of earpieces would likely cause otitis externa, as the use is consistent with transmitting bacteria into the ear canal.  Dr. K. noted the VA examiner's finding of no evidence during service, which is in error as there is clear treatment of otitis externa during service.

There is no indication prior to entry to service of a diagnosis of ear infections, to include otitis externa.  As such the presumption of soundness has not been rebutted. 

There is a report of an ear infection during service.  The Veteran reported an onset of symptoms during service that has continued to present.  The Veteran is also competent to testify regarding facts or circumstances that can be observed and described by a layperson.

There are positive and negative opinions of record.  The Board will resolve reasonable doubt in the Veteran's favor, and conclude the evidence is nearly balanced as to whether otitis externa is attributable to active service.

In light of the foregoing, the Board finds that service connection for otitis externa is warranted.  See 38 C.F.R. § 3.310 (a).  The benefit of the doubt doctrine applies. 38 U.S.C. §5107 (b), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

H.M. WALKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Skiouris, Elena

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.