SKIN CONDITIONS

DANETTE MINCEY · 2026 · Case ID: A26036357

MIXED

Summary

The veteran, who served in the U.S. Navy from November 1998 to November 2002, appeals the denial of service connection for multiple conditions, including bilateral hearing loss, tinnitus, cervical spine degenerative disc disease, thoracolumbar spine degenerative arthritis, bilateral upper extremity radiculopathy, and a right ankle injury. The Board denied these claims, finding insufficient evidence to establish a nexus to service or a current diagnosis for some conditions. For pseudofolliculitis barbae, the Board found the veteran did not meet the criteria for a compensable rating, as the condition affected less than 5% of the body and required no treatment. The Board denied bilateral hearing loss, finding the VA audiological evaluation did not meet the criteria for a disabling hearing loss and the examiner opined it was less likely than not related to service due to lack of in-service complaints and delayed onset. Tinnitus was also denied, as the VA examiner opined it was less likely than not service-related due to lack of in-service complaints, delayed onset, and no hearing shifts during service. Claims for cervical spine degenerative disc disease, thoracolumbar spine degenerative arthritis, and bilateral upper extremity radiculopathy were denied based on negative VA medical opinions finding the conditions less likely than not related to service, attributing them to post-service overuse or injury. The right ankle injury claim was denied due to a lack of current diagnosis. The Board remanded claims for head injury, left ankle injury, and right hip strain secondary to right ankle injury for further development and adequate VA examinations and opinions.

Rationale

Condition affected less than 5% of body/exposed areas; No treatment required; Symptoms did not warrant higher rating

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250205-516132

Full Decision Text

Citation Nr: A26036357
Decision Date: 04/20/26 Archive Date: 04/20/26

DOCKET NO. 250205-516132
DATE: April 20, 2026

ORDER

Entitlement to an initial compensable rating evaluation of pseudofolliculitis barbae is denied.

Entitlement to service connection of service connection for bilateral hearing loss is denied.

Entitlement to service connection of service connection for tinnitus is denied.

Entitlement to service connection for cervical spine degenerative disc disease, spinal stenosis is denied.

Entitlement to service connection for degenerative arthritis of the thoracolumbar spine is denied.

Entitlement to service connection for left upper extremity radiculopathy is denied.

Entitlement to service connection for right upper extremity radiculopathy is denied.

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

REMANDED

Entitlement to service connection for head injury is remanded.

Entitlement to service connection for a left ankle injury is remanded.

Entitlement to service connection for a right hip strain, to include as secondary to right ankle, is remanded.

FINDINGS OF FACT

1. The Veteran's pseudofolliculitis barbae does not manifest with characteristic lesions involving at least 5 percent but less than 20 percent of the Veteran's total body or exposed areas affected; nor does the Veteran require intermittent systemic therapy.

2. The Veteran does not have a bilateral hearing loss disability for VA compensation purposes.

3. The Veteran's symptoms of tinnitus were not chronic in service, did not manifest to a compensable degree within one year of separation, and have not been continuous since service separation; the Veteran's tinnitus is not etiologically related to service.

4. There is no competent evidence showing the Veteran's cervical spine degenerative disc disease and spinal stenosis is etiologically related to service.

5. There is no competent evidence showing the Veteran's degenerative arthritis of the thoracolumbar spine is etiologically related to service.

6. There is no competent evidence showing the Veteran's left upper extremity radiculopathy is etiologically related to service.

7. There is no competent evidence showing the Veteran's right upper extremity radiculopathy is etiologically related to service.

8. The Veteran has not been diagnosed with a right ankle disorder.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial compensable rating evaluation of pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 7813.

2. The criteria for entitlement to service connection of service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for entitlement to service connection of service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

4. The criteria for entitlement to service connection for cervical spine degenerative disc disease, spinal stenosis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for entitlement to service connection for degenerative arthritis of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

6. The criteria for entitlement to service connection for left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

7. The criteria for Entitlement to service connection for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

8. The criteria for entitlement to service connection for a right ankle injury have not been met. 38 U.S
, 3.304.

6. The criteria for entitlement to service connection for left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

7. The criteria for Entitlement to service connection for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

8. The criteria for entitlement to service connection for a right ankle injury have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from November 1998 to November 2002.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which confirmed a noncompensable rating for pseudofolliculitis barbae and confirmed and continued the denials of the remaining claims.

In the February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the August 2022 agency of original jurisdiction (AOJ/RO) decision, which was subsequently subject to the January 2025 higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ/RO issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

The Board recognizes that the Veteran submitted a lay statement in December 2025. While the Veteran entitled the same as "evidence," the Veteran did not provide new information only his report of his experience. As such, the Board finds this to be argument, which is acceptable under the Appeals Modernization Act (AMA).

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, 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 head injury and left ankle, any evidence the Board could not consider will be considered by the AOJ/RO in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

By way of procedural background, the Veteran initially submitted a claim for service connection in April 2022, which included claims for bilateral hearing loss, bilateral ringing in ears, herniated disc/cervical strain, shoulder pinch nerve, right ankle injury, right hip secondary to right ankle, left ankle injury, right elbow numbness, pseudofolliculitis barbae, head injury and curve spine due to herniated disc. A rating decision was issued in August 2022, which granted service connection for pseudofolliculitis barbae and assigned a noncompensable rating. The August 2022 rating decision denied the remaining claims as they neither incurred in nor were caused by service.

In August 2022, the Veteran sought a higher level review seeking a higher rating for pseudofolliculitis barbae and service connection for bilateral hearing loss, tinnitus, cervical spine degenerative disc disease spinal stenosis, left upper extremity radiculopathy, right ankle injury, right hip strain as secondary to right ankle injury, left ankle injury, right upper extremity radiculopathy, head injury and degenerative arthritis of the thoracolumbar spine.

At the same time, the Veteran sought an August 2022 appeal to the Board (VA Form 21-10182). However, the Veteran withdrew the claim on an August 30, 2022 VA Form 21-4138 stating, "I, [the Veteran], would like to withdraw my board appeal claim." An October 2024 Board decision dismissed the claim. In November 2024, the Veteran sought another appeal to the Board
enerative disc disease spinal stenosis, left upper extremity radiculopathy, right ankle injury, right hip strain as secondary to right ankle injury, left ankle injury, right upper extremity radiculopathy, head injury and degenerative arthritis of the thoracolumbar spine.

At the same time, the Veteran sought an August 2022 appeal to the Board (VA Form 21-10182). However, the Veteran withdrew the claim on an August 30, 2022 VA Form 21-4138 stating, "I, [the Veteran], would like to withdraw my board appeal claim." An October 2024 Board decision dismissed the claim. In November 2024, the Veteran sought another appeal to the Board. However, in a January 2025 letter, the Board advised the Veteran that the appeal could not be docketed as it was untimely.

A rating decision was issued in January 2025, which confirmed the compensable rating for pseudofolliculitis barbae and confirmed and continued the prior denials of the remaining claimed issues. The Veteran timely submitted a notice of disagreement (10182/NOD) in February 2025, seeking review of the claim. As such, the claim for a compensable rating for pseudofolliculitis barbae and the claims for service connection of bilateral hearing loss, tinnitus, cervical spine degenerative disc disease, spinal stenosis, degenerative arthritis of the thoracolumbar spine, head injury, left ankle injury, right ankle injury, left upper extremity radiculopathy, right upper extremity radiculopathy and right hip strain are properly before the Board for adjudication.

The Board acknowledges that 38 C.F.R. § 20.202 (c)(2) provides that an appellant may modify a notice of disagreement (NOD) and change Board dockets by submitting a new NOD within one year of notification of the decision on appeal or within 60 days of the date that the Board received the original NOD, whichever is later. The Veteran was notified of the January 2025 rating decision on a January 28, 2025 letter. The Board received the Veteran's 10182/NOD on February 5, 2025. Accordingly, the Veteran had until January 28, 2026, one year from the rating decision; or until April 6, 2025, 60 days from when VA received the Veteran's appeal to the Board. Accordingly, the time has elapsed to select a different Board review option. See Williams v. McDonough, No. 21-7363, U.S. Vet. App. June 21, 2024. As such, the Board will proceed with its review.

Increased Disability Ratings Laws and Regulations

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1.

Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of a veteran working or seeking work. 38 C.F.R. § 4.2. Reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Staged ratings are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509- 10 (2007).

Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a veteran's
4.7.

Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a veteran's service-connected disability. 38 C.F.R. § 4.14 (2020). However, it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; the critical element in permitting the assignment of several evaluations under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995).

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 (musculoskeletal system) or § 4.73 (muscle injury); 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 [or 4.73] criteria.").

It is the intention to recognize actual painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59.

In rendering a decision on appeal, the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (199
evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Entitlement to an initial compensable rating evaluation of pseudofolliculitis barbae.

The Veteran generally asserts that an initial higher rating for his pseudofolliculitis barbae is warranted. The Veteran has been assigned a noncompensable rating for the entire period.

The Veteran's skin disability has been rated in accordance with the criteria under 38 C.F.R. § 4.118, Diagnostic Code 7813 which directs evaluation under the General Rating Formula. VA amended the criteria for rating skin disabilities effective from August 13, 2018. While the Veteran's claim was not pending prior to 2018, the amended criteria is instructive. Specifically, a note preceding 38 C.F.R. § 4.118 defines "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin."

Under the Skin Rating Formula, a non-compensable (0 percent) rating is warranted where no more than topical therapy is required over the past 12-month period and there is at least one of the following: characteristic lesions involving less than 5 percent of the entire body; or characteristic lesions involving less than 5 percent of exposed areas. 38 C.F.R. § 4.118, DC 7806.

The Skin Rating Formula provides that a 10 percent rating is assigned where at least one of the following is present: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs are required for a total duration of less than 6 weeks over the past 12-month period. Id.

A 30 percent disability rating is warranted where at least one of the following is present: characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. Id.

A 60 percent disability rating is assigned for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Id.

Since "systemic therapy," which is the type of therapy that creates compensability, is connected to the phrase "corticosteroids or other immunosuppressive drugs" by the phrase "such as," those drug types do not constitute an exhaustive list of all compensable systemic therapies, but rather serve as examples of the kind and degrees of treatments used to justify a particular disability rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Consequently, the types of systemic treatment that are compensable under DC 7806 are not limited to "corticosteroids or other immunosuppressive drugs." Compensation is warranted for all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs. Warren v. McDonald, 28 Vet. App. 194 (2016).

The Board notes
oids or other immunosuppressive drugs" by the phrase "such as," those drug types do not constitute an exhaustive list of all compensable systemic therapies, but rather serve as examples of the kind and degrees of treatments used to justify a particular disability rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Consequently, the types of systemic treatment that are compensable under DC 7806 are not limited to "corticosteroids or other immunosuppressive drugs." Compensation is warranted for all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs. Warren v. McDonald, 28 Vet. App. 194 (2016).

The Board notes that the United States Court of Appeals for Veterans Claims (Court) held that topical use of corticosteroids constitutes systemic therapy under DC 7806. Johnson v. McDonald, 27 Vet. App. 497 (2016). The United States Court of Appeals for the Federal Circuit (Federal Circuit), however, reversed the decision by the Court. Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). In reversing, the Federal Circuit agreed with the VA Secretary that the Court erred when it "read DC 7806 as unambiguously elevating any form of corticosteroid treatment, including any degree of topical corticosteroid treatment, to the level of systemic therapy." The Federal Circuit noted that DC 7806 "draws a clear distinction between 'systemic therapy' and 'topical therapy' as the operative terms of the diagnostic code." The Federal Circuit went on to explain that systemic therapy means 'treatment pertaining to or affecting the body as a whole,' "whereas topical therapy means "treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied." Although a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, this possibility does not mean that all applications of topical corticosteroids amount to systemic therapy.

The record does not show the Veteran sought post-service VA healthcare.

A review of the Veteran's private health care treatment does not show the Veteran reported or sought treatment for his pseudofolliculitis barbae. See Norton Healthcare.

The Veteran was afforded a July 2022 VA skin examination. The VA examiner noted a diagnosis of pseudofolliculitis barbae. The Veteran reported he had no treatment in the prior 12 months, either oral, topical or by injection. The Veteran also reported he had not had any treatment or procedures in the prior 12 months. On physical examination, the Veteran had less than 5 percent of his total body and less than 5 percent of his exposed area affected by pseudofolliculitis barbae. The examiner described the appearance and location as raised lesions at the Veteran's neckline. The VA examiner noted the Veteran's pseudofolliculitis barbae had no functional impact on his ability to work.

Because the Veteran did not require any medication or treatment and he was affected by less than 5 percent of both his total body and exposed area, a noncompensable rating is warranted.

The Board does not find evidence that the Veteran's pseudofolliculitis barbae affected at least 5 percent but less than 20 percent of the Veteran's entire body or exposed area or the Veteran required intermittent systemic therapy. Therefore, a higher rating is not warranted.

In the Veteran's December 2025 statement, the Veteran reported, "Razor bumps still occur when shaving and require me to limit or avoid shaving to prevent bleeding and irritation."

Based on a review of the record, the Board finds that the Veteran's skin disorder does not more nearly approximate the level of severity contemplated by an increased rating. Therefore, a compensable rating is not warranted.

For these reasons, the Board finds that the evidence weighs persuasively against the claim for a compensable rating for the Veteran's service connected pseudofolliculitis barbae. Because the evidence weighs substantially against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for a compensable claim for pseudofolliculitis barbae is denied.

Service Connection Laws and Regulations

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be
claim for a compensable rating for the Veteran's service connected pseudofolliculitis barbae. Because the evidence weighs substantially against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for a compensable claim for pseudofolliculitis barbae is denied.

Service Connection Laws and Regulations

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The U.S. Court of Appeals for Veterans Claims (Court) has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382(1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998).

A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment, including by a veteran. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner's opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the weight of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

Entitlement to service connection of service connection for bilateral hearing loss.

The Veteran asserts that his hearing loss is the result of his military service and service connection is warranted for his bilateral hearing loss.

Impaired hearing is considered a disability for VA compensation purposes when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; the thresholds for at least three of these frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Court has held that a veteran may establish the required nexus between current hearing loss disability and his term of military service if he can show by competent evidence that his hearing loss disability resulted from the in-service acoustic trauma even when the hearing loss disability does not arise in service. Godfrey v. Derwinski, 2 Vet. App. 352 (1992).

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b).

During a July 202
decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b).

During a July 2022 VA audiological evaluation, pure tone thresholds, in decibels, were as follows:

HERTZ

1000 2000 3000 4000 average

RIGHT 15 25 10 5 13.75

LEFT 10 10 5 15 10

Speech audiometry revealed speech recognition ability scores using the Maryland CNC Test of discrimination score of 96 percent was noted in the right ear and 94 in the left ear.

The July 2022 VA audiology consult report findings, applied to Table VI, yield a numeric designation of I in the right ear on the basis of 13.75 decibel puretone threshold average and 96 percent speech discrimination, and a numeric designation of I in the left ear on the basis of 10 decibel puretone threshold average, and 94 percent speech discrimination. The numeric designation for the right ear (I) along with the numeric designation for the left ear (I), entered into Table VII, produce a 0 percent evaluation for hearing impairment.

Because auditory thresholds in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz were not 40 decibels or greater, the thresholds for at least three of these frequencies were not 26 or greater, and speech recognition scores using the Maryland CNC Test were not less than 94 percent, the criteria to establish a current hearing loss disability in the right ear as required by 38 C.F.R. § 3.385 are not met.

The Board notes that puretone thresholds reported on the audiological evaluations discussed above were not 55 decibels or more at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) and were not recorded at 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz in either ear. Thus, the provision of 38 C.F.R. § 4.86 for exceptional patterns of hearing impairment do not apply in this case.

The remaining evidence of record also does not demonstrate bilateral hearing loss as required by 38 C.F.R. § 3.385. The Veteran has not indicated that there are any outstanding VA or private treatment records pertaining to his claimed hearing loss disorder.

Moreover, and specifically in respect to hearing loss, an audiologist must fully describe the functional effects caused by a hearing disability in the final report. Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In this case, the July 2022 VA examiner indicated the Veteran reported that the Veteran's functional impact was that his "wife is always telling me I am not hearing her." The Board finds that this functional effect of his hearing loss disability is adequately considered by the rating criteria for hearing loss.

As the evidence does not show that the Veteran's hearing loss is to a disabling degree according to 38 C.F.R. § 3.385, the weight of the evidence demonstrates that the Veteran's right ear hearing loss has not met the threshold to establish current hearing loss "disability," and the claim must be denied.

Additionally, the VA examiner opined that the Veteran's hearing loss was not caused by or the result of an event in military service. The VA examiner reasoned, "The Veteran's military occupational specialty of Aviation Boatswain's Mate had a high probability of hazardous noise exposure. He was awarded a Pistol Marksmanship Ribbon. There were no shifts in hearing noted on any hearing conservation exam and there is no significant shift comparing his entrance exam to today. The only threshold outside of normal is 8000 Hz which is not included in military screening and is not considered as meeting VA criteria for hearing loss today. With no shift in hearing on active duty and still no shift for the same frequencies today and since it has been twenty years since his discharge from service, knowing the normal progression of hearing as people age, it is less likely than not that his bilateral hearing loss is a result of his military noise exposure."

In the Veteran
's military occupational specialty of Aviation Boatswain's Mate had a high probability of hazardous noise exposure. He was awarded a Pistol Marksmanship Ribbon. There were no shifts in hearing noted on any hearing conservation exam and there is no significant shift comparing his entrance exam to today. The only threshold outside of normal is 8000 Hz which is not included in military screening and is not considered as meeting VA criteria for hearing loss today. With no shift in hearing on active duty and still no shift for the same frequencies today and since it has been twenty years since his discharge from service, knowing the normal progression of hearing as people age, it is less likely than not that his bilateral hearing loss is a result of his military noise exposure."

In the Veteran's December 2025 statement, the Veteran reported he continued to experience hearing difficulty.

For these reasons, the Board finds that the evidence weighs persuasively against the claim for service connection for bilateral hearing loss. Because the evidence weighs substantially against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for service connection for bilateral hearing loss is denied.

Entitlement to service connection of service connection for tinnitus.

The Veteran asserts that his tinnitus is the result of his military service and service connection is warranted.

The Board finds that the Veteran has a current tinnitus disability. See July 2022 VA audio examination. The Veteran is competent to describe observable symptoms such as ringing in the ears as these are observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Charles v. Principi, 16 Vet. App. at 374 (a veteran is competent to testify that he experienced ringing in his ears in service and had experienced ringing in his ears ever since service).

The Veteran's service treatment records (STRs) are negative for any complaints, diagnosis or treatment for tinnitus. The STRs show the Veteran was enrolled in a hearing conservation program that included examinations. At December 1998, August 1999, and November 2001 examinations, no hearing loss or significant threshold shift was shown on audiometry. At a May 2001 medical questionnaire for potential respirator users, the Veteran denied hearing problems.

The record does not show the Veteran sought post-service VA healthcare.

During the Veteran's post-service private treatment, the Veteran did not report ear or hearing complaints. See Norton Healthcare.

The Veteran was afforded a July 2022 VA audio examination. The Veteran reported he first started hearing ringing in his ears sometime between 2008 to 2010. It was less often at first and had become more frequent over time and now, the Veteran reported daily ringing in both ears for 5-10 minutes.

While the Veteran is not service connected for hearing loss, the July 2022 VA examiner opined that the Veteran had a diagnosis of clinical hearing loss, and his tinnitus was at least as likely as not a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. However, the VA examiner opined that the Veteran's tinnitus was less likely than not caused by or a result of military noise exposure.

The July 2022 VA examiner reasoned that "Veteran's military occupational specialty of Aviation Boatswain's Mate had a high probability of hazardous noise exposure. He was awarded a Pistol Marksmanship Ribbon. There were no shifts in hearing noted on any hearing conservation exam. There are no records of complaint of tinnitus until the time of the claim and he reports the onset of symptoms to be between 2008-2010, several years after his discharge from service. Tinnitus is a common health problem that affects between 10 - 30% of the population, approximately 3 - 4% presenting to the doctor at least once in their life. There are many causes that lead to tinnitus in the general population, including otology, metabolic, neurologic, or cardiovascular conditions, as well as being a common side effect of many medications. The IOM Noise and Military Service (2005) study states that "as the interval between noise exposure and the onset of tinnitus lengthens, the possibility that tinnitus will be triggered by other factors increases." The VA examiner concluded that with no shift in hearing on active duty, and a reported delayed onset of symptoms by several years after service, it is less likely than not that his tinnitus is a result of his military noise exposure.

The Board finds this opinion to be probative as it provides a clear rationale and sufficient explanation. Additionally, the opinion considers the possibility of late-onset tinnitus and finds that because the Veteran had no shift in hearing on active duty, it was not likely
being a common side effect of many medications. The IOM Noise and Military Service (2005) study states that "as the interval between noise exposure and the onset of tinnitus lengthens, the possibility that tinnitus will be triggered by other factors increases." The VA examiner concluded that with no shift in hearing on active duty, and a reported delayed onset of symptoms by several years after service, it is less likely than not that his tinnitus is a result of his military noise exposure.

The Board also finds that the evidence of record does not establish any manifestations of tinnitus to a degree of 10 percent or more within the applicable time period; as such, the criteria for presumptive service connection on the basis of a chronic disease have not been satisfied. See 38 C.F.R. § 3.307 (a)(3).

The Board next finds that symptoms of tinnitus have not been continuous since service separation. The Veteran first reported tinnitus at the July 2022 VA audio examination, approximately 21 years after service separation. Furthermore, the Veteran reported that the ringing in his ears started sometime between 2008 and 2010, after his release from active duty. The Board finds that this long lapse of time between service separation and treatment for tinnitus symptoms is one factor that weighs against a finding that the Veteran's tinnitus is related to service. See Maxson v. Gober, 230 F. 3d 1330, 1333 (Fed. Cir. 2000) (holding that it was proper to consider the veteran's entire medical history in determining if service-connection is warranted, including a lengthy period of absence of complaints).

The Board acknowledges that symptoms, not treatment, are the essence of any evidence of continuity of symptomatology (Savage v. Gober, 10 Vet. App. 488, 496 (1997)); however, here, the Veteran reported his tinnitus began after his military service.

As it pertains to a current tinnitus disability and a possible nexus to service, the Board notes that at his July 2022 VA audio examination, the Veteran reported his tinnitus began between 2008 and 2010, occurring less often and became more frequent over time. The examiner reviewed the Veteran's claims file and opined that the Veteran's tinnitus was less likely than not related to service. The examiner explained that while the Veteran had a high probability of hazardous noise exposure, there were no shifts of the Veteran's hearing noted on any on the Veteran's hearing conservation examinations. Likewise, the July 2022 examiner considered the IOM Noise and Military Service study and concluded it was more likely that other factors, rather than delayed onset, were the cause of the Veteran's tinnitus.

In the Veteran's December 2025 statement, the Veteran repeated that during service he had constant exposure to engine and jet noise with high-frequency pitch, often without effective hearing protection and had ringing in his ears after long fuel ops. The Veteran also stated that he continued to experience ringing, especially in quiet rooms or at night. However, this does not negate the examiner's opinion who reviewed the prior record and concluded it was less likely than not that the Veteran's tinnitus was a result of his military noise exposure.

The Board has considered the Veteran's general statements purporting to relate his currently diagnosed tinnitus to service. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder of hearing loss and tinnitus. Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that required a medical opinion to diagnose and to relate to service). Tinnitus is a medically complex disease process because of its multiple possible etiologies and manifest symptomatology that may overlap with other disorders. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (holding that rheumatic fever is not a condition capable of lay diagnosis).

For these reasons, the Board finds that the weight of the evidence is against the claim for service connection for tinnitus, and the claim must be denied. Because the weight of the evidence is against the claim, the benefit of the doubt doctrine is
Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that required a medical opinion to diagnose and to relate to service). Tinnitus is a medically complex disease process because of its multiple possible etiologies and manifest symptomatology that may overlap with other disorders. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (holding that rheumatic fever is not a condition capable of lay diagnosis).

For these reasons, the Board finds that the weight of the evidence is against the claim for service connection for tinnitus, and the claim must be denied. Because the weight of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for service connection for tinnitus is denied.

Entitlement to service connection for cervical spine degenerative disc disease, spinal stenosis.

The Veteran asserts that his cervical spine disorder is the result of military service and service connection is warranted.

A review of the Veteran's service treatment record shows the Veteran sought treatment in February 2000 for complaints of a head injury and neck pain. While the record is unclear, it appears that the Veteran was diagnosed with a concussion and cervical strain. The Veteran continued follow-up treatment and was observed to have improved later in February 2000 with a notation of "resolving cervical strain." In May 2001, the Veteran sought medical treatment after falling down a ladder well. The Veteran refused treatment, including x-rays of his cervical spine to look for fractures and/or dislocations. During an August 2005 treatment for a right finger strain, the Veteran denied neck pain. The remainder of the Veteran's STRs are silent for any complaints, diagnosis or treatment of his neck or cervical spine.

The record does not show the Veteran sought post-service VA healthcare.

During post-service private medical treatment in July 2019, August 2020, October 2020 and October 2021 for his neck pain, the Veteran's neck pain was noted to be chronic, intermittent, unchanged and associated with a remote injury. It was noted that the Veteran's previous cervical MRI was in 2014 and it showed a herniated disc. The Veteran was diagnosed with herniation of cervical intervertebral disc with radiculopathy and neck pain See Norton Healthcare.

The Veteran was afforded a July 2022 VA neck examination. The VA examiner noted a diagnosis of degenerative disc disease of the cervical spine and spinal stenosis. The Veteran reported onset in 2015 with neck pain for at least five or more years. The Veteran reported no injuries and that the pain had gradually gotten worse and now he had pain shooting down both arms (left side past shoulder and right side past elbow). The Veteran reported that while the pain started after service, he felt like it was due to being on his feet in the boat going up and down steps for 12 hours at a time. The VA examiner noted the Veteran's functional impact was described as "difficult to turn head fully to look around and drive; difficult to bend or lift."

In a separate July 2022 medical opinion, the VA examiner opined that the claimed cervical spine condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that in "2/10/2000 [the Veteran reported] neck pain and was told cervical strain, 2/14/2000 had cervical strain follow up and on this exam reported no pain, also 5/7/2001 denied and neck symptoms. Reported numbness tingling 2014 with some neck pain. 2021 cervical DD per MRI. The records are silent for evidence in the veteran's service treatment records to show that chronic symptoms began in service or manifested within one year of veterans discharge from service. Therefore, it is my medical opinion that the veteran's current diagnosis of neck DDD is less likely than not incurred in or caused by the service treatment records during service. More likely due to post-service injury or overuse."

The Board finds this opinion to be probative as it provides a clear rationale and sufficient explanation. Additionally, the opinion considers a chronic condition. As such, the Board assigned great probative weight to the July 2022 opinion. Nieves-Rodrigues v Peake, 22 Vet. App. 295 (2008).

The Board has considered the Veteran's general statements purporting to relate his cervical spine disorder to service. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder of the cervical spine. Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that required a medical opinion to diagnose and to relate to service). Degenerative disc disease of the cervical spine is a medically complex disease process because of its multiple possible etiologies and manifest symptomatology that may overlap with other disorders. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (holding that rheumatic fever is not a condition capable of lay diagnosis).

Additionally, the Veteran's contentions are outweighed by the opinion of the VA examiner who reviewed his service records, recognized the Veteran's cervical spinal disorder, but still concluded that the Veteran's neck disorder was related to a post-service injury or overuse. As the only medical opinion of record addressing the etiology of the Veteran's current back disorder is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor.

The Board also considered the Veteran's December 2025 statement in which he stated he required chiropractic care for his spine and hips and lost work days. However, this does not overcome the medical opinion that found the Veteran's neck disorder was related to a post-service injury or overuse.

For these reasons, the Board finds that the weight of the evidence is against the claim for service connection for degenerative disc disease of the cervical spine, and the claim must be denied. Because the weight of the evidence is against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for service connection for degenerative disc disease of the cervical spine and spinal stenosis is denied.

Entitlement to service connection for degenerative arthritis of the thoracolumbar spine.

The Veteran asserts that his thoracolumbar spine disorder is the result of military service and service connection is warranted.

A review of the Veteran's service treatment record show the Veteran sought treatment in May 2001, after falling down a ladder well. The Veteran refused treatment, including x-rays of his thoracolumbar spine to look for fractures and/or dislocations. The remainder of the Veteran's STRs are silent for any complaints, diagnosis or treatment of his neck or thoracolumbar spine.

The record does not show the Veteran sought post-service VA healthcare.

During post-service private medical treatment in October 2021, the Veteran sought care for his chronic neck pain but did not report back pain. The remainder of the Veteran's private treatment records are silent for complaints of thoracolumbar or back pain. See Norton Healthcare.

The Veteran was afforded a July 2022 VA back examination. The VA examiner noted a diagnosis of degenerative arthritis of the lumbar spine. The veteran reported onset in 2010 when he started working out and lifting heavy items. The Veteran reported that since then, his back has gotten worse. In 2019, the Veteran was told he had arthritis to his lower back. The veteran reported that while the pain started after service, he felt like it was due to being on his feet in the boat going up and down steps for 12 hours at a time. The VA examiner noted the Veteran's functional impact was described as "difficulty to bend, walking, running, walking up and down stairs, lifting, squatting, or standing for long periods. Difficulty squatting, bending tying shoe, putting sock and shoes on."

In a separate July 2022 medical opinion, the VA examiner opined that the claimed thoracolumbar spine condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that in "5/7/2001 [the Veteran] denied and neck / back symptoms, numbness tingling. 06/17/2014 reports back pain. 2019 Mild L4-L5 facet osteoarthritis is noted I did not see scoliosis on x-ray. The records are silent for evidence in the veteran's service treatment records to show that chronic symptoms began in
standing for long periods. Difficulty squatting, bending tying shoe, putting sock and shoes on."

In a separate July 2022 medical opinion, the VA examiner opined that the claimed thoracolumbar spine condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that in "5/7/2001 [the Veteran] denied and neck / back symptoms, numbness tingling. 06/17/2014 reports back pain. 2019 Mild L4-L5 facet osteoarthritis is noted I did not see scoliosis on x-ray. The records are silent for evidence in the veteran's service treatment records to show that chronic symptoms began in service or manifested within one year of veterans discharge from service. Therefore, it is my medical opinion that the veteran's current diagnosis of Mild L4-L5 facet osteoarthritis (degenerative arthritis) is less likely than not incurred in or caused by the service treatment records during service. More likely due to post-service injury or overuse."

The Board finds this opinion to be probative as it provides a clear rationale and sufficient explanation. Additionally, the opinion considers a chronic condition. As such, the Board assigns great probative weight to the July 2022 opinion. Nieves-Rodrigues v Peake, 22 Vet. App. 295 (2008).

The Board has considered the Veteran's general statements purporting to relate his thoracolumbar spine disorder to service. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder of the thoracolumbar spine. Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that required a medical opinion to diagnose and to relate to service). Degenerative arthritis of the thoracolumbar spine is a medically complex disease process because of its multiple possible etiologies and manifest symptomatology that may overlap with other disorders. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (holding that rheumatic fever is not a condition capable of lay diagnosis).

Additionally, the Veteran's contentions are outweighed by the opinion of the VA examiner who reviewed his service records, recognized his thoracolumbar spinal disorder, but still concluded that the Veteran's back arthritis is related to a post-service injury or overuse. As the only medical opinion of record addressing the etiology of the Veteran's current thoracolumbar disorder is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor.

For these reasons, the Board finds that the weight of the evidence is against the claim for service connection for degenerative arthritis of the lumbar spine, and the claim must be denied. Because the weight of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for service connection for degenerative disc disease of the degenerative arthritis of the thoracolumbar spine is denied.

Entitlement to service connection for left upper extremity radiculopathy.

Entitlement to service connection for right upper extremity radiculopathy.

The Veteran asserts that his left and right upper extremity radiculopathy disorder is the result of military service and service connection is warranted.

A review of the Veteran's service treatment record is silent for any complaints, diagnosis or treatment for the Veteran's left arm, shoulder, elbow, wrist or hand. In August 2005, the Veteran sought treatment for numbness in his right little finger and elbow. The Veteran reported he had been playing football and thought he bent his fingers back. The Veteran reported shoulder pain. X-ray of his right hand was normal. The Veteran was diagnosed with a right hand 5th digit strain.

The record does not show the Veteran sought post-service VA healthcare.

The Veteran's post-service private medical treatment silent for any complaints, diagnosis or treatment for the Veteran's left or right arm, shoulder, elbow, wrist or hand. See Norton Healthcare.

The Veteran was afforded a July 2022 VA neck examination. At the July 2022 VA neck examination, the VA examiner noted a diagnosis of bilateral cervical radiculopathy. The VA examiner noted involvement of the bilateral C5/C6 nerve roots
elbow. The Veteran reported he had been playing football and thought he bent his fingers back. The Veteran reported shoulder pain. X-ray of his right hand was normal. The Veteran was diagnosed with a right hand 5th digit strain.

The record does not show the Veteran sought post-service VA healthcare.

The Veteran's post-service private medical treatment silent for any complaints, diagnosis or treatment for the Veteran's left or right arm, shoulder, elbow, wrist or hand. See Norton Healthcare.

The Veteran was afforded a July 2022 VA neck examination. At the July 2022 VA neck examination, the VA examiner noted a diagnosis of bilateral cervical radiculopathy. The VA examiner noted involvement of the bilateral C5/C6 nerve roots (upper radicular group) and right C7 nerve root (middle radicular group) due to cervical degenerative disc disease (DDD) and stenosis with cervical radiculopathy.

In a separate July 2022 medical opinion, the VA examiner opined that the claimed left shoulder pinched nerve was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that in "5/7/2001 [the Veteran] denied and joint symptoms, numbness tingling, 2014 shoulder pain. The records are silent for evidence in the veteran's service treatment records to show that chronic symptoms began in service or manifested within one year of veterans discharge from service. Therefore, it is my medical opinion that the veteran's current diagnosis of left upper extremity radiculopathy is less likely than not incurred in or caused by the service treatment records during service. More likely due to post-service neck injury or overuse."

In the same separate July 2022 medical opinion, the VA examiner opined that the claimed right elbow condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that in "5/7/2001 [the Veteran] denied and joint symptoms, numbness tinkling. 2005 reported some right elbow numbness and tingling (post-service), 2015 report elbow pain and numbness (post-service). The records are silent for evidence in the veteran's service treatment records to show that chronic symptoms began in service or manifested within one year of veterans discharge from service. Therefore, it is my medical opinion that the veteran's current diagnosis of right upper extremity radiculopathy is less likely than not (less than 50 percent probability) Incurred in or caused by the service treatment records during service. Due to post-service neck injury or overuse."

The Board finds these opinions to be probative as they provide a clear rationale and sufficient explanation. Additionally, the opinion considers a chronic condition. As such, the Board assigned great probative weight to the July 2022 opinion. Nieves-Rodrigues v Peake, 22 Vet. App. 295 (2008).

The Board has considered the Veteran's general statements purporting to relate his radiculopathy to service. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder of radiculopathy. Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that required a medical opinion to diagnose and to relate to service). Radiculopathy is a medically complex disease process because of its multiple possible etiologies and manifest symptomatology that may overlap with other disorders. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (holding that rheumatic fever is not a condition capable of lay diagnosis).

Additionally, the Veteran's contentions are outweighed by the opinion of the VA examiner who reviewed his service records, recognized his radiculopathy, but still concluded that the Veteran's radiculopathy is related to a post-service injury or overuse. As the only medical opinion of record addressing the etiology of the Veteran's current radiculopathy is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor.

For these reasons, the Board finds that the weight of the evidence is against the claim for service connection for left and right upper extremity radiculopathy, and the claims must be denied. Because the weight of the evidence is against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for service connection for left upper extremity radiculopathy is denied. Likewise, the claim for service connection for right upper extremity radiculopathy is denied.
Veteran's current radiculopathy is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor.

Entitlement to service connection for a right ankle injury.

The Veteran asserts that his right ankle injury is the result of military service and service connection is warranted.

A review of the Veteran's STRs show the Veteran sought medical treatment in October 2002 for right foot pain after he slipped down the stairs. The Veteran was diagnosed with right ankle sprain. The Veteran's record shows the Veteran refused to go for x-rays, refused all treatment and did not comply with the medical recommendations. The remainder of the Veteran's STRs are silent for any complaint, diagnosis or treatment for his right ankle.

The record does not show the Veteran sought post-service VA healthcare.

During post-service private medical treatment, the Veteran reported he had surgery to his left ankle 2010 for a fracture, however, the Veteran did not report, complain or otherwise seek treatment for his right ankle. See Norton Healthcare.

The Veteran was afforded a July 2022 VA ankle examination. The VA examiner noted there was no current diagnosis associated with any claimed right ankle condition. The VA examiner noted no subjective or objective evidence to support a diagnosis of the claimed right ankle injury diagnosis or pain. The Veteran reported onset of right ankle pain in 2000. The Veteran reported he had right ankle pain two to three times a week and reported it hurt maybe two to three hours when it does hurt. The VA examiner noted the Veteran had no functional impact from the claimed right ankle condition.

In a separate July 2022 medical opinion, the VA examiner opined that the claimed right ankle condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that on May 7, 2001, the Veteran "denied and joint symptoms, numbness tingling. 10/6/2002 did twist his right ankle, DATE: January 18, 2014. Ankle sprain. X-ray showed swelling but no breaks. However, no subjective or objective evidence to support diagnosis of the claimed RIGHT ANKLE INJURY or diagnosis or pain, therefore, no nexus can be made at this time."

After reviewing all of the evidence of record, the Board finds that the entirety of the probative medical evidence fails to demonstrate that the Veteran was diagnosed with a medical condition manifesting as a right ankle disorder and these claims cannot be granted. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). The Board notes that the Veteran was diagnosed with a sprain in 2002, however, the record does not show that the Veteran has a current diagnosis or condition. In the absence of any evidence that the Veteran actually has a right ankle disorder, the first element required for service connection - the existence of a present disability has not been met, and service connection is not warranted. Additionally, the U.S. Court of Appeals for Veterans Claims (Court) has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Because the record does not show a diagnosis of a right ankle disorder, service connection is not warranted.

For these reasons, the Board finds that the evidence weighs persuasively against the claim for service connection of a right ankle disorder as the Veteran has not been diagnosed with a right ankle disorder. Because the evidence weighs substantially against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for service connection of a right ankle injury is denied.

REASONS FOR REMAND

Entitlement to
mer v. Derwinski, 3 Vet. App. 223, 225 (1992). Because the record does not show a diagnosis of a right ankle disorder, service connection is not warranted.

REASONS FOR REMAND

Entitlement to service connection for head injury.

The Veteran asserts that service connection is warranted for his claimed head injury.

A review of the Veteran's STRs show the Veteran sought treatment in February 2000 for complaints of a head injury and neck pain. While the record is unclear, it appears that the Veteran was diagnosed with a concussion and cervical strain. The Veteran continued follow-up treatment and was observed to have improved later in February 2000. The remainder of the Veteran's STRs are silent for any complaints, diagnosis or treatment of his head or head injury.

VA must provide a VA medical examination or medical opinion when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The third element, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be associated with the established event, is a low threshold. Id. at 83.

The Veteran has not been afforded a VA examination regarding the claimed head injury. As such, the Board finds that an examination is necessary in order to assist in determining the nature and etiology of this claimed condition. See McLendon, 20 Vet. App. 81.

Under the Appeals Modernization Act (AMA), the Board must remand to the AOJ/RO to correct pre-decisional duty to assist errors (including when the AOJ/RO failed to make reasonable efforts to obtain VA treatment records or relevant federal or private treatment records, failed to obtain a VA examination, or provided an inadequate VA examination or opinion). Additionally, the Board must remand for any pre-decisional error on the part of the AOJ/RO to satisfy its duties under 38 U.S.C. § 5103A and may remand for correction of any other error by the AOJ/RO in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802 (a).

For the above reasons, a remand is warranted for a new opinion to cure a pre-decisional duty to assist error.

Entitlement to right hip strain, to include as secondary to right ankle.

The Veteran asserts that his right hip strain is the result of his right ankle disorder.

A review of the Veteran's STRs show the Veteran complained of right foot pain in October 2002 and was diagnosed with a right ankle sprain. The Veteran refused to go for x-rays, attend follow up treatment or comply with recommendations. However, his STRs showed a diagnosis of right ankle sprain.

The Veteran was afforded a July 2022 VA hip examination. The VA examiner noted a diagnosis of right hip strain. The Veteran reports onset in 2010 and that after his back started to hurt, he started to have right hip pain that got worse through the week. The Veteran reported no direct injury to the hip. The VA examiner noted the Veteran's functional impairment was described as "difficulty to bend, walking, running, walking up and down stairs, lifting, squatting, or standing for long periods. Difficulty squatting, bending tying shoe, putting sock and shoes on."

In a separate July 2022 medical opinion, the VA examiner opined that the claimed right hip condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that on "May 7, 2001 [the Veteran] denied and joint symptoms, numbness tingling. 2013 veteran reports his pain this was well after services. The records are silent for evidence in
no direct injury to the hip. The VA examiner noted the Veteran's functional impairment was described as "difficulty to bend, walking, running, walking up and down stairs, lifting, squatting, or standing for long periods. Difficulty squatting, bending tying shoe, putting sock and shoes on."

In a separate July 2022 medical opinion, the VA examiner opined that the claimed right hip condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that on "May 7, 2001 [the Veteran] denied and joint symptoms, numbness tingling. 2013 veteran reports his pain this was well after services. The records are silent for evidence in the veteran's service treatment records to show that chronic symptoms began in service or manifested within one year of veterans discharge from service. Therefore, it is my medical opinion that the veteran's current diagnosis of right hip strain is less likely than not (less than 50 percent probability) incurred in or caused by the service treatment records during service. More likely due to post-service injury or overuse."

While the VA examiner provided an opinion regarding direct service connection, the Veteran claimed his right hip was secondary to his right ankle and the VA examiner did not provide a sufficient opinion to address the Veteran's claim.

Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v Brown, 5 Vet. App. 458, 461 (1993). Accordingly, the Board finds a pre-determination duty to assist error and a remand is required for an adequate VA examination and opinion. Here, the VA examiner did not provide a secondary service connection opinion for the Veteran's claimed right hip strain.

For the above reasons, a remand is warranted for a new opinion to cure a pre-decisional duty to assist error.

Entitlement to service connection for a left ankle injury.

The Veteran asserts that service connection is warranted for his left ankle injury.

A review of the Veteran's STRs are silent for any complaints, diagnosis or treatment for the Veteran's left ankle.

The record does not show the Veteran sought post-service VA healthcare.

During post-service private medical treatment, the Veteran reported he had surgery to his left ankle in 2010 for a fracture. The remainder of the Veteran's post-service private treatment records are silent for any complaint, diagnosis or treatment for the Veteran's left ankle. See Norton Health Care.

The Veteran claimed service connection for a left ankle injury in an April 2022 VA form 526. The Veteran was afforded a July 2022 VA ankle examination where the VA examiner noted there was no diagnosis for the Veteran's right ankle. The VA examiner noted the Veteran's left ankle was "unclaimed joint is damaged," however, the examiner did not examine the Veteran's left ankle.

Under the Appeals Modernization Act (AMA), the Board must remand to the AOJ/RO to correct pre-decisional duty to assist errors (including when the AOJ/RO failed to make reasonable efforts to obtain VA treatment records or relevant federal or private treatment records, failed to obtain a VA examination, or provided an inadequate VA examination or opinion). Additionally, the Board must remand for any pre-decisional error on the part of the AOJ/RO to satisfy its duties under 38 U.S
App. 458, 461 (1993). Accordingly, the Board finds a pre-determination duty to assist error and a remand is required for an adequate VA examination and opinion for the Veteran's claimed left ankle injury.

For the above reasons, a remand is warranted for a new opinion to cure a pre-decisional duty to assist error.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination to determine the current nature and likely etiology of the Veteran's claimed head injury. The contents of the entire electronic claims file, to include a copy of this REMAND, must be made available to the medical specialist, and the medical opinion should reflect full consideration of the Veteran's documented medical history and lay assertions.

(a.) The examiner should identify all diagnoses associated the claimed head injury.

(b.) For each diagnosis, the examiner should opine whether any identified head injury is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to an in-service event or injury, to include the February 2000 fall.

(c.) In providing the requested opinion, the examiner should consider the Veteran's reported symptoms in service and thereafter, including the nature of the Veteran's reported disease and the onset, progression and severity of the reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of the current disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?

2. Obtain an opinion from an appropriate clinician in which the examiner is to address the nature and etiology of the Veteran's claimed right hip strain. The examiner is to review the claims file, including all lay and medical evidence. The examiner is to specifically provide an opinion for the following:

(a.) Whether any identified right hip strain is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) caused by (proximately due to or the result of) the Veteran's right ankle disorder.

(b.) Whether any identified right hip strain is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated by of the right ankle disorder.

**The examiner is advised that aggravation of the cervical spine disorder need NOT be permanent, and as such should consider any incremental increase in severity. See Ward v. Wilkie, 31 Vet. App. 233 (2019).

3. Schedule the Veteran for a VA examination to determine the current nature and likely etiology of the Veteran's claimed left ankle injury. The contents of the entire electronic claims file, to include a copy of this REMAND, must be made available to the medical specialist, and the medical opinion should reflect full consideration of the Veteran's documented medical history and lay assertions.

(a.) The examiner should identify all diagnoses associated the claimed left ankle injury.

(b.) For each diagnosis, the examiner should opine whether any identified left ankle injury is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to an in-service event or injury.

**The examiner is to specifically consider the post-service 2010 surgical repair of a left ankle fracture as reported by the Veteran.

4. A complete and detailed rationale for all opinions must be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she must make clear that he or she has considered all procurable data, but any member of the medical community at large could not provide such an opinion without resorting to speculation. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not
specifically consider the post-service 2010 surgical repair of a left ankle fracture as reported by the Veteran.

5. After ensuring full compliance with this remand, readjudicate the claim on appeal.

Danette Mincey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Melnyk, H.

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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