TINNITUS

MARIAH N. SIM · 2026 · Case ID: A26038540

MIXED

Summary

The Veteran served in the U.S. Army from September 1972 to September 1975. The Veteran appeals the denial of service connection for several conditions, including tinnitus, bilateral hearing loss, headaches, Peyronie's disease, lower back pain, anxiety, left elbow disorder, right elbow disorder, right bicep tear, and left and right foot disorders. The Board granted service connection for tinnitus and bilateral hearing loss, finding the Veteran's lay statements and a private medical opinion from Dr. J.M. to be more probative than the VA examiner's opinion, which was deemed inadequate for failing to address the Veteran's statements and for lacking sufficient rationale. The VA examiner's opinions for tinnitus and hearing loss were found inadequate because they did not adequately consider the Veteran's lay statements and the in-service diagnosis of anxiety. The Board remanded the remaining claims for left elbow, right elbow, right bicep tear, right foot, left foot disorders, headaches, Peyronie's disease, lower back pain, and anxiety. The remands are for the purpose of obtaining adequate VA medical examinations and opinions to determine the nature and etiology of these conditions, as the prior examinations were deemed inadequate or not provided.

Rationale

Favorable finding by AOJ for tinnitus; Veteran's lay statements regarding onset and continuity; Probative private medical opinion supporting service connection; Inadequate VA examination opinion

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210803-177549

Full Decision Text

Citation Nr: A26038540
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 210803-177549
DATE: April 24, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for bilateral hearing loss is granted.

REMANDED

Entitlement to service connection for a left elbow disorder is remanded.

Entitlement to service connection for a right elbow disorder is remanded.

Entitlement to service connection for a right bicep tear disorder, to include as secondary to left elbow, is remanded.

Entitlement to service connection for a right foot operation is remanded.

Entitlement to service connection for a left foot operation is remanded.

Entitlement to service connection for headaches is remanded.

Entitlement to service connection for Peyronie's disease is remanded.

Entitlement to service connection for lower back pain (also claimed as lumbar pain) is remanded.

Entitlement to service connection for anxiety (also claimed as sadness and guilt) is remanded.

FINDINGS OF FACT

1. Resolving all doubt in favor of the Veteran, his tinnitus began during active service.

2. Resolving all doubt in favor of the Veteran, his bilateral hearing loss began during active service.

CONCLUSIONS OF LAW

1. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from September 1972 to September 1975.

The rating decision on appeal was issued in April 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 30, 2025. Therefore, the Board may only consider the evidence of record at the time of the April 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims of service connection for headaches, Peyronie's disease, lower back pain, and anxiety, 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).

SERVICE CONNECTION

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 116
by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, including psychosis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). Generally, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3).

For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). When the disease identity is established, there is no requirement of evidentiary showing of continuity. Id. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. Continuity of symptomatology is only applicable to those diseases recognized as chronic for VA purposes. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309.

Pertinent to a claim for service connection, such a determination requires a finding of a 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 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) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability").

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he/she files his/her claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

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. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3rd 1391 (2021).

1. Tinnitus and Bilateral Hearing Loss

The Veteran seeks entitlement to service connection for tinnitus and bilateral hearing loss as etiologically related to his active service. Specifically, the Veteran asserts that he noticed ringing in ears during active service after an explosion, and that he noticed bilateral hearing loss after service, "from my wife and other people around me saying I didn't hear them properly." See January 2025 Board hearing transcript at 6-8.

During the January 2025 Board hearing, the Veteran stated that his tinnitus began during active service. He further stated that "Well, I didn't know what it was, other than the fact that there was a lot of ringing in my ears, if you will, and I was always hearing some background noise. So, I never really knew what it was." He stated that "there was an explosion around us, and ever since then, it's just been a constant thing." He believed that he noticed hearing loss after service "from my wife and other people around me saying I didn't hear them properly."

The AOJ has favorably found that the Veteran has diagnoses of tinnitus and bilateral hearing loss that conforms to 38 C.F.R. § 3.385, and that he has been exposed to noise during service based on his military occupational specialty (MOS) of power-generation equipment repairer. See April 2021 rating decision. The Board is bound by these favorable findings. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104 (c).

The Veteran's service treatment records are silent for any complaints, treatment, or diagnosis of tinnitus and/or bilateral hearing loss or decreased hearing acuity.

After service, the Veteran's medical records are silent for any complaints of tinnitus or hearing loss/decreased hearing acuity until 2018.

A November 2018 VA record shows the Veteran complained of bilateral tinnitus and hearing loss. He reported he was exposed to noise from helicopters, rocket launchers, grenades, and explosions while in the military. A subsequent November 2018 VA ear, nose, and throat (ENT) record noted a diagnosis of bilateral sensorineural hearing loss. A December 2018 VA record noted that hearing aids were ordered for the Veteran.

During an April 2021 VA examination for hearing loss and tinnitus, the Veteran was diagnosed with bilateral hearing loss and tinnitus. He stated that his hearing loss and tinnitus began years ago, but he was unsure of the exact onset. He reported noise exposure from helicopters, motor pool, and gunfire in service. The examiner noted that the Veteran's MOS of power generation equipment operator had high probability of noise exposure. The examiner opined that the Veteran's bilateral hearing loss not at least as likely as not caused by or a result of an event in military service. She noted that there is no significant permanent shift in hearing thresholds beyond test variability from entrance to separation, which is objective evidence of no permanent auditory damage on active duty from conceded noise. She stated that there is no report of complaint/treatment for hearing decrease in service treatment records or at separation. She stated that although noise exposure is conceded and the relationship of noise, auditory damage, and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise alone. She stated that there must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology. She stated that the evidence is against a nexus in this case, and therefore, it is less likely than not that the hearing loss is related to military noise exposure.

The examiner further opined that the Veteran's tinnitus is less likely than not caused by or a result of military noise exposure. She noted that the Veteran has a diagnosis of clinical hearing loss, and that his tinnitus is at least as likely as not a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. She further stated that service treatment records indicate no significant permanent shift in hearing thresholds greater than normal measurement variability from entrance to separation, which is evidence of no permanent auditory damage on active duty. She noted that there is no complaint of tinnitus in service treatment records or at separation. She stated that although excessive noise exposure on active duty is conceded and tinnitus is reported today, there is no nexus of auditory damage on active duty to relate current report of tinnitus to military noise.

The Board finds the April 2021 VA examination opinion inadequate to decide the claim. In this regard, the VA examiner failed to adequately address the Veteran's lay statements and contentions when rendering the opinions. When VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, the Board finds the April 2021 VA medical opinions incomplete to decide the claims. These opinions are afforded little, if any, probative weight.

In an August 2023 private opinion received by the Board in February 2025, Dr. J.M. stated that the Veteran has hearing loss and tinnitus. Dr. J.M. stated that the Veteran "apparently was a generator operator working in a motor pool and has, again, hearing loss and tinnitus, which is more than likely to have been caused by the noise that he had doing these jobs."

The Board affords the May 2023 private medical opinion highly probative. The private medical opinion provided a thorough review and assessment of both the Veteran and his lay statements, including medical literature and resources consulted. In addition, the private doctor considered the lay statements and contentions of the Veteran, and provided an opinion supported by a clear rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In addition, the private doctor considered the Veteran's circumstances of his service, to include the impact of his service when rendering the opinions. Accordingly, this opinion is afforded high probative weight.

In sum, the Veteran has current diagnoses of tinnitus and bilateral hearing loss for VA purposes. The only probative opinions of record are in support of the Veteran's claim for entitlement to service connection. Moreover, there is no sufficient basis for the Board to reject this supportive opinion and to further develop the claim. Cf. Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (holding that, because it is not permissible for VA to undertake additional development to obtain evidence against an appellant's case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose).

Accordingly, the Board finds that the evidence is for the claims and entitlement to service connection for tinnitus and bilateral hearing loss, is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303
the Board to reject this supportive opinion and to further develop the claim. Cf. Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (holding that, because it is not permissible for VA to undertake additional development to obtain evidence against an appellant's case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose).

REASONS FOR REMAND

1. Service Connection - Left Elbow, Right Elbow, Right Bicep Tear, Right Foot, and Left Foot Disorders

The Veteran seeks entitlement to service connection for left elbow, right elbow, right bicep tear, right foot, and left foot disorders a etiologically related to active service. Specifically, as to the right bicep tear, the Veteran contends that the condition is secondary to a left elbow disorder. See March 2021 VA Form 21-526EZ.

During the January 2025 Board hearing, the Veteran stated that he lifted heavy generators in service. He believed he has a right bicep condition because "I think it had to do with not able to use my left arm equally, so maybe I was compensating with the right, but it just happened. The pain got really excruciating and then I couldn't really do much. So even today, I still can't lift very much weight. I have to be very careful." He stated that the same reason applies to his claims for elbows. He stated, "I was in pretty good shape back then and we pretty much muscle through all the pain and agony, you know, things we've got to do to get things done." Regarding his feet, he stated that "My feet, that was -- mostly everything we did back then was with boots. All our PT, all our running, all our field work was always boots. And my feet did hurt, but I don't - didn't have any inserts." He stated that "It just got worse as I got older. And they got worse, I couldn't stand more than a certain amount of time before pain would start. It was excruciating. So, I ended up having both of my feet operated over time."

The AOJ found that the Veteran's private treatment records showed right deltoid repair in 2017. See April 2021 rating decision. The Board is bound by this favorable finding. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104 (c).

The Veteran's service treatment records are silent for any complaints, treatment, or diagnosis of elbow, foot, or right bicep conditions. The Veteran's August 1972 enlistment Report of Medical Examination (RME) and August 1975 separation RME show that that his upper extremities and feet were evaluated as normal.

The Board acknowledges that the Veteran submitted the private DBQ for elbow and forearm conditions in April 2025 that shows a current diagnosis of bilateral bursitis.

VA examinations were not provided for elbow, foot, or right bicep conditions at the time of the AOJ decision on appeal. The Secretary must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006).

VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to make a decision on the claim. 38 U.S.C. § 5103A (d) (2012); 38 C.F.R. § 3.159 (c)(4) (2019); Duenas v. Principi, 18 Vet. App. 512 (2004); Robinette v. Brown, 8 Vet. App. 69 (1995); McLendon v. Nicholson, 20 Vet. App. 79 (2006). For the above reasons, the Board finds that a VA examination is necessary in order to determine the nature and etiology of the Veteran's claimed disorders. The AOJ's failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error that necessitates a remand for development.

2. Service Connection - Headaches

The Veteran seeks service connection for headaches. See March 2021 VA Form 21-526EZ.

The AOJ has found that the Veteran's service treatment records dated in October 1974 and August 1975 shows complaints for headaches. See April 2021 rating decision; 38 C.F.R. § 3.104(c). Indeed, the October 1974 record noted tightness in right neck producing pain over right temporal area; the impression was tension headaches. The August 1975 record noted headaches for 3-4 weeks after strenuous activity of any type; the assessment was "[illegible] HA [headaches]."

The Veteran was not provided a VA examination at the time of the AOJ decision on appeal. Here, the Veteran asserts recurrent symptoms of headaches; multiple service treatment records show complaints of headaches during active service; he has generally asserted that his headaches are related to service; and there is insufficient competent medical evidence on file. Given the foregoing, the Board finds that the McLendon criteria were met at the time of the AOJ decision on appeal, and failure to provide an examination constituted a pre-decisional duty to assist error. On remand, a VA examination and opinion should be obtained.

The Board acknowledges that the Veteran submitted the private DBQ for headaches in April 2025. While Dr. E.W. noted a diagnosis of tension headaches and the Veteran's reported history of headaches, he did not provide a nexus opinion. Further, Dr. E.W. noted that "No records of headache complaints are found in the veteran's service treatment records"; this is incorrect as the record shows, and the AOJ has already favorably found, that the Veteran complained of and was diagnosed with headaches in October 1974 and August 1975. Thus, that DBQ is inadequate to establish service connection. The AOJ's failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error that necessitates a remand for development.

3. Service Connection - Peyronie's Disease

The Veteran contends that his current Peyronie's disease is due to heavy lifting during active service. See March 2021 VA Form 21-526EZ.

The AOJ has favorably found that the Veteran's private treatment records show a current diagnosis of Peyronie's disease. See April 2021 rating decision; 38 C.F.R. § 3.104(c).

The Veteran was not provided a VA examination at the time of the AOJ decision on appeal. Here, the Veteran has a current diagnosis of Peyronie's disease; his MOS of power-generation equipment repair generator likely required heavy lifting; he is claiming his Peyronie's disease as related to service; and there was insufficient competent medical evidence on file. Resolving any doubt in the Veteran's favor, the Board finds that the McLendon criteria were met at the time of the AOJ decision on appeal, and failure to provide a VA examination constituted pre-decisional duty to assist error that warrants a remand.

4. Service Connection - Low Back Pain

The Veteran contends that his current lower back pain is related to heavy lifting, carrying heavy backpacks, and equipment operations during active service. See March 2021 VA Form 21-526EZ.

The AOJ has favorably found that the Veteran's private treatment records show a current diagnosis of lumbar sprain. See April 2021 rating decision; 38 C.F.R. § 3.104(c).

The Veteran contends that his current lower back pain is related to heavy lifting, carrying heavy backpacks, and equipment operations during active service. See March 2021 VA Form 21-526EZ.

The AOJ has favorably found that the Veteran's private treatment records show a current diagnosis of lumbar sprain. See April 2021 rating decision; 38 C.F.R. § 3.104(c).

The Veteran was not provided a VA examination at the time of the AOJ decision on appeal. The Veteran has a current diagnosis of lumbar sprain; his MOS of power-generation equipment repair generator likely required heavy lifting; he is claiming his back disability is related to service; and there was insufficient competent medical evidence on file. Resolving any doubt in the Veteran's favor, the Board finds that the McLendon criteria were met at the time of the AOJ decision on appeal, and failure to provide one constituted a pre-decisional duty to assist error that warrants a remand.

The Board acknowledges that the Veteran submitted an August 2023 opinion from Dr. J.M. in February 2025. Dr. J.M. stated that "Problems with his lower back for many, many years. It is likely that this could be from his serving in the military, at least exacerbating, and is something to at least look into." However, this opinion is inadequate as it provides a conclusive statement without sufficient rationale. Accordingly, the Board affords it little, if any, probative value.

The Board also acknowledges that the Veteran submitted a private DBQ in April 2025. While it shows a diagnosis of intervertebral disc syndrome (IVDS) and the Veteran's reported medical history, Dr. E.W. did not provide a nexus opinion. The attached Functional Capacity Evaluation also does not include a nexus opinion. Thus, it does not establish service connection.

5. Service Connection - Anxiety Disorder

The Veteran seeks service connection for sadness, anxiety, and guilt. See March 2021 VA Form 21-526EZ.

The AOJ has favorably fount that the Veteran has a current diagnosis of generalized anxiety disorder, and that a March 1975 service treatment record shows he was diagnosed with acute anxiety. See April 2021 rating decision; 38 C.F.R. § 3.104(c). The March 1975 treatment record and the March 1975 mental consultation sheet show the Veteran was diagnosed with acute anxiety reaction and was prescribed Librium.

During an April 2021 VA examination, the Veteran was not diagnosed with a mental disorder. The Veteran reported that he first experienced mental health issues when he could not go out of base due to fear of being targeted due to being an immigrant and Vietnam era veteran. He reported depressive symptoms, anxiety symptoms, and difficulty sleeping. While in service, he learned about many close friends who lost their life in service, and he was very affected by these losses and experienced feelings of guilt for not having deployed to be there for his friends, wondering if he could have done something for them if he had been there. He stated that due memories of lost friends, he has difficulty being around veterans who have been to war. He also had anxiety and depressive symptoms that last several days when he has experiences that remind him of the war and the friends he lost. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. She noted that the Veteran's symptoms are currently subclinical and do not interfere with his daily, occupational, or social functioning. She noted that the Veteran does not meet DSM-5 criteria for any mental health disorder.

The Boards finds the April 2021 VA examination inadequate. The Veteran's private treatment records show diagnosis of generalized anxiety disorder. The Veteran stated during the VA examination that he experiences difficulty being around the veterans who have been to war, and anxiety and depressive symptoms that last several days when his service-related memories are triggered. His service treatment records show that he was treated for and prescribed medication for the claimed condition in service. However, the VA examiner dismisses the Veteran's reported symptoms without sufficient explanation, and she fails to discuss in-service diagnosis of and prescription for the claimed condition. The AOJ's denial of the claim based on this inadequate VA examination constituted pre-decisional duty to assist error that warrants a remand.

The Board acknowledges that the Veteran submitted an August 2023 opinion from Dr. J.M. in February 2025. Dr. J.M. stated that "Anxiety, which I have noted in old records. He tells me that he has had this since being in the military. It is actually worse and worse, and I think it is likely that this has occurred from his military service." However, this opinion is inadequate as it provides a conclusive statement without sufficient rationale. Accordingly, the Board finds that a remand
and she fails to discuss in-service diagnosis of and prescription for the claimed condition. The AOJ's denial of the claim based on this inadequate VA examination constituted pre-decisional duty to assist error that warrants a remand.

The Board acknowledges that the Veteran submitted an August 2023 opinion from Dr. J.M. in February 2025. Dr. J.M. stated that "Anxiety, which I have noted in old records. He tells me that he has had this since being in the military. It is actually worse and worse, and I think it is likely that this has occurred from his military service." However, this opinion is inadequate as it provides a conclusive statement without sufficient rationale. Accordingly, the Board finds that a remand is warranted to afford the Veteran a VA examination. The AOJ's failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error that necessitates a remand for development.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination with an appropriate medical examiner and obtain an etiology opinion to determine the nature and etiology of the Veteran's claimed left and right elbow disorders. The need for physical examination or telehealth evaluation is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail.