TINNITUS

DELYVONNE M. WHITEHEAD · 2026 · Case ID: A26037484

MIXED

Summary

The Veteran, an Air Force Veteran who served from March 1985 to November 2007, appeals the denial of service connection for right ear hearing loss and an increased rating for left ear hearing loss, as well as the denial of an increased rating for left knee strain. The Board found favorable AOJ findings that the Veteran has a current right ear hearing loss and experienced in-service noise exposure. Despite conflicting VA opinions on the nexus for right ear hearing loss, the Board found one VA opinion adequate, noting that normal hearing at separation does not preclude service connection. The Board granted service connection for right ear hearing loss, applying the benefit of the doubt. For bilateral hearing loss, the Board recharacterized the appeal to include both ears and, based on March 2025 audiological testing showing specific hearing loss levels, granted a 10 percent disability rating for bilateral hearing loss from March 21, 2025. Regarding the left knee strain, the Veteran sought an increased rating. The Board reviewed range of motion findings from multiple VA examinations, noting that the Veteran's left knee flexion was 125 degrees and extension was 0 degrees, with pain on motion. However, the Board found that the Veteran did not meet the criteria for a higher rating based on limitation of motion or painful motion, as he was already receiving a 10 percent rating for painful motion and did not meet the specific range of motion thresholds for higher ratings. The Board denied an increased rating for the left knee strain.

Rationale

Favorable AOJ findings for present disability and in-service incurrence.; Adequate VA opinion found relating hearing loss to service.; Benefit of the doubt applied in favor of the Veteran.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250824-579229

Full Decision Text

Citation Nr: A26037484
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 250824-579229
DATE: April 22, 2026

ORDER

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

Entitlement to a 10 percent disability rating, but no higher, for bilateral hearing loss, from March 21, 2025, is granted.

Entitlement to a compensable disability rating for left knee strain, limitation of extension, is denied.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, he is found to have a current right ear hearing loss disability that as likely as not is related to service.

2. From March 21, 2025, the Veteran's bilateral hearing has been manifested by hearing acuity of Level III in the right ear and Level IV in the left ear.

3. The Veteran's left knee strain does not manifest extension limited to 5 degrees. He has not been found to have any ankylosis, subluxation, lateral instability, condition of the patellofemoral complex with recurrent instability, meniscal conditions, or other knee impairment.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for right ear hearing loss have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

2. The criteria for a 10 percent disability rating for bilateral hearing loss has been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

3. The criteria for Entitlement to a compensable disability rating for left knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5260, 5261.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from March 1985 to November 2007.

This matter comes before the Board of Veterans' Appeals (Board) from a March 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), the Agency of Original Jurisdiction (AOJ), that denied an increased rating for left knee strain, and an April 2025 AOJ decision that denied service connection for right ear hearing loss and an increased rating for left ear hearing loss. In August 2025, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal, in which he elected the Direct review docket.

The Board may only consider the evidence of record at the time of the March 2025 AOJ decision on appeal regarding left knee strain and the April 2025 AOJ decision regarding bilateral hearing loss. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 rating 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.

As this case is being decided under VA's modernized appeal system, pursuant to the Appeals Modernization Act (known as the AMA), the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. The relevant favorable findings identified in the April 2025 decision were that participation in a toxic exposure risk activity (TERA) is conceded, the Veteran was exposed to a high level of noise in service, and he has a present diagnosis of right ear hearing loss, as of April 8, 2025. The Board is bound by these favorable findings. 38 C.F.R. § 3.104.

1. Right Ear Hearing Loss

The Veteran has requested service connection for right ear hearing loss, which he contends began in service.

Generally, service connection may be granted for
Modernization Act (known as the AMA), the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. The relevant favorable findings identified in the April 2025 decision were that participation in a toxic exposure risk activity (TERA) is conceded, the Veteran was exposed to a high level of noise in service, and he has a present diagnosis of right ear hearing loss, as of April 8, 2025. The Board is bound by these favorable findings. 38 C.F.R. § 3.104.

1. Right Ear Hearing Loss

The Veteran has requested service connection for right ear hearing loss, which he contends began in service.

Generally, service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§1110, 1131; 38 C.F.R. §3.303(a). Service connection requires evidence satisfying three criteria: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Favorable findings from the April 2025 AOJ rating decision on appeal establish that the Veteran has a present right ear hearing loss disability and in-service incurrence or aggravation of that disability. Therefore, the first two elements for service connection have been met and the only question is that of nexus.

In September 2022, the Veteran attended a VA examination to assess the nature and etiology of his right ear hearing loss. The examiner found that the Veteran had sensorineural hearing loss but did not give an opinion regarding etiology. In an October 2022 addendum opinion, the examiner opined that the right ear hearing loss was less likely than not incurred in or caused by in-service noise exposure because "no significant threshold shifts were recorded in the right ear during service."

The Board finds this medical opinion to be inadequate. While a VA examiner can consider in-service audiology test results in forming an opinion, normal hearing limits on separation from service does not, on its own, preclude establishing service connection for hearing loss. Hensley v. Brown, 5 Vet. App. 155 (1993).

In November 2023, the Veteran attended a second VA medical examination for his right ear. The examiner also found that the Veteran had sensorineural hearing loss and found that it was as likely as not related to his in-service noise exposure. The examiner reasoned that because no hearing test was administered at the time of discharge, and given the amount of noise exposure in service, it is as likely as not that the Veteran's right ear hearing loss was caused by that noise exposure. The Board finds this medical opinion to be adequate, competent evidence on the nexus question. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The Board notes that at the time of this examination, the Veteran did not meet the criteria for right ear hearing loss for VA purposes. However, the Veteran later met this standard in April 2025, as seen in the favorable findings above.

In March 2025, the Veteran attended a third VA medical examination for his right ear hearing loss. Here, the examiner found sensorineural hearing loss but found to was less likely than not related to the in-service noise exposure. The examiner reasoned that because the Veteran did not show hearing loss under VA guidelines until after discharge from service, the hearing loss cannot be caused by an event in service. The Board finds this opinion inadequate because the examiner failed to give a medically based rationale for this opinion and did not explain why the Veteran's hearing loss could not have met VA criteria after discharge from service.

In April 2025, this examiner participated in a second VA examination with the Veteran and gave the same opinion as the March 2025 examination. The Board also finds this opinion inadequate. The examiner also opined whether the Veteran's in-service TERA caused his right ear hearing loss. Even though the prompted question was different, this examiner gave the same rationale from the March 2025 opinion. Therefore, the Board also finds this opinion inadequate.

In sum, the Veteran has a current diagnosis of right ear hearing loss that has been related by competent medical evidence to service. Entitlement to service connection for right ear hearing loss is granted. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) ("By requiring only an 'approximate balance of positive and negative evidence' the Nation, 'in recognition of our debt to our veterans,' has
Board also finds this opinion inadequate. The examiner also opined whether the Veteran's in-service TERA caused his right ear hearing loss. Even though the prompted question was different, this examiner gave the same rationale from the March 2025 opinion. Therefore, the Board also finds this opinion inadequate.

2. Bilateral Hearing Loss

The Veteran has requested a higher disability rating for his bilateral hearing loss. Originally, because the Veteran was only service connected for left ear hearing loss, he had requested an increased rating for the left ear. However, because he has now been service connected for the right ear as well, the issue has been recharacterized to include both ears.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity. 38 C.F.R. § 4.10; See Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100.

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).

The Veteran attended VA medical examinations to assess his bilateral hearing loss in October 2016, December 2019, September 2022, and November 2023. At each examination, the Veteran's hearing loss amounted to a 0 percent disability rating.

However, the results of audiological testing at the March 2025 VA examination show that the Veteran had a Puretone threshold average of 38 for the right ear, and 56 for the left ear. Speech recognition testing using the Maryland CNC test revealed speech recognition ability of 56 percent in the right ear and 68 percent in the left ear. Application of these findings to Table VII corresponds to a 10 percent evaluation considering the Roman Numeral designation of Level III in the right
The Veteran attended VA medical examinations to assess his bilateral hearing loss in October 2016, December 2019, September 2022, and November 2023. At each examination, the Veteran's hearing loss amounted to a 0 percent disability rating.

However, the results of audiological testing at the March 2025 VA examination show that the Veteran had a Puretone threshold average of 38 for the right ear, and 56 for the left ear. Speech recognition testing using the Maryland CNC test revealed speech recognition ability of 56 percent in the right ear and 68 percent in the left ear. Application of these findings to Table VII corresponds to a 10 percent evaluation considering the Roman Numeral designation of Level III in the right ear and Level IV in the left ear. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown.

Based on the foregoing, the Board concludes that the Veteran's bilateral hearing loss warrants a rating of 10 percent disability rating from March 21, 2025.

3. Left Knee Strain

The Veteran has requested an increased disability rating for the left knee limitation of extension. He is currently in receipt of a noncompensable (0 percent) disability rating, effective August 22, 2024.

Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluations will be assigned if the disability more closely approximates the criteria required for that rating. 38 C.F.R. § 4.7.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually 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.

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. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016).

Range of motion of the knee is measured in flexion and extension. For VA purposes, a normal range of knee motion is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. A limitation of flexion of the leg allows for a 10 percent evaluation when it is limited to 45 degrees, and a 20 percent evaluation when it is limited to 30 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. A limitation of leg extension is evaluated as 10 percent disabling when extension is limited to 10 degrees, and it is 20 percent disabling when extension is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

Separate ratings for knee disabilities may be assigned for disability of the same joint if none of the symptomatology on which each rating is based is duplicative or overlapping. See VAOPGCPREC 9-04 (2004); 69 Fed. Reg. 59,990 (2004); 38 C.F.R. § 4.14.

Evalu
C.F.R. § 4.71a, Diagnostic Code 5260. A limitation of leg extension is evaluated as 10 percent disabling when extension is limited to 10 degrees, and it is 20 percent disabling when extension is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

Evaluations for knee impairment can also be assigned due to ankylosis, recurrent subluxation or lateral instability, malunion/nonunion of the tibia and fibula, symptomatic removal of the cartilage, dislocated semilunar cartilage, or genu recurvatum. The Veteran has not at any time during the appellate term been found to have these disorders; these diagnostic codes are therefore not applicable and will not be further discussed. See 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5257, 5258, 5259, 5262, 5263.

The Veteran most recently attended a VA examination in March 2025. The Veteran reported that his left knee condition began in 1997, and that the pain has worsened over the years and he treats it with NSAIDS, rest, ice, heat, and elevation. He reported no flare ups but noted that he has functional loss in the form of pain with climbing stairs, running, squatting, walking over a mile, kneeling, doing yard work, and doing household chores.

Range of motion testing found right and left knee flexion to 125 degrees, and extension to 0 degrees. There was pain with weight-bearing, nonweight-bearing, active motion, and passive motion, as well as functional loss with the above mentioned actions. There was no crepitus or tenderness with palpation. After repetitive motion, flexion was to 140 degrees, and extension was unchanged. With repeated use over time, for both knees, flexion would be to 100 degrees, and extension would be to 0 degrees. With flare ups, flexion would be to 140 degrees, and extension would be to 0 degrees. There was no ankylosis, muscle atrophy, recurrent subluxation, recurrent dislocation, or recurrent effusion. There was no persistent instability or patellar instability, and no history of a ligament tear. There were no meniscal conditions, and the Veteran did not use an assistive device.

After reviewing all of the evidence of record, the Board finds that a rating higher than 10 percent for left knee strain based on painful limitation of motion is not warranted, nor are any higher ratings warranted based on limitation of flexion or extension. See 38 C.F.R. § 4.71a, Diagnostic Code 5261. The Veteran has never been found to have flexion limited to 45 degrees or extension limited above 10 degrees, even when considering painful motion, repetitive motion, and flare ups. Compensable ratings are therefore not warranted based on the reduction or extension under Diagnostic Codes 5260 and 5261.

The Board also does not find that a higher rating than 10 percent is warranted due to painful motion. This is because the Veteran is already in receipt of a 10 percent rating for left knee limitation of flexion due to painful motion. The Veteran's left knee is one joint. 38 C.F.R. § 4.45(f). As such, he is entitled to a single rating under 38 C.F.R. § 4.59 for painful motion of the knee when no compensable rating is otherwise warranted. He is not entitled to ratings under 38 C.F.R. § 4.59 for each limitation of motion Diagnostic Code pertaining to the knee. A claimant receives the minimally compensable rating for painful motion under 38 C.F.R. § 4.59 once per joint when he or she does not meet the range of motion criteria for a limitation of motion rating. Estevez v. McDonough, 36 Vet. App. 157, 173 (2023).

For the foregoing reasons, the weight of the persuasive evidence is against assigning any ratings higher than those already assigned for the Veteran's left knee strain disabilities. The evidence is not in approximate balance, and the benefit-of-the-doubt rule does not apply. See Lynch, 21 F. 4th 776.

Signature on the next page

DELYVONNE M. WHITEHEAD

Veterans Law Judge

Board

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