HIP IMPAIRMENT OF

A. J. SPECTOR · 2026 · Case ID: A26038001

MIXED

Summary

The Veteran served from March 1971 to June 1979. The Veteran appeals the denial of service connection for multiple conditions, including left and right hip, left and right ankle, right knee, bilateral hearing loss, sleep apnea, hypertension, tinnitus, and allergic rhinitis. The Board denied service connection for these conditions, finding that the evidence persuasively weighed against a service connection or secondary connection to pes planus, or that the criteria for service connection were not met. For hypertension, the Board noted it was not shown as chronic in service and did not manifest to a compensable degree within the presumptive period, with no continuity of symptomatology or other etiological relation to service. Tinnitus was denied an increased rating as the Veteran was already receiving the maximum schedular rating. Allergic rhinitis was denied a compensable rating as it did not meet specific criteria for obstruction or polyps. The Board remanded claims for right and left shoulder disabilities, headaches secondary to allergic rhinitis, vertigo, right and left wrist disabilities, left knee disability secondary to pes planus, low back disability secondary to pes planus, an acquired psychiatric disability, an increased rating for bilateral pes planus with metatarsalgia, and entitlement to TDIU. Remand was ordered for inadequate VA medical opinions, failure to obtain private treatment records, failure to obtain VA examinations, and opinions based on inaccurate factual premises.

Rationale

Evidence persuasively weighs against service connection; Evidence persuasively weighs against secondary connection to pes planus

Special Benefit

TDIU

Docket No.

200819-104662

Full Decision Text

Citation Nr: A26038001
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 200819-104662
DATE: April 23, 2026

ORDER

Entitlement to service connection for a left hip disability, to include as secondary to service-connected pes planus is denied.

Entitlement to service connection for a right hip disability, to include as secondary to service-connected pes planus is denied.

Entitlement to service connection for a left ankle disability, to include as secondary to service-connected pes planus is denied.

Entitlement to service connection for a right ankle disability, to include as secondary to service-connected pes planus is denied.

Entitlement to service connection for a right knee disability, to include as secondary to service-connected pes planus is denied.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for sleep apnea, to include as secondary to service-connected allergic rhinitis, is denied.

Entitlement to service connection for hypertension is denied.

Entitlement to an initial rating higher than 10 percent for tinnitus is denied.

Entitlement to an initial compensable rating for allergic rhinitis is denied.

REMANDED

Entitlement to service connection for a right shoulder disability is remanded.

Entitlement to service connection for a left shoulder disability is remanded.

Entitlement to service connection for headaches, to include as secondary to service-connected allergic rhinitis, is remanded.

Entitlement to service connection for vertigo, to include as secondary to service-connected allergic rhinitis, is remanded.

Entitlement to service connection for a right wrist disability is remanded.

Entitlement to service connection for a left wrist disability is remanded.

Entitlement to service connection for a left knee disability, to include as secondary to service-connected pes planus is remanded.

Entitlement to service connection for a low back disability, to include as secondary to service-connected pes planus is remanded.

Entitlement to service connection for an acquired psychiatric disability is remanded.

Entitlement to an initial rating higher than 10 percent for bilateral pes planus with metatarsalgia is remanded.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that Veteran's left hip disability is secondary to service-connected pes planus or is otherwise related to an in-service injury or disease.

2. The evidence of record persuasively weighs against finding that Veteran's right hip disability is secondary to service-connected pes planus or is otherwise related to an in-service injury or disease.

3. The evidence of record persuasively weighs against finding that Veteran's left ankle disability is secondary to service-connected pes planus or is otherwise related to an in-service injury or disease.

4. The evidence of record persuasively weighs against finding that Veteran's right ankle disability is secondary to service-connected pes planus or is otherwise related to an in-service injury or disease.

5. The evidence of record persuasively weighs against finding that Veteran's right knee disability is secondary to service-connected pes planus or is otherwise related to an in-service injury or disease.

6. The evidence of record persuasively weighs against finding that the Veteran has had a bilateral hearing loss disability for VA purposes at any time during or approximate to the pendency of the claim.

7. The evidence of record persuasively weighs against finding that Veteran's sleep apnea is secondary to service-connected allergic rhinitis or is otherwise related to an in-service injury or disease.

8. The Veteran's hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease.

9. The Veteran is in receipt of the maximum schedular rating assignable for tinnitus and there is no evidence his tinnitus disability picture is outside the norm, such that the rating schedule would not capture his symptoms.

10. The Veteran's allergic rhinitis is not manifest by polyps or greater than 50-percent obstruction of the nasal passage on both sides or complete obstruction on one side.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left hip disability due to service or service-connected pes planus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for a right hip disability due to service or service-connected pes planus are not met. 38 U.S.C. §§ 1110, 1131, 5107
10. The Veteran's allergic rhinitis is not manifest by polyps or greater than 50-percent obstruction of the nasal passage on both sides or complete obstruction on one side.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left hip disability due to service or service-connected pes planus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for a right hip disability due to service or service-connected pes planus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a left ankle disability due to service or service-connected pes planus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for a right ankle disability due to service or service-connected pes planus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for a right knee disability due to service or service-connected pes planus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385.

7. The criteria for service connection for obstructive sleep apnea due to service or service-connected allergic rhinitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

8. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

9. There is no legal basis for the assignment of a disability evaluation in excess of 10 percent for tinnitus. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.87, Diagnostic Code (DC) 6260.

10. The criteria for a compensable rating for service-connected allergic rhinitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.97, DC 6522.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1971 to June 1979.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2019 rating decision by a Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ).

The Veteran elected the Board's hearing docket in his August 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). The Veteran appeared at a hearing on April 1, 2025. A transcript is of record.

Therefore, the Board may only consider the evidence of record at the time of the December 2019 rating decision, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302. If evidence was submitted either (1) during the period after the AOJ issued the December 2019 rating decision on appeal and prior to the Board hearing, or (2) more than 90 days following the April 2025 hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302, 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.
Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302. If evidence was submitted either (1) during the period after the AOJ issued the December 2019 rating decision on appeal and prior to the Board hearing, or (2) more than 90 days following the April 2025 hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302, 20.801.

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

For the issues on appeal being remanded, any evidence the Board could not consider will be considered by the AOJ in the readjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Although the December 2019 rating decision on appeal assigned a noncompensable rating from August 6, 2018 for bilateral pes planus with metatarsalgia, a January 2021 rating decision subsequently found that the December 2019 rating decision had committed clear and unmistakable error and assigned a 10 percent rating from August 5, 2018. The issue on appeal has thus been recharacterized to reflect the rating that has been assigned by the January 2021 rating decision.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). 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) proximately caused or (b) proximately aggravated by a service-connected disability. Id.

1. Entitlement to service connection for a left hip disability, to include as secondary to service-connected pes planus

2. Entitlement to service connection for a right hip disability, to include as secondary to service-connected pes planus

3. Entitlement to service connection for a left ankle disability, to include as secondary to service-connected pes planus

4. Entitlement to service connection for a right ankle disability, to include as secondary to service-connected pes planus

5. Entitlement to service connection for a right knee disability, to include as secondary to service-connected pes planus

The Veteran believes that his bilateral hip and ankle disabilities, as well as his right knee disability, are secondary to his service-connected pes planus and related changes to his balance and gait. He also testified that the pain in his hips, ankles, and knees has been present since service. See April 2025 hearing.

A VA examination was not conducted as to the right knee disability or bilateral hip or ankle disabilities. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there is otherwise sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5013A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Additionally, because
evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there is otherwise sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5013A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Additionally, because under the Appeals Modernization Act (AMA) the duty to assist only applies to evidence submitted prior to the issuance of the rating decision on appeal, evidence that was first introduced at the April 2025 hearing may not be considered when determining whether the McLendon factors were met. In this case, a VA examination is not required because there is no competent or credible evidence of an in-service event or association with service, or with a service-connected disability received prior to the issuance of the December 2019 rating decision on appeal. The Veteran's service treatment records (STRs) contain no evidence of a right knee, hip, or ankle injury or pain, and the June 1979 separation examination found normal lower extremities. There was no competent evidence of an in-service right knee, or bilateral hip or ankle injury or of an association between the Veteran's right knee or bilateral hips or ankles and any service-connected disability prior to the December 2019 rating decision on appeal.

The Board recognizes that the Veteran did provide competent lay evidence of an in-service injury and an assertion of right knee or bilateral hip and ankle pain since service in his April 2025 hearing testimony. However, the Board may not remand for an examination based upon evidence introduced for the first time after the rating decision on appeal was issued. 38 C.F.R. § 20.802.

The Veteran sincerely believes that his right knee and bilateral hip and ankle disabilities began during service or were caused by his service-connected pes planus and related balance and gait changes. There is no evidence that the Veteran has specialized medical training, which means that he is a lay person. Although lay people are competent to provide opinions on some medical issues, the etiology of a right knee or bilateral hip or ankle disability is outside the realm of common knowledge of a lay person because it involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Competent medical evidence is necessary where the determinative question requires medical knowledge. Jandreau, 492 F.3d at 1372. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a) (1). No such opinion is contained in the record.

Accordingly, the evidence is persuasively against the claims. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a right knee disability, bilateral hip disability, and bilateral ankle disability is not warranted. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc); 38 C.F.R. § 3.102.

If the Veteran wishes VA to perform an examination as to his right knee, hips, and ankles, he may file a Supplemental Claim (VA Form 20-0995) as to those issues within one year of this decision accompanied by evidence of a relationship between his bilateral hip and ankle disabilities and service or his service-connected disabilities. If the AOJ finds this evidence to be new and relevant, then they will readjudicate the claim and perform any necessary development. It is important to submit this supplemental claim and evidence within one year of this decision to preserve the effective date. 38 C.F.R. § 3.2501.

6. Entitlement to service connection for bilateral hearing loss

The Veteran believes that he has bilateral hearing loss that was caused by exposure to loud noise during service. See April 2025 hearing.

The threshold for normal hearing is from 0 to
VA Form 20-0995) as to those issues within one year of this decision accompanied by evidence of a relationship between his bilateral hip and ankle disabilities and service or his service-connected disabilities. If the AOJ finds this evidence to be new and relevant, then they will readjudicate the claim and perform any necessary development. It is important to submit this supplemental claim and evidence within one year of this decision to preserve the effective date. 38 C.F.R. § 3.2501.

6. Entitlement to service connection for bilateral hearing loss

The Veteran believes that he has bilateral hearing loss that was caused by exposure to loud noise during service. See April 2025 hearing.

The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). However, not all hearing loss constitutes hearing loss "disability" for VA purposes. In order to be considered a hearing loss disability for VA purposes, there must be evidence of impaired hearing that meets the criteria of 38 C.F.R. § 3.385. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

The October 2019 VA examination found that the Veteran does not meet the criteria for a hearing loss disability for VA purposes, and the treatment records associated with the claims file do not contradict these findings. Therefore, all the competent medical evidence of record supports a finding that the Veteran does not have a current hearing loss disability for VA purposes.

In reaching this determination, the Board does not question the sincerity of the Veteran's reports of difficulty hearing others speak and recognizing tones for singing, and it acknowledges that, as a lay person, he is competent to report that he has difficulty hearing. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Unfortunately, as a layperson, the Veteran does not have the requisite expertise to diagnose a current hearing loss disability in accordance with VA standards, as such matters require medical expertise. Specifically, the results of an audiogram and Maryland CNC Test administered by a state-licensed audiologist are the only type of evidence deemed competent to show a hearing impairment for VA purposes. 38 C.F.R. § 4.85. As such, the Board gives more probative weight to competent medical evidence. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for bilateral hearing loss is not warranted. See 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776; 38 C.F.R. § 3.102.

7. Entitlement to service connection for sleep apnea

The Veteran believes his sleep apnea is related to his allergic rhinitis or sinuses or is because he worked out frequently during service resulting in a large, muscular neck that could constrict airflow. He testified that he began snoring loudly after service. See April 2025 hearing.

As with the right knee, hip, and ankle disabilities, a VA examination was not conducted as to sleep apnea. The factors that determine whether the duty to assist requires that a VA examination be conducted with respect to a claim for benefits are discussed above. In this case, a VA examination is not required because there is no competent or credible evidence of an in-service event or association with service, or with a service-connected disability, received prior to the issuance of the December 2019 rating decision on appeal. There is no evidence of sleep apnea in the Veteran's STRs, and the Veteran did not provide lay testimony regarding his sleep apnea until after the rating decision on appeal. The Board reiterates that it may not remand for an examination based upon evidence that was submitted for the first time after the rating decision on appeal was issued.

The Veteran has submitted a June 2025 opinion from a private physician regarding the etiology of his sleep apnea. The private clinician
above. In this case, a VA examination is not required because there is no competent or credible evidence of an in-service event or association with service, or with a service-connected disability, received prior to the issuance of the December 2019 rating decision on appeal. There is no evidence of sleep apnea in the Veteran's STRs, and the Veteran did not provide lay testimony regarding his sleep apnea until after the rating decision on appeal. The Board reiterates that it may not remand for an examination based upon evidence that was submitted for the first time after the rating decision on appeal was issued.

The Veteran has submitted a June 2025 opinion from a private physician regarding the etiology of his sleep apnea. The private clinician stated that they had reviewed the Veteran's military records, and that the Veteran's military service included deployments during which he was exposed to hazardous materials or irritants in the environments, which are known to cause inflammation, reactive airway disease, and long-term respiratory compromise. The clinician also stated that the Veteran's erratic and unscheduled sleeping including intermittent night patrols and stressful active situations have increased his vulnerability even more to sleep apnea. The clinician noted that prior to service, the Veteran did not experience any sleep-related issues, but after returning from service, he began to experience poor sleep and sleep apnea symptoms. The clinician concluded that the Veteran's sleep apnea is at least as likely as not proximately due to and permanently aggravated beyond its natural progression by his service-connected distress as well as to occupational exposures. The clinician provided a References section that cited articles regarding airborne hazards and the open burn pit registry report, and sleep disruptions among returning combat veterans from Iraq and Afghanistan.

The Board's review of the Veteran's STRs and personnel records does not find evidence that the Veteran was deployed to an area where he would experience toxic exposure risk activity (TERA), to include exposure to hazardous materials or environmental irritants. The Veteran has not submitted lay statements indicating that he engaged in TERA during service. Moreover, the specific environmental exposures of burn pits and the experiences of veterans of Iraq and Afghanistan that the clinician cited are not consistent with the Veteran's military service from 1971 to 1979. Additionally, the private clinician's assertion that the Veteran's sleep apnea is proximately due to service-connected distress is not supported by an adequate rationale. The clinician noted earlier in their letter that the Veteran's stressful active situations have increased his vulnerability to sleep apnea, but they do not explain how they came to that conclusion. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). Therefore, the June 2025 private medical opinion is inadequate and is not assigned any probative value.

As the probative evidence of record does not support a finding that the Veteran's sleep apnea was caused by service or by a service-connected disability, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for sleep apnea is not warranted. See 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776; 38 C.F.R. § 3.102.

If the Veteran wishes VA to perform an examination as to his sleep apnea, he may file a Supplemental Claim (VA Form 20-0995) as to that issue within one year of this decision accompanied by evidence of a relationship between his sleep apnea and service or his service-connected disabilities. If the AOJ finds this evidence to be new and relevant, then they will readjudicate the claim and perform any necessary development. It is important to submit this supplemental claim and evidence within one year of this decision to preserve the effective date. 38 C.F.R. § 3.2501.

8. Entitlement to service connection for hypertension

The Veteran contends that his hypertension was related to stressful in-service events involving aircraft or is secondary to his acquired psychiatric disability. See April 2025 hearing.

Certain chronic diseases, including hypertension, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708
to his acquired psychiatric disability. See April 2025 hearing.

In this case, there is no evidence of hypertension during service or within the presumptive period of one year following service. The Veteran denied high blood pressure in a June 1979 STR, and there are no STRs diagnosing hypertension. The Veteran has not testified that he was diagnosed with hypertension during or within one year of service. Therefore, the Board may not grant service connection for hypertension under the chronic disease presumption.

The Board will also consider whether hypertension is directly caused by service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). As with the right knee, hip, ankle, and sleep apnea disabilities, a VA examination was not conducted as to hypertension. The factors that determine whether the duty to assist requires that a VA examination be conducted with respect to a claim for benefits are discussed earlier in this decision. In this case, a VA examination is not required because there is no competent or credible evidence of an in-service event or association with service, or with a service-connected disability, received prior to the issuance of the December 2019 rating decision on appeal. As is noted above, there is no evidence of hypertension in the Veteran's STRs, and the Veteran denied high blood pressure in June 1979. The Veteran did not provide lay testimony relating his hypertension to in-service events with aircraft or his psychiatric disability until after the rating decision on appeal. The Board reiterates that it may not remand for an examination based upon evidence that was submitted for the first time after the rating decision on appeal was issued.

While the Veteran believes that his hypertension is related to in-service incidents involving aircrafts, the etiology of hypertension is outside the realm of common knowledge of a lay person such as the Veteran because it involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. Therefore, the Veteran's sincere belief is not competent medical evidence of a nexus or connection between the Veteran's hypertension and stressful incidents involving aircrafts in service.

As to the Veteran's belief that his hypertension is secondary to his acquired psychiatric disability, the Board notes that the Veteran is not currently service-connected for an acquired psychiatric disability. Moreover, even if the Veteran were service-connect for an acquired psychiatric disability, the Veteran would still lack the specialized medical training to determine the etiology of his hypertension. The Board would not be able to remand for an examination regarding the relationship between hypertension and the acquired psychiatric disability because the Veteran's belief that his hypertension is secondary to his acquired psychiatric disability was not raised until after the issuance of the rating decision on appeal.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for hypertension is not warranted. See 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776; 38 C.F.R. § 3.102.

If the Veteran wishes VA to perform an examination as to his hypertension, he may file a Supplemental Claim (VA Form 20-0995) as to that issue within one year of this decision accompanied by evidence of a relationship between his hypertension and service or his service-connected disabilities. If the AOJ finds this evidence to be new and relevant, then they will readjudicate the claim and perform any necessary development. It is important to submit this supplemental claim and evidence within one year of this decision to preserve the effective date. 38 C.F.R. § 3.2501.

Increased Rating

Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities found in 38 C.F.R. Part 4. Disability ratings are intended to compensate for impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Pertinent regulations do not require that all cases show all
relationship between his hypertension and service or his service-connected disabilities. If the AOJ finds this evidence to be new and relevant, then they will readjudicate the claim and perform any necessary development. It is important to submit this supplemental claim and evidence within one year of this decision to preserve the effective date. 38 C.F.R. § 3.2501.

Increased Rating

Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities found in 38 C.F.R. Part 4. Disability ratings are intended to compensate for impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002).

Evaluation of a service-connected disorder requires a review of the veteran's entire medical history regarding that disorder. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In all claims for an increased disability rating, VA has a duty to consider the possibility of assigning staged ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary.

9. Entitlement to an initial rating higher than 10 percent for tinnitus

The Veteran believes he should be assigned an initial rating higher than 10 percent for tinnitus because it is constant, and because it always sounds like something is going off in his head, causing him to look around for something that is not there. See April 2025 hearing.

The Veteran is currently assigned a 10 percent rating for tinnitus pursuant to 38 C.F.R. § 4.87, Diagnostic Code (DC) 6260. The 10 percent rating is the maximum schedular rating for tinnitus under 38 C.F.R. § 4.87, DC 6260. A single rating is warranted for tinnitus regardless of whether it is unilateral or bilateral. 38 C.F.R. § 4.87, DC 6260, Note (2). Because the Veteran is already receiving the maximum schedular rating for tinnitus, it is not possible to increase his rating, and the Veteran's claim must be denied.

The Veteran has not raised any other issue, nor has any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (Vet. App. March 17, 2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

The Veteran's testimony that his tinnitus is constant and that it causes him to look around for the source of the noise, which is not there, is contemplated by the 10 percent rating that is assigned. Entitlement to an initial rating higher than 10 percent must be denied.

10. Entitlement to an initial compensable rating for allergic rhinitis

The Veteran believes that he should be assigned an initial compensable rating for allergic rhinitis because it causes constant discomfort. See April 2025 hearing.

The Veteran has been assigned a noncompensable rating pursuant to DC 6522. Under this DC, a 10 percent rating is assigned for allergic or vasomotor rhinitis without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side. A 30 percent rating is assigned for allergic or vasomotor rhinitis with polyps. 38 C.F.R. § 4.97, DC 6522.

In the December
. Entitlement to an initial compensable rating for allergic rhinitis

The Veteran believes that he should be assigned an initial compensable rating for allergic rhinitis because it causes constant discomfort. See April 2025 hearing.

In the December 2019 VA examination, the Veteran reported that his allergic rhinitis symptoms were controlled with sinus rinses, but that he still gets almost daily nasal congestion, runny nose, phlegm, coughing, and sneezing. The examiner found that the Veteran does not have greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, nor was there complete obstruction on one side due to rhinitis. There were no nasal polyps and no permanent hypertrophy. The examiner found that the allergic rhinitis has no impact on the Veteran's ability to work.

The Veteran testified in the April 2025 hearing that his allergic rhinitis is constant, and causes him to feel like he has a cold all the time, with constant "green slime" coming out of his head. This "green slime" is presumably a reference to the runny nose and phlegm noted in the December 2019 examination. The Veteran testified that he wears a mask most of the time outside and stays inside the house more often than he would like. He also testified that he believes his headaches and vertigo are related to his allergic rhinitis.

While sympathetic to the Veteran's belief that his symptoms warrant a higher initial rating, after a thorough review of the record, the Board finds that the current evidence does not provide a basis for granting a compensable rating for allergic rhinitis under DC 6522. There is no evidence of greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on one side, or nasal polyps, as is required for a compensable rating. The Veteran's symptoms of feeling that he has a cold all the time with associated phlegm, runny nose, coughing, and sneezing, as well as his practice of spending more time inside and wearing a mask when outside in order to control his allergic rhinitis, are contemplated by the noncompensable rating that has been assigned.

The Board recognizes that the Veteran believes that he experiences vertigo and headaches due to his allergic rhinitis. Although the Veteran is competent to describe his experiences of a headache or vertigo, he is not competent to determine the etiology of his headaches or vertigo. The etiology of vertigo or headaches is outside the realm of common knowledge of a lay person because it involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. There is no competent medical evidence that the Veteran's headaches and vertigo are symptoms of his allergic rhinitis. Moreover, because the evidence that the Veteran believes his headaches and vertigo are symptoms of allergic rhinitis was first introduced to the record after the issuance of the rating decision on appeal, the duty to assist does not apply and the Board may not remand to obtain a VA examination to determine whether the headaches and vertigo are proximately due to or aggravated by the Veteran's service-connected allergic rhinitis. Therefore, the Board may not consider the Veteran's claimed headaches or vertigo when rating his allergic rhinitis. However, the Board notes that service connection for headaches and vertigo are being remand for other reasons addressed below.

For the foregoing reasons, the Board finds that the probative evidence of record persuasively weighs against the Veteran's appeal for a compensable evaluation for allergic rhinitis; therefore, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). Accordingly, entitlement to an initial compensable rating for allergic rhinitis is denied.

REASONS FOR REMAND

1. Entitlement to service connection for a right shoulder disability is remanded.

2. Entitlement to service connection for a left shoulder disability is remanded.

The December 2019 VA shoulder examination notes that the Veteran receives treatment with a private doctor, but no records are available. Failure to attempt to obtain these relevant private treatment records was a pre-decisional duty to assist error. Upon remand, the AOJ should attempt to
a compensable evaluation for allergic rhinitis; therefore, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). Accordingly, entitlement to an initial compensable rating for allergic rhinitis is denied.

REASONS FOR REMAND

1. Entitlement to service connection for a right shoulder disability is remanded.

2. Entitlement to service connection for a left shoulder disability is remanded.

Additionally, in the December 2019 examination, the Veteran reported a gradual onset of bilateral shoulder pain in 1974, during service, which had gotten worse. The examiner provided a negative nexus opinion due to lack of continuity of a left shoulder condition since 1976. The nexus opinion is inadequate because it is based solely on the absence of medical records, without considering the Veteran's lay statements of continued pain since service. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007); Miller v. Wilkie, 32 Vet. App. 249 (2020). Additionally, the examiner failed to provide a nexus opinion as to the right shoulder in spite of the Veteran's competent lay evidence of bilateral shoulder pain with its onset during service. Accepting this inadequate opinion was a pre-decisional duty to assist error. As such, remand is necessary to obtain an adequate medical opinion.

3. Entitlement to service connection for headaches, to include as secondary to service-connected allergic rhinitis is remanded.

The October 2019 VA examination provided a negative nexus opinion because there are no STRs documenting the Veteran's headaches except for one April 1971 progress note that related it to his upper respiratory infection/tonsillitis. However, this statement is not accurate - in addition to the April 1971 STR, there is an August 1976 STR noting a sinus headache with congestion and a May 1971 notation of a headache. Opinions based on an inaccurate factual premise have no probative value. Reonal v. Brown, 5 Vet. 458, 461 (1993). Accepting an inadequate VA medical opinion was a pre-decisional duty to assist error that must be remedied upon remand.

4. Entitlement to service connection for vertigo is remanded.

A VA examination was not conducted as to vertigo, even though an April 1971 STR notes that the Veteran experienced dizziness. Failure to obtain a VA examination in spite of the Veteran's current reports of vertigo and evidence of dizziness during service is a pre-decisional duty to assist error. See McLendon, 20 Vet. App. at 83. Upon remand, a VA examination must be scheduled.

5. Entitlement to service connection for a right wrist disability is remanded.

6. Entitlement to service connection for a left wrist disability is remanded.

The December 2019 VA examination noted that the Veteran reported the gradual onset of bilateral wrist pain in 1975 due to his military duties. The examiner provided a negative nexus opinion with the rationale that although records show a right wrist fracture in August 1972, STRs show no evidence of any continuity of care for this condition. The examiner also noted that the Veteran had De Quervain's tendinitis, which is different than the Veteran's right wrist injury in service. The examiner concluded that due to the lack of continuity of symptoms from what occurred during service, it is less likely than not that the Veteran's diagnosed bilateral De Quervain's tendinitis was incurred in or caused by wrist issues during service. This opinion is inadequate because it does not consider the Veteran's competent lay evidence of bilateral wrist pain since service in 1975. Buchanan, 451 F.3d 1331; Dalton, 21 Vet. App. 23, 40; Miller, 32 Vet. App. 249. Moreover, the opinion states in a conclusory fashion that De Quervain's tendinitis is different than the in-service right wrist injury but does not discuss whether the in-service right wrist injury caused the current De Quervain's tendinitis.

Accepting an inadequate VA examination was a pre-decisional duty to assist error that must be remedied by requesting a new medical opinion upon remand.

7. Entitlement to service connection for a left knee disability, to include as secondary to service-connected pes planus is remanded.

A VA examination was not conducted as to the Veteran's
1331; Dalton, 21 Vet. App. 23, 40; Miller, 32 Vet. App. 249. Moreover, the opinion states in a conclusory fashion that De Quervain's tendinitis is different than the in-service right wrist injury but does not discuss whether the in-service right wrist injury caused the current De Quervain's tendinitis.

Accepting an inadequate VA examination was a pre-decisional duty to assist error that must be remedied by requesting a new medical opinion upon remand.

7. Entitlement to service connection for a left knee disability, to include as secondary to service-connected pes planus is remanded.

A VA examination was not conducted as to the Veteran's claimed left knee disability, despite a May 1971 STR noting a complaint of muscle strain in the left knee. Failure to obtain a VA examination was a pre-decisional duty to assist error. See McLendon, 20 Vet. App. at 83. Upon remand, a VA examination must be scheduled.

8. Entitlement to service connection for a low back disability, to include as secondary to service-connected pes planus is remanded.

A December 2019 VA examination as to the low back disability indicates that the Veteran has not submitted relevant private treatment records. Failure to attempt to obtain these records was a pre-decisional duty to assist error. Upon remand, an attempt should be made to obtain private treatment records related to his low back disability.

Additionally, the December 2019 VA examiner provided a negative nexus opinion due to the lack of continuity of a back condition since 1977, noting the lack of post-service treatment records. The nexus opinion is inadequate because it is based solely on the absence of medical records, without considering the Veteran's lay statements of continued pain since service. Buchanan, 451 F.3d 1331; Dalton, 21 Vet. App. 23, 40; Miller, 32 Vet. App. 249.

9. Entitlement to service connection for an acquired psychiatric disability is remanded.

A VA examination was not conducted as to the Veteran's acquired psychiatric disability, in spite of a September 2018 statement relating the Veteran's psychiatric disability to an in-service hard landing of a C-117 with an engine fire, and an incident where a C-130 lost power and slid off the runway. See McLendon, 20 Vet. App. at 83. Upon remand, a VA examination must be scheduled as to the Veteran's acquired psychiatric disability.

10. Entitlement to an initial rating higher than 10 percent for bilateral pes planus with metatarsalgia is remanded.

A December 2019 VA examination notes that the Veteran's pes planus is followed by a podiatrist. However, there are no podiatric records associated with the claims file, and there is no indication that the AOJ attempted to request them. Failure to request relevant private treatment records was a pre-decisional duty to assist error that must be remedied upon remand.

11. Entitlement to a TDIU is remanded.

The resolution of the issue of entitlement to a TDIU depends on the outcome of the claims remanded above. Accordingly, adjudication of this claim will be deferred until further development of the inextricably intertwined issues is completed. Gurley v. Peake, 528 F.3d 1322 (Fed. Cir. 2008) (noting that remand of inextricably intertwined claims was warranted for reasons of judicial economy even in absence of administrative error); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (providing that two or more issues are inextricably intertwined if one claim could have significant impact on the other).

The matters are REMANDED for the following action:

1. Ask the Veteran to complete a VA Form 21-4142 for the private facility that treats his bilateral shoulder disability, low back disability, and bilateral pes planus with metatarsalgia. Make two requests for the authorized records from any facility so identified unless it is clear after the first request that a second request would be futile.

If these records are unavailable, this must be documented in the record. The Veteran should be notified of unsuccessful efforts and allowed an opportunity to obtain and submit those records for VA review.

2. Obtain an addendum opinion regarding the etiology of the Veteran's bilateral shoulder disability, headaches, bilateral wrist disability, and low back disability. Copies of all pertinent records must be made available to the examiner for review. Schedule the Veteran for an examination and/or further testing if deemed necessary by the reviewing clinician.

After reviewing the relevant evidence, the examiner is asked to provide an opinion as to the following:

(a.) Is it at least as likely as not (likelihood
identified unless it is clear after the first request that a second request would be futile.

After reviewing the relevant evidence, the examiner is asked to provide an opinion as to the following:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has a bilateral shoulder disability that had its onset in or is otherwise related to service, to include April 1976 and May 1976 reports of left shoulder pain and decreased range of motion, and the Veteran's report in the December 2019 examination that his bilateral shoulder pain had its onset during service?

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's headaches disability had its onset in or is otherwise related to service, to include the April 1971 STR noting sore throat, headaches, dizziness, cold, and chills, the May 1971 STR noting headache, and the August 1976 STR noting sinus headache with congestion?

(c.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral wrist disability had its onset in or is otherwise related to service, to include the August 1972 STR attempting to rule out a fracture of the right wrist? The clinician must address the Veteran's report in the December 2019 VA examination that he had gradual onset of bilateral wrist pain in 1975, which is during service.

(d.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's low back disability had its onset in or is otherwise related to service, to include STRs reporting treatment for low back pain in May 1975, May 1976, September 1976, June 1977, and August 1977? The Veteran reported recurring back pain in September 1977. In the December 2019 VA examination, the Veteran reported a gradual onset of low and mid back pain during service, identifying the onset as 1973.

Each opinion offered must be supported by a complete rationale, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state why and what, if any, additional evidence would permit such an opinion to be made.

The clinician is advised that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology such as pain, and such reports must be acknowledged and considered in formulating any opinion. If the clinician finds any medical reason to reject the lay reports, then they must provide an explanation for such rejection.

The clinician must not rely solely on the absence of diagnosis or treatment in service, or the lack of medical documentation, as the basis for a negative opinion

3. Obtain an examination regarding the etiology of the Veteran's vertigo, left knee disability, and acquired psychiatric disability. Copies of all pertinent records must be made available to the examiner for review.

After reviewing the relevant evidence, the examiner is asked to provide an opinion as to the following:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's vertigo had its onset in or is otherwise related to service, to include the April 1971 STR noting sore throat, headaches, dizziness, cold, and chills?

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has a left knee disability that had its onset during or is otherwise related to service, to include a May 1971 STR noting a complaint of muscle strain of the left knee?

(c.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has an acquired psychiatric disability that had its onset during or is otherwise related to service, to include the Veteran's report in a September 2018 statement of a hard landing of a C-117 with an engine fire, and an incident where a C-130 lost power and slid off the runway?

Each opinion offered must be supported by a complete rationale, citing to supporting factual data and medical literature, as appropriate. If the
Veteran has a left knee disability that had its onset during or is otherwise related to service, to include a May 1971 STR noting a complaint of muscle strain of the left knee?

The clinician is advised that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology, and such reports must be acknowledged and considered in formulating any opinion. If the clinician finds any medical reason to reject the lay reports, then they must provide an explanation for such rejection.

The clinician must not rely solely on the absence of diagnosis or treatment in service, or the lack of medical documentation, as the basis for a negative opinion.

A. J. Spector

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Budd, Counsel

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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