DERMATITIS OR ECZEMA

J. NICHOLS · 2026 · Case ID: A26038022

MIXED

Summary

The veteran, who served in the Army from August 1985 to May 1988, appeals the denial of service connection for allergic rhinitis, sinusitis, left ear hearing loss, and obstructive sleep apnea (OSA). The Board denied service connection for allergic rhinitis, finding the evidence weighed against a service connection, as the VA examiner's opinion was less likely than not related to service and was consistent with normal findings on separation examination. The Board also denied service connection for sinusitis, noting no current residuals or impairment of earning capacity beyond the allergic rhinitis, and that the VA examination diagnosed only allergic rhinitis. For left ear hearing loss, the Board denied service connection, finding the VA examiner's opinion more probative than the private opinion. The VA examiner noted no significant threshold shifts during service and opined the current hearing loss was unrelated to service, consistent with normal enlistment and separation audiograms. The Board also found no evidence of continuity of symptomatology or onset within one year of service. Service connection for OSA was denied due to a lack of evidence linking the condition to service, as the private diagnosis occurred in 2017 and no in-service complaints or nexus were established. The case was remanded for further development on lumbar spine, cervical spine, and left hip osteoarthritis claims.

Rationale

Service treatment records silent for allergic rhinitis.; Separation examination showed normal sinuses/nose.; VA examiner opined less likely than not related to service.; Veteran's statement about onset in service is credible but lacks medical nexus.; Evidence persuasively weighs against service connection.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250929-593616

Full Decision Text

Citation Nr: A26038022
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 250929-593616
DATE: April 23, 2026

ORDER

Entitlement to service connection for allergic rhinitis is denied.

Entitlement to service connection for sinusitis is denied.

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

Entitlement to service connection for obstructive sleep apnea (OSA) is denied.

REMANDED

Entitlement to service connection for a lumbar spine condition is remanded.

Entitlement to service connection for a cervical spine condition is remanded.

Entitlement to a compensable rating for left hip osteoarthritis with chronic strain, limited abduction/adduction/rotation, is remanded.

Entitlement to a compensable rating for left hip osteoarthritis with chronic strain, limited extension, is remanded.

FINDINGS OF FACT

1. The preponderance of the evidence is against a finding that the allergic rhinitis was caused by or onset during the Veteran's active duty service.

2. The Veteran does not have sinusitis or current residuals or impairment of his earning capacity associated with his sinuses other than the symptoms of his diagnosed allergic rhinitis.

3. The diagnosed left ear hearing loss was not caused by and did not onset during active duty service or within one year of separation from service, and the symptoms have not been continuous since service.

4. The evidence does not indicate that the diagnosed sleep apnea was caused by or onset during the Veteran's service.

CONCLUSIONS OF LAW

1. The criteria for service connection for allergic rhinitis have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

2. The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for service connection for left ear hearing loss have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

4. The criteria for service connection for obstructive sleep apnea (OSA) have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Army from August 1985 to May 1988.

These matters are before the Board of Veterans' Appeals (Board) on appeal from March 2025 and April 2025 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

In September 2025, the Veteran submitted a VA Form 10182 Decision Review Request form to appeal his claim to the Board and selected the Direct Review lane. As explained in the VA Form 10182, "direct review" means that the Board's decision must be based upon the evidence of record at the time of the prior decision, with no evidence submission or hearing request. As such, the Board has considered only the evidence of record at the time of the March 2025 and April 2025 decisions.

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.

As a preliminary note, the Veteran filed a second VA Form 10182 Decision Review Request in October 2025, appealing to the Board. That appeal included these eight issues which had been listed on the September 2025 appeal, as well as several additional issues. This decision addresses the eight issues which were listed in both the September 2025 appeal and the October 2025 appeal. The Board decided the additional issues, which were not listed on the September 2025 appeal, in a March 2026 decision.

Service Connection

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303
VA Form 10182 Decision Review Request in October 2025, appealing to the Board. That appeal included these eight issues which had been listed on the September 2025 appeal, as well as several additional issues. This decision addresses the eight issues which were listed in both the September 2025 appeal and the October 2025 appeal. The Board decided the additional issues, which were not listed on the September 2025 appeal, in a March 2026 decision.

Service Connection

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases will be presumed related to service 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, 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 F.3d 1331, 1338 (Fed. Cir. 2013).

1. Entitlement to service connection for allergic rhinitis

The Veteran contends that he has allergic rhinitis which onset during his active duty service.

Turning to the evidence, the Veteran's service treatment records are silent for any complaint, diagnosis, or treatment for sinusitis or rhinitis. He was treated for upper respiratory infections in October and November 1985. See STR - Medical, May 9, 2024, p57, 64. His separation examination in March 1988 stated that his sinuses and nose were normal and the Veteran wrote "I'm in good health." Id., p31-32.

A March 2025 VA memorandum concluded that the Veteran did not participate in any toxic exposure risk activities during his service. See other, March 4, 2025.

In March 2025, a VA contractor completed a Disability Benefits Questionnaire (DBQ) for Sinusitis/Rhinitis and Other Conditions. Based on an in-person examination and a review of the VA e-folder, the examiner diagnosed allergic rhinitis only. The Veteran said that the condition began during active duty in 1988 with a runny nose, and he said that his current symptoms were rhinitis and headaches. He used over-the-counter Fluticasone, Zyrtec, and Allegra for relief. The Veteran's rhinitis did not result in greater than 50 percent obstruction of both nasal passages, or complete obstruction of either one, or permanent hypertrophy of the nasal turbinates, or nasal polyps. There were no other pertinent physical findings and no diagnostic testing. Functional impairment included discomfort, affecting his ability to focus and perform occupational tasks effectively.

The March 2025 examiner prepared a medical opinion with the DBQ. The medical opinion concluded that it was less likely than not that the Veteran's allergic rhinitis was caused by the in-service injury, event, or illness. The rationale was that the Veteran enlisted in service with no pre-existing conditions and separated with no documented complaints on his separation physical examination related to his sinus or allergic rhinitis, and "Allergic rhinitis can also be caused by seasonal changes and there could be an influence of non-military exposure to pollen that can contribute to the condition. Therefore no Nexus has been established."

Turning to the criteria for service connection, the March 2025 DBQ diagnosed allergic rhinitis. Therefore, the first requirement has been met. See Saunders, supra.

The second requirement is an in-service incident, injury, or illness. The Veteran told the March 2025 examiner that he had a runny nose beginning during active duty service in 1988. The Veteran's statement is credible and there is no evidence indicating otherwise; therefore, the
separation physical examination related to his sinus or allergic rhinitis, and "Allergic rhinitis can also be caused by seasonal changes and there could be an influence of non-military exposure to pollen that can contribute to the condition. Therefore no Nexus has been established."

Turning to the criteria for service connection, the March 2025 DBQ diagnosed allergic rhinitis. Therefore, the first requirement has been met. See Saunders, supra.

The third requirement for service connection is a connection between the in-service incident and the present disability; in this case, there must be evidence that the reported nasal discharge in 1988 caused or is related to the present allergic rhinitis. 38 C.F.R. § 3.303. The March 2025 medical opinion is based on a review of the medical history and an in-person examination of the Veteran. It concluded that the allergic rhinitis is less likely than not related to his service. That conclusion is supported by a rationale based on his medical history. It is consistent with the March 1988 examination which found the Veteran's nose and sinuses normal and the Veteran's statement that he was in good health at that time. There is no medical evidence to support the Veteran's claim. Therefore, the preponderance of the evidence is against a finding that the allergic rhinitis was caused by or onset during the Veteran's active duty service, and service connection has not been established.

The Board has considered the Veteran's statements; as a layperson, he is competent to testify regarding observable symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, the probable etiology of a disorder such as allergic rhinitis falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Veteran has not demonstrated or alleged expertise in determining a medical nexus, and he does not offer any supporting medical opinion. Therefore, his opinion in this matter has no probative value.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection is warranted. Rather, the evidence persuasively weighs against it. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021), affirmed en banc (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

2. Entitlement to service connection for sinusitis

The Veteran has also appealed the denial of service connection for sinusitis.

As noted above, the Veteran's service treatment records are silent for any complaint, diagnosis, or treatment for sinusitis or rhinitis. He was treated for upper respiratory infections in October and November 1985. See STR - Medical, May 9, 2024, p57, 64. His separation examination in March 1988 stated that his sinuses and nose were normal and the Veteran wrote "I'm in good health." Id., p31-32.

Also noted above, in March 2025, a VA contractor completed a Disability Benefits Questionnaire (DBQ) for Sinusitis/Rhinitis and Other Conditions and diagnosed allergic rhinitis but not sinusitis. All of the Veteran's reported symptoms were attributed to the diagnosed allergic rhinitis.

The first requirement for service connection is a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means functional impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1. See also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991);
connection is a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means functional impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1. See also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

In determining whether the current disability requirement has been met, the Board must consider the entire claim period and the period preceding it. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim) and whether there have been symptoms causing impairment in earning capacity or a different but related disorder diagnosed during this period. Saunders, 886 F.3d at 1364-65 (pain alone can constitute disability under 38 U.S.C. § 1131); Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim).

With the preponderance of the evidence showing no current residuals or impairment of the Veteran's earning capacity associated with his sinuses other than the symptoms discussed above concerning his allergic rhinitis, the Veteran has not met the current disability requirement, even considering this requirement broadly in terms of both the entire claim period plus the period preceding it pursuant to McClain and Romanowsky, impairment in earning capacity under Saunders, and related disorders under Clemons. As the Veteran has not established an essential element of his claim, the claim must be denied. See Degmetich v. Brown, 104 F.3d 1328, 1333 (Fed. Cir. 1997) (38 U.S.C. § 1131 requires "a presently existing disability" to warrant compensation). Moreover, because preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

3. Entitlement to service connection for left ear hearing loss

The Veteran contends that his diagnosed left ear hearing loss was caused by exposure to hazardous noise during his service.

Turning to the evidence, the Veteran underwent a hearing test at the time of his enlistment in December 1984. Pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 20 05 10 05

LEFT 25 20 05 15 15

Speech recognition was not tested.

At his separation from active duty in March 1988, pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 15 15 15 20 15

LEFT 25 20 10 20 10

Again, speech recognition was not tested.

The Veteran's DD
ment in December 1984. Pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 20 05 10 05

LEFT 25 20 05 15 15

Speech recognition was not tested.

At his separation from active duty in March 1988, pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 15 15 15 20 15

LEFT 25 20 10 20 10

Again, speech recognition was not tested.

The Veteran's DD Form 214 states that his military occupational specialty was cannon crew member, which has a high probability for exposure to hazardous noise.

In October 2024, the Veteran filed a Statement in Support of his claim for service connection for hearing loss. The Veteran said that his military occupational specialty was artillery and that he was exposed to hazardous noise as a result. He said that he was provided with hearing protection but that it fit poorly and was of poor quality, and that he had to remove it frequently in order to communicate with others. He reported current symptoms of hearing loss in both ears.

The Veteran submitted several medical opinions from J.L., a nurse practitioner. The opinion for hearing loss stated that the Veteran's hearing loss began after his exposure to hazardous noise during active duty, and that it was more likely than not that the in-service noise exposure "resulted in acoustic trauma damaging the inner hair cells, spinal ganglion cells, and the cochlear nerve afferent, ultimately leading to hearing loss." See Medical Opinion, October 24, 2024, p16. The report cited several studies including one which found that permanent hearing damage can occur years after exposure to hazardous noise.

A VA contractor completed a hearing examination in February 2025. Pure tone thresholds were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 25 25 25 20

LEFT 30 35 30 30 30

Speech audiometry revealed speech recognition ability of 96 percent in the right ear and of 94 percent in the left ear.

The examiner diagnosed sensorineural hearing loss in the Veteran's left ear, and recurrent tinnitus. The examiner found that the left ear hearing loss was less likely than not caused by or a result of an event, injury, and/or disease incurred during military service. His rationale was that, although the Veteran's military occupational specialty had a high likelihood of hazardous noise exposure, there were no significant threshold shifts from enlistment to separation. Both examinations were normal. As there were no significant threshold shifts during service, the examiner opined "any hearing loss currently present occurred after active duty due to factors unrelated to military service." He also said that "the Institute of Medicine (2006) stated there was insufficient scientific basis to conclude that permanent hearing loss directly attributable to noise exposure will develop long after noise exposure."

Turning to the requirements for service connection, the February 2025 DBQ made a diagnosis of sensorineural hearing loss in the left ear based on a hearing examination. Therefore, the first requirement has been met. See Saunders, supra.

The Veteran served as a cannon crew member, which has a high probability of exposure to hazardous noise. Therefore, the second requirement of service connection has been met. Id.

The third requirement for service connection is evidence that the in-service incident caused the present disability. The two medical opinions are in disagreement. The VA contractor's medical opinion holds more probative value because it is based on an audiogram examination of the Veteran, it is consistent with the similar audiograms at enlistment and separation, and it is supported by a sound rationale. The private medical opinion did not include a hearing test, did not discuss the audiograms from enlistment and separation, and relied on speculative language in studies ("permanent damage can occur years later following noise exposure" (emphasis added)) that was at variance with its conclusion that permanent damage did occur years later in the Veteran's case, without any further explanation. Thus, after weighing the medical evidence, the Board finds that the VA contractor's opinion holds greater probative value. Therefore, the preponderance of the evidence is against a finding that the Veteran's left ear hearing loss was caused by or onset during his service.

As noted above, service connection for certain disabilities may be established by a showing that the disability onset during service or within one year of separation from service or showing that it was noted in service with symptoms continuously since separation from service. 38 C.F.R. § 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As an organic disease of the nervous system, hearing loss is one such disability. However, the evidence does not indicate that the current hearing loss onset within one year of separation from service or was noted in service with symptoms continuously since service. The VA examiner found that the 1988 audiogram did not show a significant threshold shift compared to the 1984 audiogram. In his Statement in Support, the Veteran did not contend that his hearing loss onset during or within one year of his separation from service or that his symptoms have been continuous since service. The earliest evidence of hearing loss is the October 2024 private medical opinion which was prepared 36 years after the Veteran separated from service. Therefore, service connection cannot be established by the presumption for chronic diseases under 38 C.F.R. § 3.307 or by showing continuity of symptoms under Walker.

4. Entitlement to service connection for obstructive sleep apnea (OSA)

The Veteran appeals the denial of service connection for obstructive sleep apnea.

Turning to the evidence, there is no evidence of sleep apnea or snoring in the Veteran's service treatment records. As noted above, his March 1988 separation examination was normal for his lungs and chest, and the Veteran wrote "I'm in good health."

In January 2025, the Veteran submitted two pages of treatment records which show a private diagnosis of sleep apnea in October 2017. See Medical Treatment Record - Non-Government Facility, January 9, 2025 (two records).

As noted above, a March 2025 VA memorandum concluded that the Veteran did not participate in any toxic exposure risk activities during his service. See other, March 4, 2025.

Turning to the requirements of service connection, the October 2017 private diagnosis of sleep apnea satisfies the first requirement of a current disability.

However, the evidence does not indicate or even allege a connection between the diagnosed sleep apnea and the Veteran's active duty service. As the evidence does not demonstrate that the diagnosed sleep apnea was caused by or onset during the Veteran's service, service connection has not been established. See Saunders, supra.

The Veteran was not afforded a VA examination; however, one was not required for this claim. The record does not indicate an association between any symptoms that may be related to sleep apnea which was diagnosed in 2017 and the Veteran's service from 1984 to 1988. Thus, a VA examination is not required. 38 U.S.C. § 5103A(a)(2); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). See also Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (a conclusory generalized lay statement alleging nexus between a current disability and service does not meet the standard to warrant a VA examination).

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection is warranted. Rather, the evidence persuasively weighs against it. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021
See also Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (a conclusory generalized lay statement alleging nexus between a current disability and service does not meet the standard to warrant a VA examination).

REASONS FOR REMAND

1. Entitlement to service connection for: (1) a lumbar spine condition; and (2) a cervical spine condition, are remanded.

VA did not obtain an examination or medical opinion for the Veteran's reported lumbar spine condition and cervical spine conditions.

VA must provide an examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

Under the Appeals Modernization Act, the Board can only remand to correct a duty to assist error that existed at the time of the decision on appeal. As such, in this case, the Board can only remand for a VA examination if the record at the time of the March 4, 2025, rating decision met the McLendon standard. 38 C.F.R. § 20.802(a); McLendon, supra.

At that time, the record included Statements in Support of Claim for each disability as well as favorable medical opinions which were deficient in their rationales. See VA 21-4138 Statement In Support of Claim, October 24, 2024; Medical Opinion, October 24, 2024. Additionally, a private treatment record diagnosed cervical spondylosis and left cervical radiculopathy. See Medical Treatment Record - Non-Government Facility, January 9, 2025.

To date, the Veteran has not been provided with a VA examination for his claimed lumbar spine and cervical spine disabilities. The failure to obtain VA examinations before issuing the March 2025 rating decision reflects a pre-decisional duty to assist error. The claims must be remanded to obtain examinations and medical opinions.

2. Entitlement to a compensable rating for: (1) left hip osteoarthritis with chronic strain, limited abduction/adduction/rotation; and (2) left hip osteoarthritis with chronic strain, limited extension, are remanded.

VA obtained a DBQ for Hip and Thigh Conditions in February 2025. The Veteran told the examiner that he had flare ups three to four times per week which were moderate and lasted 10-15 minutes. However, the report states that during flare ups, there was no change in the range of motion or other factors of disability such as interference with standing or disturbance of locomotion. See C&P Exam, February 26, 2025, p7-8.

The DBQ is inadequate because it failed to explain the worsening during the Veteran's flare ups. Remand is required in order to record the reduced range of motion, additional factors of disability, or else explain why the Veteran's flare ups do not affect his symptoms.

The matters are REMANDED for the following actions:

1. Schedule the Veteran for two VA examinations for the reported lumbar spine and cervical spine disabilities. The examiner must review the claims file.

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

The examiner is asked to provide a response to the following:

(a.) Is the disability at least as likely as not related to service, including falling during active duty service?

(b.) If arthritis is diagnosed, is it at least as likely as not that the disability (1) began during active service, (2) manifested within one year after discharge from service, or (3) was
:

1. Schedule the Veteran for two VA examinations for the reported lumbar spine and cervical spine disabilities. The examiner must review the claims file.

The examiner is asked to provide a response to the following:

(a.) Is the disability at least as likely as not related to service, including falling during active duty service?

(b.) If arthritis is diagnosed, is it at least as likely as not that the disability (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service?

Provide a rationale to support the opinions.

2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected left hip disabilities. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

(a.) In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

(b.) In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

(c.) The Veteran reported flare ups during his February 2025 examination. The examiner should record the reduced range of motion or additional factors of disability during flare ups, or else

explain why the Veteran's flare ups do not affect his symptoms.

J. NICHOLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Dean, Robert

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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