TINNITUS

LAURA E. COLLINS · 2026 · Case ID: A26035481

MIXED

Summary

The veteran, who served in the Air National Guard from October 1991 to February 1992, appeals a September 2020 rating decision. The veteran sought service connection for depression, insomnia, migraine headaches with dizziness, obstructive sleep apnea, left ear hearing loss, a seizure disorder, right knee disorder, left knee disorder, and a back disorder. The veteran also appealed the denial of a rating in excess of 10 percent for tinnitus and a compensable rating for right ear hearing loss. The Board dismissed the tinnitus and right ear hearing loss issues as withdrawn by the veteran. Service connection for depression, insomnia, migraine headaches with dizziness, obstructive sleep apnea, and left ear hearing loss was granted based on the benefit of the doubt doctrine, as the evidence was found to be in approximate balance. The Board found the private medical opinions from S.B. and J.D. persuasive, linking these conditions to an in-service tear gas exposure, despite a VA examiner's negative opinion on headaches. The Board granted left ear hearing loss based on similar noise exposure to the service-connected right ear, finding the evidence in approximate balance. However, service connection for a seizure disorder, right knee disorder, left knee disorder, and back disorder was denied. For the seizure disorder, the Board found no competent evidence of a current diagnosis. For the knee and back disorders, the Board found the evidence weighed against service connection, noting the veteran's pre-service right knee injury and lack of competent medical evidence linking current conditions to service or to each other. The Board also noted that VA's duty to assist was not triggered for these denied claims due to insufficient evidence of a potential nexus.

Service Branch

AIR NATIONAL GUARD

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201005-114402

Full Decision Text

Citation Nr: A26035481
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 201005-114402
DATE: April 16, 2026

ORDER

The issue of entitlement to a rating in excess of 10 percent for tinnitus is dismissed.

The issue of entitlement to a compensable rating for right ear hearing loss is dismissed.

Entitlement to service connection for depression and insomnia is granted.

Entitlement to service connection for migraine headaches with dizziness is granted.

Entitlement to service connection for obstructive sleep apnea is granted.

Entitlement to service connection for left ear hearing loss is granted.

Entitlement to service connection for a seizure disorder is denied.

Entitlement to service connection for a back disorder is denied.

Entitlement to service connection for a left knee disorder is denied.

Entitlement to service connection for a right knee disorder is denied.

FINDINGS OF FACT

1. At the July 2024 Board hearing, prior to the promulgation of a decision in the appeal, the appellant requested to withdraw his appeal as to the issues of entitlement to a rating in excess of 10 percent for tinnitus and a compensable rating for right ear hearing loss.

2. The competent and credible evidence of record is in approximate balance as to whether depression and insomnia is related to a disease or injury incurred in or aggravated in the line of duty during ACDUTRA.

3. The competent and credible evidence of record is in approximate balance as to whether migraine headaches with dizziness is related to a disease or injury incurred in or aggravated in the line of duty during ACDUTRA.

4. The competent and credible evidence of record is in approximate balance as to whether obstructive sleep apnea is related to a disease or injury incurred in or aggravated in the line of duty during ACDUTRA.

5. The competent and credible evidence of record is in approximate balance as to whether left ear hearing loss is related to an in-service injury or illness.

6. The competent and credible evidence of record persuasively weighs against finding a current seizure disorder. The evidence is not in approximate balance.

7. The competent and credible evidence of record persuasively weighs against finding that any right knee arthritis manifested during active-duty service or within one year thereafter or that a right knee disorder is related to an in-service injury or disease. The evidence is not in approximate balance.

8. The competent and credible evidence of record persuasively weighs against finding that any left knee arthritis manifested during active-duty service or within one year thereafter or that a left knee disorder is related to an in-service injury or disease or was caused by a service-connected disability. The evidence is not in approximate balance.

9. The competent and credible evidence of record persuasively weighs against finding that any lumbar spine arthritis manifested during active-duty service or within one year thereafter or that a low back disorder is related to an in-service injury or disease or was caused by a service-connected disability. The evidence is not in approximate balance.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of the appeals of the issues of entitlement to a rating in excess of 10 percent for tinnitus and a compensable rating for right ear hearing loss are met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55.

2. The criteria for entitlement to service connection for depression and insomnia are met. 38 U.S.C. §§ 101, 1110, 5107; 38 C.F.R. §§ 3.303.

3. The criteria for entitlement to service connection for migraine headaches and dizziness are met. 38 U.S.C. §§ 101, 1110, 5107; 38 C.F.R. §§ 3.303.

4. The criteria for entitlement to service connection for obstructive sleep apnea are met. 38 U.S.C. §§ 101, 1110, 5107; 38 C.F.R. §§ 3.303.

5. The criteria for entitlement to service connection for left ear hearing loss are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303.

6. The criteria for entitlement to service connection for a seizure disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.

7. The criteria for entitlement to service connection for a right knee disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

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

6. The criteria for entitlement to service connection for a seizure disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.

7. The criteria for entitlement to service connection for a right knee disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

8. The criteria for entitlement to service connection for a left knee disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

9. The criteria for entitlement to service connection for a low back disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1991 to February 1992 with additional service in the Air National Guard.

These matters are before the?Board of Veterans' Appeals?(Board) on appeal of a September 2020 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the October 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on July 16, 2024.

Therefore, the Board may only consider the evidence of record at the time of the September 2020 agency of original jurisdiction (AOJ) 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(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

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. The issue of entitlement to a rating in excess of 10 percent for tinnitus is dismissed.

2. The issue of entitlement to a compensable rating for right ear hearing loss is dismissed.

An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by her authorized representative. 38 C.F.R. § 19.55. At the July 16, 2024 Board hearing, prior to the promulgation of a decision in the appeal, the Veteran informed the Board that he wished to withdraw his appeal as to the issues of entitlement to a rating in excess of 10 percent for tinnitus and a compensable rating for right ear hearing loss.

An oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018) (the Board must address all three prongs of the DeLisio standard when it applies). If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal. 38 C.F.R. § 19.55 (b)(1).

Here, at the July 16, 2024 Board
full understanding of the consequences of such action on the part of the claimant. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018) (the Board must address all three prongs of the DeLisio standard when it applies). If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal. 38 C.F.R. § 19.55 (b)(1).

Here, at the July 16, 2024 Board hearing, prior to the promulgation of a decision in the appeal, the Veteran explicitly and unambiguously informed the Board that he wished to withdraw his appeal as to these specific issues. The undersigned explained the consequences of such action and the Veteran expressed understanding and continued desire to withdraw the appeals. The Board finds that the criteria for an oral withdrawal are met and the issues of entitlement to a rating in excess of 10 percent for tinnitus and a compensable rating for right ear hearing loss are dismissed.

3. Entitlement to service connection for depression and insomnia is granted.

4. Entitlement to service connection for headaches and dizziness is granted.

5. Entitlement to service connection for obstructive sleep apnea is granted.

The Veteran contends that he has a psychiatric disorder, migraines headaches, dizziness and obstructive sleep apnea which are related to in-service tear gas exposure and subsequent development of seizures.

Service connection is established on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d).

Service-connection can be granted based on a period of service in the Air National Guard only where the Veteran becomes disabled as a result of a disease or injury incurred in or aggravated in the line of duty during ACDUTRA or an injury incurred in or aggravated in the line of duty during inactive duty training (INACDUTRA). 38 U.S.C. § 101(24).

If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Service treatment records show a history of seizures in March or April 1992 and June 1993 treated with medication, as well as headaches. It was noted that the first seizure occurred "while on active duty." The Board interprets this notation to mean that the Veteran was serving on a period of ACDUTRA when the first seizure occurred.

A July 2020 VA examiner found a current diagnosis of headaches. The examiner opined against an in-service etiology of headaches based on the absence of medical documentation of headaches between 1994 and 2020.

In October 2024, S.B., a private psychologist stated that the Veteran had depression and insomnia which were related to training in a gas chamber in 1992. S.B. observed that the Veteran reported having his first grand mal seizure "a few days" after the gas chamber training, and a second seizure in 1993. The Veteran further reported first beginning to experience depression shortly after treatment with Dilantin for the seizure disorder. Insomnia was reported to be a possible symptom of depression but may also be related to the Veteran's headaches. S.B. concluded that depression and insomnia were related to the in-service exposure to tear gas. S.B. further observed that the Veteran had a diagnosis of OSA and opined that the condition was also related to the exposure to tear gas, reasoning that medical research supported a strong predisposition for sleep apnea in patients with seizure disorders.

In an October 2024 statement, a private physician, J.D., opined that the Veteran had obstructive sleep apnea, migraine headaches and depression which were related to the Veteran's military service. J.D. reasoned that medical research showed a relationship between obstructive sleep apnea and seizure disorders. J.D. further observed that the Veteran reported the beginning of sleep difficulty and chronic headaches following exposure to tear gas.

In November 2020, private physician, Dr. N.H. opined that the Veteran's seizures and headaches were related to being exposed to tear gas in March 1992. Dr. N.H
to tear gas, reasoning that medical research supported a strong predisposition for sleep apnea in patients with seizure disorders.

In November 2020, private physician, Dr. N.H. opined that the Veteran's seizures and headaches were related to being exposed to tear gas in March 1992. Dr. N.H. observed that the Veteran described a history of developing seizures and headaches shortly after exposure to tear gas.

At his July 2024 Board hearing, the Veteran reiterated that he first experienced headaches and seizures following tear gas training. He reported that, following the development of seizures, he developed psychiatric symptoms and sleep disturbances which persist to the present time. The Veteran also stated that dizziness was a symptom of his headaches.

The Board finds that the Veteran is competent to describe a history of these symptoms since service and his claims are supported by the competent private medical opinions of record discussed above. While the July 2020 VA examiner found that headaches were not related to the exposure to tear gas, the examiner's opinion was based solely on the absence of medical records and failed to consider the Veteran's competent lay statements describing continuous symptoms of headaches since service. There is no other competent medical evidence against the claims.

The evidence is in approximate balance as to whether the Veteran has depression, insomnia, headaches, dizziness and obstructive sleep apnea which are related to a disease or injury incurred in or aggravated in the line of duty during ACDUTRA.

Accordingly, the claims are granted.

6. Entitlement to service connection for left ear hearing loss is granted.

The Veteran contends that his left ear hearing loss is caused by in-service noise exposure.

The Veteran was granted service connection for right ear hearing loss in a September 2020 rating decision which simultaneously denied entitlement to service connection for left ear hearing loss.

On VA examination in September 2020, audiological testing revealed left ear hearing loss for VA purposes. However, while the examiner found a significant permanent shift in hearing threshold from entrance to separation in the right ear, the examiner found no such shift in the left ear. The examiner concluded that, with respect to the left ear, "[t]here is no evidence to support a nexus to relate current hearing loss to military noise [and] not another etiology."

However, the Board finds that the evidence relating the Veteran's right ear hearing loss to service also supports that the current left ear hearing loss is related to service. For example, it is evident that the left ear was exposed to a similar level of noise exposure in service as the service-connected right ear, and that similar patterns of damage could reasonably be expected. The Board concludes that the evidence is in approximate balance as to whether left ear hearing loss is related to the Veteran's active-duty service.

The claim is granted.

7. Entitlement to service connection for a seizure disorder is denied.

The Veteran contends that service connection is warranted for a seizure disorder.

The service treatment records show the Veteran first had a seizure in March 1992, for which he was prescribed medication. Records show a second seizure in June 1993 and diagnosis with a seizure disorder.

The Veteran submitted a claim for service connection for a seizure disorder in June 2020.

At his July 2024 Board hearing, the Veteran acknowledged that he was not currently having seizures, nor was he taking anti-seizure medication.

The evidence of record weighs persuasively against finding a current diagnosis of a seizure disorder. In this regard, the available medical evidence shows no seizures or treatment for a seizure disorder during the period on appeal.

While the Veteran was diagnosed with a seizure disorder during service in the Air National Guard, the requirement of having a current disability is met "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The diagnosis of a seizure disorder in 1993, as well as any seizures or treatment for seizures documented years before the June 2020 claim, are too remote from the current appeal period to support a finding that the Veteran has a current seizure disability.

To the extent that the Veteran believes that he has a current seizure disorder, he is not shown to have the relevant training or education to offer a medical opinion diagnosing a left ankle disorder. The diagnosis of a seizure disorder is medically complex as it requires specialized education and knowledge of complex diagnostic instruments. Jandre
claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The diagnosis of a seizure disorder in 1993, as well as any seizures or treatment for seizures documented years before the June 2020 claim, are too remote from the current appeal period to support a finding that the Veteran has a current seizure disability.

To the extent that the Veteran believes that he has a current seizure disorder, he is not shown to have the relevant training or education to offer a medical opinion diagnosing a left ankle disorder. The diagnosis of a seizure disorder is medically complex as it requires specialized education and knowledge of complex diagnostic instruments. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). While the Veteran is competent to report having seizures, he has not reported any seizures during the period on appeal, and he is not competent to diagnose a current seizure disorder. There is thus no competent evidence diagnosing any current seizure disorder.

As there is no evidence of a current seizure disorder for which service connection may be granted, service connection is not warranted. Brammer v. Brown, 3 Vet. App. 223 (1992).

Based on the foregoing, the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for a seizure disorder is warranted. Rather, the evidence persuasively weighs against finding any current seizure disorder. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, supra. The claim is denied.

8. Entitlement to service connection for a right knee disorder is denied.

9. Entitlement to service connection for a left knee disorder is denied.

10. Entitlement to service connection for a back disorder is denied.

The Veteran contends that he has a right knee and left knee and low back disorders which are related to service, or that left knee and low back disorders are caused or aggravated by his right knee disorder.

Certain chronic diseases, including arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Service connection may also be granted on a secondary basis for a disability that is due to a service-connected condition. 38 C.F.R. § 3.310 (a). Service connection is also possible when a service-connected condition has aggravated a claimed condition, but compensation is only payable for the degree of additional disability attributable to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995).

On his August 1991 report of medical history on entrance to active-duty service, the Veteran reported a history of "trick or locked knee." The knee was examined at that time and found to have full range of motion with no complaints, and no other symptoms related to the right knee. In May 1994 it was noted that the Veteran had undergone arthroscopic surgery of the right knee in November 1988. Follow-up orthopedic evaluations since that time had been negative, without recommendations for restrictions or further evaluation, and the Veteran had "remained asymptomatic, without giving way or clicking."

At his July 2024 Board hearing, the Veteran reported that he injured his right knee in 1988 (prior to his period of service). He stated that he believed there was arthritis in the right knee. The Veteran attributed his current right knee pain to the repetitive physical demands of his service. He further stated that he believed that he had developed left knee and back problems due to compensation for the right knee. While the Veteran stated at his Board hearing that he was only pursuing a theory of secondary service connection, his testimony indicates that the Veteran believes that his left knee and low back disorders may be related to compensation for the right knee which took place during service. Therefore, the Board has also considered the theories of presumptive and direct service connection for the left knee and low back.

First, the Board will address the question of whether a current right knee disorder preexisted active-duty service. A veteran is presumed sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time
of his service. He further stated that he believed that he had developed left knee and back problems due to compensation for the right knee. While the Veteran stated at his Board hearing that he was only pursuing a theory of secondary service connection, his testimony indicates that the Veteran believes that his left knee and low back disorders may be related to compensation for the right knee which took place during service. Therefore, the Board has also considered the theories of presumptive and direct service connection for the left knee and low back.

First, the Board will address the question of whether a current right knee disorder preexisted active-duty service. A veteran is presumed sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.§ 1111; 38 C.F.R. § 3.304 (b).

The presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it pre-existed service. In this case, on an August 1991 report of medical history, the Veteran reported a history of trick or locked knee. An accompanying examination shows a history of right knee arthroscopic surgery, but no knee disorder was found on examination at that time. Therefore, with respect to the claimed right knee disorder, the presumption of soundness attaches. 38 C.F.R. § 3.304 (b).

Because the presumption of soundness attaches with respect to the right knee, to rebut the presumption there must be clear and unmistakable evidence that the disorder both pre-existed service and was not aggravated in service. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). Clear and unmistakable evidence is defined as obvious or manifest. 38 C.F.R. § 3.306 (b). Clear and unmistakable evidence means that the evidence "'cannot be misinterpreted and misunderstood, i.e., it is undebatable.' "Quirin v Shinseki, 22 Vet. App. 390, 396 (2009). Here, the evidence does not clearly and unmistakably demonstrate that a current diagnosed right knee disorder preexisted active-duty service. Thus, the Board will turn to whether service connection is warranted.

To the extent that the Veteran has arthritis in his right or left knee or low back, arthritis is a disease which, if manifest to a degree of 10 percent within one year after separation from active duty, may be presumed to have been incurred in service. To the extent that the Veteran asserts that his right and left knee and low back pain began during active-duty service, or within one year thereafter, he is not competent to determine that any such symptoms were manifestations of arthritis. The diagnosis of those symptoms as arthritis is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing such as x-rays. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran is not shown to possess the requisite medical experience, expertise, or training to provide competent medical evidence on these complex questions. Accordingly, there is no evidence of right or left knee or low back arthritis during active-duty service or within one year thereafter. Accordingly, service connection is not warranted on a presumptive basis.

Turning to direct service connection, the evidence also weighs persuasively against finding that any right or left knee or low back disorder is related to an in-service injury or illness. To the extent the Veteran asserts that these conditions are related to the repetitive physical demands of his service, including compensation for his right knee, he is not competent to provide an opinion in this case. The etiology of his right and left knee and low back disorders is medically complex, as those disorders have multiple possible etiologies. Jandreau, 492 F.3d 1372 at 1377 n.4. The Veteran is not shown to possess the requisite medical experience, expertise, or training to provide competent medical evidence on these complex questions. There is thus no competent medical evidence linking any right or left knee or low back disorder to any in-service injury. In the absence of evidence relating the right and left knee and low back disorders to an in-service injury or illness, service connection is not warranted on a direct basis.

The Board acknowledges that a VA medical examination was not obtained to consider whether right and left knee and low back disorders were related to an in-service injury or illness. VA's duty to assist includes providing a medical examination when necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology).

However, at the time of the September 2020 rating decision on appeal, the record lacked any evidence that a current right or left knee or low back disorder may be associated with any in-service injury. Indeed, prior to the rating decision on appeal, there was no evidence showing an in-service injury of the knees or back, nor had the Veteran explained how he believed the claimed disorders were related to any such injury. Accordingly, even the low threshold under McLendon was not met and VA's duty to obtain a medical opinion as to this question was not triggered. See 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159 (c), 3.326; Bardwell v. Shinseki, 24 Vet. App. 36, 39 (2010); Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (a conclusory lay statement is insufficient to establish nexus or require an examination under 38 U.S.C. § 5103A (d)(2)(B).

Finally, as the right knee disorder is not service-connected, service connection also cannot be awarded for a left knee or low back disorder as secondary to the claimed right knee disorder.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for right and left knee and low back disorders is warranted. Rather, the evidence weighs persuasively against finding that any current right and left knee and low back disorder manifested during active-duty service or within one year thereafter or that a right and left knee and low back disorder is related to an in-service injury or disease or that a left knee or low back disorder was caused by a service-connected disability. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claims are denied.

Laura E. Collins

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bametzreider, Paul

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

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