Case A26037742

S. SORATHIA · 2026 · Case ID: A26037742

MIXED

Summary

The veteran, who served in the United States Marine Corps from July 1998 to June 2011, appeals the denial of service connection for right and left ankle conditions, and the grant of service connection for left hip bursitis, right hip bursitis, headaches, and tinnitus. The veteran claimed the ankle and hip conditions were secondary to his service-connected lumbar spine disability and bilateral lower extremity radiculopathy, and the headaches were secondary to his service-connected left eye keratitis. The Board denied the ankle claims, finding no current disability or functional impairment, and thus no duty to provide an examination. For the hip conditions, the Board found the March 2021 VA opinion inadequate, as it did not adequately address causation or aggravation from the service-connected lumbar spine disability. However, a private opinion from August 2025 found it was at least as likely as not that the hip bursitis was proximately due to the lumbar spine disability, which the Board found highly probative. Therefore, service connection for left and right hip bursitis was granted on a secondary basis, with the benefit of the doubt afforded. For headaches, a private opinion also found it at least as likely as not that the headaches were proximately due to the service-connected left eye keratitis, leading to a grant of service connection. For tinnitus, the Board found the veteran's MOS in Logistics indicated hazardous noise exposure, and his testimony regarding tinnitus onset during service was presumed credible. Despite a negative VA opinion, a private opinion found the tinnitus was at least as likely as not directly due to acoustic trauma, leading to a grant of service connection with the benefit of the doubt. The claims for left knee, right knee, and left shoulder conditions were remanded due to inadequate VA medical opinions regarding secondary service connection and aggravation.

Rationale

No current diagnosis or functional impairment of the right ankle.; Service treatment records do not indicate complaints, diagnoses, or treatments for right ankle impairment.; VA examination showed normal strength and reflexes in the right ankle.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210712-171478

Full Decision Text

Citation Nr: A26037742
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 210712-171478
DATE: April 22, 2026

ORDER

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

Entitlement to service connection for a left ankle condition is denied.

Entitlement to service connection for left hip bursitis as secondary to lumbar disc degeneration is granted.

Entitlement to service connection for right hip bursitis as secondary to lumbar disc degeneration is granted.

Entitlement to service connection for headaches as secondary to left eye keratitis is granted.

Entitlement to service connection for tinnitus is granted.

REMANDED

Entitlement to service connection for a left knee condition, diagnosed as osteoarthritis, is remanded.

Entitlement to service connection for a right knee condition, to include right knee pain, is remanded.

Entitlement to service connection for a left shoulder condition, diagnosed as left shoulder strain, is remanded.

FINDINGS OF FACT

1. The persuasive evidence is against finding the Veteran has a current right ankle condition that results in functional impairment of earning capacity sufficient to warrant characterization as a current disability that may be service-connected.

2. The persuasive evidence is against finding the Veteran has a current left ankle condition that results in functional impairment of earning capacity sufficient to warrant characterization as a current disability that may be service-connected.

3. The persuasive evidence is in approximate balance that the Veteran's current left hip bursitis diagnosis is due to or the result of his service-connected lumbar spine disability.

4. The persuasive evidence is in approximate balance that the Veteran's current right hip bursitis diagnosis is due to or the result of his service-connected lumbar spine disability.

5. The persuasive evidence indicates that the Veteran's current headaches condition is due to or the result of his service-connected left eye keratitis disability.

6. Affording the Veteran the benefit of the doubt, his current tinnitus had its initial onset during service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a right ankle condition have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for entitlement to service connection for a left ankle condition have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to service connection for left hip bursitis have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for entitlement to service connection for right hip bursitis have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for entitlement to service connection for a headaches condition have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107(b); 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 Marine Corps from July 1998 to June 2011.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2021 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO).

On his July 2021 VA Form 10182 (Notice of Disagreement), the Veteran elected the Hearing docket. In May 2025 the Veteran, through his authorized representative, withdrew his request for a Board hearing. 38 C.F.R. § 20.704(e). Because the Veteran withdrew his hearing request, in addition to the evidence considered by the agency of original jurisdiction (AOJ) prior to the March 2021 rating decision, the Board may only consider evidence submitted within 90 days of the Board's receipt of the May 2025 hearing withdrawal. 38 C.F.R. § 20.302(a), (b).

During the 90-day period following the scheduled hearing, the Veteran's authorized representative submitted additional evidence which will be considered by the Board in the adjudication of these matters.

cket. In May 2025 the Veteran, through his authorized representative, withdrew his request for a Board hearing. 38 C.F.R. § 20.704(e). Because the Veteran withdrew his hearing request, in addition to the evidence considered by the agency of original jurisdiction (AOJ) prior to the March 2021 rating decision, the Board may only consider evidence submitted within 90 days of the Board's receipt of the May 2025 hearing withdrawal. 38 C.F.R. § 20.302(a), (b).

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims of entitlement to service connection for left knee, right knee, and left shoulder conditions, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017).

Service Connection

Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1166 (Fed. Cir. 2004); 38 C.F.R. § 3.303(a).

Disorders diagnosed after discharge will still be service-connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

Service connection may be established on a secondary basis for a disability which is caused or aggravated by a service-connected disability.? Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. ?Allen v. Brown, 7?Vet. App.?439, 448 (1995) (en banc).

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for a right ankle condition

2. Entitlement to service connection for a left ankle condition

The Veteran contends he has right ankle and left ankle conditions that are secondary to his service-connected bilateral pes planus disabilities. See July 2020 VA Form 526EZ Fully Developed Claim. Since the Veteran does not allege direct service connection, nor does the record raise this theory of entitlement, the Board will restrict its analysis to secondary service connection only.

The record does not reflect any right ankle or left ankle diagnoses. Thus, the Board must first determine whether the Veteran meets the threshold element of a claim for service connection; that is, the presence of a current disability.

The Federal Circuit held in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), that where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability.

Here, muscle strength testing during the August
VA Form 526EZ Fully Developed Claim. Since the Veteran does not allege direct service connection, nor does the record raise this theory of entitlement, the Board will restrict its analysis to secondary service connection only.

Here, muscle strength testing during the August 2011 VA medical examination for back conditions revealed normal strength in the Veteran's right ankle and left ankle plantar flexion and dorsiflexion. Furthermore, reflex and sensory testing was normal for the Veteran's right and left ankles. See August 2011 VA Examination.

At the July 2012 VA medical examination for foot conditions, the examiner denied the Veteran demonstrated dorsiflexion and varus deformity that resulted in any limitation of the Veteran's bilateral ankle dorsiflexion. See July 2012 VA examination.

Furthermore, VA treatment records do not indicate any complaints, diagnoses, or treatments for right ankle or left ankle impairment, to include pain.

In light of the foregoing, the claims for service connection for right ankle and left ankle conditions are denied. The persuasive evidence is against finding that the Veteran has a right ankle or a left ankle condition that results in functional impairment of earning capacity sufficient to warrant characterization as a current disability that may be service-connected. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In absence of proof of a present disability there can be no valid claim.").

The Board acknowledges that the Veteran has not been afforded a VA medical examination for his claimed right ankle and left ankle conditions. However, an examination is not warranted for these specific claims as the duty to assist has not been triggered. McLendon v. Nicholson, 20 Vet. App. 79 (2006). There is no indication of any functional impairment of earning capacity caused by a current right ankle or left ankle condition, to include pain, that can be service-connected, nor a link between any current symptomatology and the Veteran's service-connected bilateral pes planus. As such the Veteran's broad and conclusory statements that he has right ankle and left ankle conditions that are proximately due to or aggravated by his service-connected bilateral pes planus disabilities are not sufficient to trigger VA's obligation to obtain an examination or opinion. See Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (holding that conclusory lay assertion of nexus is insufficient to entitle claimant to provision of VA medical examination).

The claims for service connection are denied. Here the evidence is neither evenly balanced nor approximately so with regard to whether the Veteran demonstrates current right ankle or left ankle conditions that can be service-connected. Rather, the evidence weighs against the claim.

On this record, the evidence that can be considered for this appeal was not in approximate balance and therefore the benefit of the doubt rule does not apply. See 38?U.S.C. §?5107(b); Lynch v. McDonough, 21 F.4th 776 (2021) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

3. Entitlement to service connection for a left hip condition

4. Entitlement to service connection for a right hip condition

The Veteran contends he has current left hip and right hip conditions that are associated with his service-connected lumbar disc degeneration and bilateral lower extremity radiculopathy disabilities. See July 2020 VA Form 526EZ Fully Developed Claim.

Affording the Veteran the benefit of the doubt, the Board finds that all three elements of service connection on a secondary basis are established by the competent and credible lay and medical evidence of record. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

The Veteran has a current diagnosis of bilateral trochanteric bursitis. See March 2021 C&P Exam.

Service-connected compensation is in effect for lumbar disc degeneration with
eneration and bilateral lower extremity radiculopathy disabilities. See July 2020 VA Form 526EZ Fully Developed Claim.

The Veteran has a current diagnosis of bilateral trochanteric bursitis. See March 2021 C&P Exam.

Service-connected compensation is in effect for lumbar disc degeneration with bulging disc (lumbar spine disability) and for bilateral lower extremity radiculopathy.

At the March 2021 VA medical examination for hip conditions, the Veteran reported the onset of increased pain in both hips, to include flareups with prolonged walking, standing, sitting, and squatting. The VA examiner opined the Veteran's bilateral trochanteric bursitis conditions were less likely than not proximately due to or the result of the Veteran's service-connected lumbar spine disability to include associated bilateral lower extremity radiculopathy because bursitis can result from an injury or overuse and thus was less likely attributable to the Veteran's service-connected lumbar spine disability. See March 2021 C&P Exam.

The Board finds this opinion does not adequately address whether the Veteran's service-connected lumbar spine disability caused or aggravated the Veteran's bilateral hip conditions because although the examiner provided examples of causes for trochanteric bursitis, the examiner did not adequately explain how the Veteran's lay statements regarding flareups with overuse did not support his contention that his service-connected lumbar spine disability caused or aggravated his bilateral hip trochanteric bursitis. Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (holding that an adequate medical examination is one that is based on consideration of veteran's prior medical history and describes his or her condition with a level of detail sufficient to allow the Board to make a fully informed decision on the relevant medical question). Furthermore, the VA examiner did not provide an opinion on whether the Veteran's service-connected lumbar spine disability aggravated his current bilateral hip conditions. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013) (stating that a secondary service connection medical opinion was inadequate because it did not discuss aggravation). Thus, the Board concludes that the March 2021 VA opinion is inadequate to adjudicate the claim.

In an August 2025 private opinion, Dr. T.W. reviewed the Veteran's entire claims file and opined that it was at least as likely as not that the Veteran's current bilateral trochanteric bursitis conditions were proximately due to or the result of the Veteran's service-connected lumbar spine disability because his service-connected lumbar spine and sciatic dysfunction disabilities led to abnormal lumbopelvic control and compensatory gait patterns that overloaded the Veteran's gluteal tendon-trochanteric complex. See August 2025 Medical Treatment Record - Non-Government Facility.

The Board finds this opinion highly probative. The examiner based her opinion on a review of the available records, her particular expertise, and a review of medical literature to support her conclusion of a clinical relationship between the Veteran's service-connected lumbar spine disability and the onset of the Veteran's bilateral hip deficits. See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding whether a service-connected disability caused or aggravated a non-service-connected disability should be broadly construed under a "but-for" analysis). The Board concludes that the private August 2025 opinion is adequate to adjudicate the claim. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (stating that "The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion.").

In light of the foregoing, and affording the Veteran the benefit of the doubt, the persuasive evidence is in approximate balance that the Veteran's current left hip bursitis and right hip bursitis diagnoses are due to or the result of his service-connected lumbar spine disability.

The claims for service connection for left hip bursitis and right hip bursitis are granted on a secondary basis. 38 C.F.R. §§ 3.102, 3.303; 3.310; Allen v. Brown
(stating that "The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion.").

The claims for service connection for left hip bursitis and right hip bursitis are granted on a secondary basis. 38 C.F.R. §§ 3.102, 3.303; 3.310; Allen v. Brown, 7?Vet. App.?439 (1995).

Entitlement to service connection for headaches

The Veteran contends his current headaches condition is associated with his service-connected left eye keratitis disability. See July 2020 VA Form 526EZ Fully Developed Claim.

In the March 2021 rating decision, the RO found that the Veteran has a current diagnosis of headaches. The Board is bound by this favorable finding absent a finding of clear and unmistakable error. See 38 C.F.R. § 3.104(c).

Service-connected compensation is in effect for left eye keratitis.

In an August 2025 private opinion, Dr. T.W. reviewed the Veteran's entire claims file and opined that it was at least as likely as not that the Veteran's current headaches condition was proximately due to or the result of his service-connected left eye keratitis disability because his left eye keratitis demonstrated surface irregularity and scarring, decreased optical degradation, and inflammation that led to an increase in recurrent headaches. See August 2025 Medical Treatment Record - Non-Government Facility.

The Board finds this opinion highly probative. As noted above, the examiner based her opinion on a review of the available records, her particular expertise, and a review of medical literature to support her conclusion of a clinical relationship between the Veteran's service-connected left eye keratitis disability and the increased recurrence of his headaches. See Spicer v. McDonough, supra. The Board concludes that the private August 2025 opinion is adequate to adjudicate the claim. See Nieves-Rodriguez v. Peake, supra.

In light of the foregoing, the persuasive evidence indicates that the Veteran's current headaches condition is due to or the result of his service-connected left eye keratitis disability.

The claim for service connection for headaches is granted on a secondary basis. 38 C.F.R. §§ 3.102, 3.303; 3.310; Allen v. Brown, 7?Vet. App.?439 (1995).

5. Entitlement to service connection for tinnitus

Tinnitus is defined as a ringing in the ears, and it is a disorder that is uniquely identifiable by the senses of the person experiencing it. It is a condition that is "simple" in nature in that respect, and thus, is a disability that can be diagnosed by the person experiencing the condition. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). That is, the confirmation of the existence of tinnitus does not require any medical expertise (i.e. is not "complex" in nature), and assuming the allegations of the Veteran are credible, testimonial evidence of an origin of the condition in service can be used to support a claim for service connection.

Furthermore, tinnitus, as an organic disease of the nervous system, is considered a "chronic" disease under?38 C.F.R. § 3.309(a). Therefore, the presumptive service connection provisions based on "chronic" in-service symptoms and "continuous" post-service symptoms under provisions 38 C.F.R. § 3.303(b) apply. Walker v. Shinseki,?708 F.3d 1331?(Fed. Cir. 2013); Fountain v. McDonald, 27?Vet. App.?258 (2015). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service.

In the March 2021 rating decision, the RO found that the Veteran's military occupational specialty (MOS
3.309(a). Therefore, the presumptive service connection provisions based on "chronic" in-service symptoms and "continuous" post-service symptoms under provisions 38 C.F.R. § 3.303(b) apply. Walker v. Shinseki,?708 F.3d 1331?(Fed. Cir. 2013); Fountain v. McDonald, 27?Vet. App.?258 (2015). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service.

In the March 2021 rating decision, the RO found that the Veteran's military occupational specialty (MOS) in Logistics was a qualifying event, injury, or disease and that the Veteran had a current diagnosis of tinnitus per the January 2021 VA audio examination. The Board is bound by these favorable findings absent a finding of clear and unmistakable error. See 38 C.F.R. § 3.104(c).

The Board notes that the AOJ's finding that the Veteran's MOS in Logistics was a qualifying event, injury, or disease suggests that the AOJ found that the Veteran was exposed to acoustic trauma during service. See July 2020 Exam Request ("record showing MOS of Logistics [...] has a [m]derate probability for hazardous noise exposure"). The Veteran also stated that during service he was exposed to noise from forklifts, aircraft engines, helicopters, explosives, and weapons. See August 2025 Correspondence. The Veteran is presumed credible in his report of experiences of excessive noise exposure during his service, and the evidence is consistent with the places, types, and circumstances of his service. Therefore, his hazardous noise exposure is recognized. See 38 U.S.C. § 1154(a). The Board does not challenge this finding.

At the January 2021 VA medical examination, the Veteran reported the onset of constant bilateral tinnitus, described as constant ringing, approximately three years prior. The examiner opined the Veteran's tinnitus was less likely than not caused by or the result of his military noise exposure because although the Veteran's MOS of Logistics had a moderate probability for hazardous noise exposure, there were no complaints of tinnitus during service, and the Veteran reported the onset of tinnitus after service.

In the August 2025 statement, the Veteran stated he began experiencing intermittent "ringing" in his ear during service that became continuous during and since service. See August 2025 Correspondence.

The August 2025 private examiner opined that the Veteran's tinnitus was "best explained" by his hazardous military noise exposure during service and was at least as likely as not directly due to his acoustic trauma incurred during military service. The examiner noted that the Veteran's 2008 in-service and 2021 post-service audiological readings show high-frequency permanent threshold shifts consistent with tinnitus pathophysiology.

The Board finds this opinion highly probative. As noted above, the examiner based her opinion on a review of the available records, her particular expertise, and a review of medical literature to support her conclusion of a relationship between the Veteran's tinnitus and his acoustic trauma exposure injury during service. The Board concludes that the private August 2025 opinion is adequate to adjudicate the claim. See Nieves-Rodriguez v. Peake, supra.

In light of the foregoing, because there is at least an approximate balance of evidence in favor of finding that the Veteran's current tinnitus had its initial onset during service, the Board will grant the claim.

Affording the Veteran the benefit of the doubt, the claim for service connection for tinnitus is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to service connection for a left knee condition, diagnosed as osteoarthritis, is remanded.

2. Entitlement to service connection for a right knee condition, to include right knee pain, is remanded.

The Veteran contends his service-connected lumbar spine disability caused or is aggravating his non-service-connected left knee and right knee conditions. See July 2020 VA Form 526EZ Fully Developed Claim. The March 2021 VA medical examination opinions are thus inadequate for several reasons.

2. Entitlement to service connection for a right knee condition, to include right knee pain, is remanded.

Initially, while the March 2021 VA examiner's opinion regarding whether the Veteran's service-connected lumbar spine caused his left knee condition discussed possible causes, the VA examiner did not offer any rationale for why the Veteran's lumbar spine disability did not cause his left knee condition. Furthermore, the rationale offered by the VA examiner concluded that the Veteran's service-connected bilateral pes planus disability did not cause his left knee condition without any further discussion. The Board finds this opinion on proximate causation conclusory and thus inadequate. Stefl v. Nicholson, 21 Vet. App. 120, 124-125 (2007) (holding that "a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor's opinion").

Furthermore, the examiner did not provide an opinion on whether the Veteran's right knee condition, diagnosed as right knee pain in August 2020, was caused by his service-connected lumbar spine disability. See October 2020 CAPRI; see also September 2020 Exam Request; Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability).

Because the March 2021 VA examiner's secondary service connection opinion on causation regarding the Veteran's left knee condition was not adequate, and because the March 2021 VA examiner failed to provide a secondary service connection opinion on causation for the Veteran's right knee condition, the Board remands the claims to correct these duty to assist errors. 38 C.F.R. § 20.802; see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that once VA has provided a VA examination or obtained a medical opinion, it is required to provide or obtain one that is adequate for the purpose sought).

Finally, the March 2021 VA examiner did not address whether the Veteran's service-connected lumbar spine disability aggravates his current non-service-connected left knee or right knee conditions. See Healey v. McDonough, 33 Vet. App. 312, 322 (2021) ("When VA instructs an examiner to provide an opinion as to secondary service connection, that examiner must separately address the causation and aggravation prongs of secondary service connection"); see also El-Amin v. Shinseki, supra. Because current caselaw defines an adequate opinion on secondary service connection to include an opinion on aggravation, the claims are remanded to correct these duty to assist errors. 38 C.F.R. § 20.802.

3. Entitlement to service connection for a left shoulder condition, diagnosed as left shoulder strain, is remanded.

The Veteran contends his service-connected lumbar spine disability caused or is aggravating his non-service-connected left shoulder condition, diagnosed as left shoulder strain. See July 2020 VA Form 526EZ Fully Developed Claim.

The March 2021 VA examiner did not address whether the Veteran's service-connected lumbar spine disability aggravates his non-service-connected left shoulder condition. See Healey v. McDonough, supra; see also El-Amin v. Shinseki, supra. Because current caselaw defines an adequate opinion on secondary service connection to include an opinion on aggravation, the claim is remanded to correct this duty to assist error. 38 C.F.R. § 20.802.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an appropriate VA medical examination to determine the nature and etiology of the Veteran's left knee and right knee conditions.

The examiner is asked to review the pertinent evidence, including the Veteran's lay statements regarding his symptoms, and undertake any indicated studies.

The examiner must provide an opinion on the following:

(a) Identify any current diagnoses or symptomology of the right and left knee.

(b) If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment of earning capacity, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below.

Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's current left knee disability was caused or aggravated by his service
's left knee and right knee conditions.

The examiner is asked to review the pertinent evidence, including the Veteran's lay statements regarding his symptoms, and undertake any indicated studies.

The examiner must provide an opinion on the following:

(a) Identify any current diagnoses or symptomology of the right and left knee.

Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's current right knee disability if present was caused or aggravated by his service-connected lumbar spine disability?

2. Obtain an addendum opinion to determine the nature and etiology of the Veteran's left shoulder condition.

The examiner is asked to review the pertinent evidence, including the Veteran's lay statements regarding his symptoms.

The examiner must provide an opinion on whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's current left shoulder strain was aggravated by his service-connected lumbar spine disability.

Continued on the next page

A complete rationale must be provided.

S. Sorathia

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Anwar, Attorney-Advisor

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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