Case A26039706

MICHAEL MARTIN · 2026 · Case ID: A26039706

MIXED

Summary

The veteran served from August 1997 to March 1998. The veteran appealed the denial of service connection for multiple conditions, including PTSD, lumbar spine disability, right shoulder disability, bilateral ankle disabilities, erectile dysfunction, sleep apnea, chronic fatigue syndrome, bilateral hearing loss, hypertension, and various radiculopathies and hip disabilities. The veteran also appealed for increased ratings for left knee strain and limitation of left knee extension, and for TDIU. The Board dismissed several issues due to withdrawal by the veteran. Service connection for generalized anxiety disorder and major depressive disorder was granted, with the Board finding the evidence in approximate balance and resolving doubt in the veteran's favor. Claims for sleep apnea, chronic fatigue syndrome, bilateral hearing loss, hypertension, and several musculoskeletal and neurological conditions were denied due to lack of probative evidence of a current diagnosis or a nexus to service. The Board granted a 40 percent rating for left knee extension limitation from August 21, 2019, to September 10, 2020, but denied higher ratings or earlier effective dates for the knee conditions. The TDIU claim was denied as the evidence did not show the veteran was unable to secure or follow substantially gainful employment. Several issues, including PTSD, lumbar spine disability, right shoulder disability, bilateral ankle disabilities, and erectile dysfunction, were remanded for further development and addendum opinions to address issues of stressor corroboration, nexus to service, and aggravation by service-connected conditions.

Special Benefit

TDIU

Docket No.

210903-183214

Full Decision Text

Citation Nr: A26039706
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 210903-183214
DATE: April 28, 2026

ORDER

The appeal seeking entitlement to service connection for pseudofolliculitis barbae has been withdrawn and is dismissed.

The appeal seeking entitlement to service connection for right lower extremity radiculopathy has been withdrawn and is dismissed.

The appeal seeking entitlement to a higher rating for right knee instability has been withdrawn and is dismissed.

The appeal seeking entitlement to a higher rating for right patellofemoral pain syndrome has been withdrawn and is dismissed.

Entitlement to service connection for generalized anxiety disorder and major depressive disorder is granted.

Entitlement to service connection for chronic fatigue syndrome is denied.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for a disability claimed as sciatic nerve (neck condition) is denied.

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

Entitlement to service connection for left upper extremity radiculopathy is denied.

Entitlement to service connection for right upper extremity radiculopathy is denied.

Entitlement to service connection for a left hip disability is denied.

Entitlement to service connection for a right hip disability is denied.

Entitlement to service connection for left lower extremity radiculopathy is denied.

Entitlement to service connection for sleep apnea is denied.

Entitlement to service connection for hypertension is denied.

Entitlement to an initial rating of 40 percent for limitation of left knee extension is granted from August 21, 2019, to September 10, 2020.

Entitlement to initial ratings in excess of 10 percent prior to August 21, 2019; 40 percent from August 21, 2019, to September 10, 2020; and noncompensable from September 11, 2020, for limitation of left knee extension is denied.

Entitlement to a compensable initial rating prior to September 11, 2020, and an initial rating in excess of 10 percent from that date for left knee strain, limitation of flexion, is denied.

Entitlement to a total disability rating based on individual unemployability (TDIU) is denied.

REMANDED

Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded.

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

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

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

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

Entitlement to service connection for erectile dysfunction is remanded.

FINDINGS OF FACT

1. On the record at a May 2025 Board hearing and prior to the promulgation of a decision in the appeal, the Veteran requested a withdrawal of the appeals seeking entitlement to service connection for pseudofolliculitis barbae, entitlement to service connection for right lower extremity radiculopathy, entitlement to a higher rating for right knee instability, and entitlement to a higher rating for right patellofemoral pain syndrome.

2. Affording the Veteran the benefit of the doubt, his diagnosed generalized anxiety disorder and major depressive disorder had their onset during his active service.

3. There is no probative evidence for consideration showing that the Veteran had a diagnosis of sleep apnea at any time during or proximate to the pendency of the claim.

4. There is no probative evidence for consideration showing that the Veteran had a diagnosis of chronic fatigue syndrome at any time during or proximate to the pendency of the claim.

5. There is no probative evidence for consideration showing that the Veteran had a bilateral hearing loss disability, as defined in 38 C.F.R. § 3.385, at any time during or proximate to the pendency of the claim.

6. There is no probative evidence for consideration showing that the Veteran had a disability related to the claimed as sciatic nerve (neck condition), a left shoulder disability, left upper extremity radiculopathy, right upper extremity radiculopathy, a left hip disability, a right hip disability, or left lower extremity radiculopathy at any time during or proximate to the pendency of the claim; that any such disabilities had their onset during his active service; or that any such disabilities are otherwise related to an in-service event, injury, or disease.

7. There is no probative evidence for consideration showing that the Veteran's hypertension began during his active service or may otherwise be related to an in-service event, injury, or disease.

8. During the review period prior to August 21, 2021, the Veteran had painful limitation of left knee extension that
left shoulder disability, left upper extremity radiculopathy, right upper extremity radiculopathy, a left hip disability, a right hip disability, or left lower extremity radiculopathy at any time during or proximate to the pendency of the claim; that any such disabilities had their onset during his active service; or that any such disabilities are otherwise related to an in-service event, injury, or disease.

7. There is no probative evidence for consideration showing that the Veteran's hypertension began during his active service or may otherwise be related to an in-service event, injury, or disease.

8. During the review period prior to August 21, 2021, the Veteran had painful limitation of left knee extension that was noncompensable under the relevant diagnostic codes.

9. During the period from August 21, 2021, to September 10, 2020, the Veteran had painful left knee extension limited to 40 degrees.

10. During the period beginning September 11, 2020, the Veteran had painful limitation of left knee extension that was noncompensable under the relevant diagnostic codes.

11. Throughout the review period, the Veteran had painful left knee flexion that was noncompensable under the relevant diagnostic codes.

12. The Veteran was not unable to secure and follow a substantially gainful occupation due to his service-connected disabilities during the review period.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of the appeal seeking entitlement to service connection for pseudofolliculitis barbae have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for withdrawal of the appeal seeking entitlement to service connection for right lower extremity radiculopathy have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

3. The criteria for withdrawal of the appeal seeking entitlement to a higher rating for right knee instability have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

4. The criteria for withdrawal of the appeal seeking entitlement to a higher rating for right patellofemoral pain syndrome have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

5. The criteria for entitlement to service connection for generalized anxiety disorder and major depressive disorder have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

6. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

7. The criteria for entitlement to service connection for chronic fatigue syndrome have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

8. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385.

9. The criteria for entitlement to service connection for a disability claimed as sciatic nerve (neck condition) have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

10. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

11. The criteria for entitlement to service connection for left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

12. The criteria for entitlement to service connection for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102,
5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

11. The criteria for entitlement to service connection for left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

12. The criteria for entitlement to service connection for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

13. The criteria for entitlement to service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

14. The criteria for entitlement to service connection for a right hip disability have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

15. The criteria for entitlement to service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

16. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

17. The criteria for entitlement to an initial rating of 40 percent for limitation of left knee extension have been met from August 21, 2019, to September 10, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.21, 4.71a, Diagnostic Code 5261.

18. The criteria for entitlement to initial ratings in excess of 10 percent prior to August 21, 2019; 40 percent from August 21, 2019, to September 10, 2020; and noncompensable from September 11, 2020, for limitation of left knee extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.21, 4.59, 4.71a, Diagnostic Code 5261.

19. The criteria for entitlement to a compensable initial rating prior to September 11, 2020, and an initial rating in excess of 10 percent from that date for left knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.21, 4.59, 4.71a, Diagnostic Code 5260.

20. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from August 1997 to March 1998.

Regarding the issues of entitlement to service connection for erectile dysfunction and entitlement to service connection for PTSD, in April 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of those issues, which had previously been denied in September 2019 and October 2019 rating decisions, respectively. In July 2021, the Regional Office (RO) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the issues based on the evidence of record at the time of that decision.

Regarding the other issues on appeal, in January 2021 the Veteran submitted a VA Form 20
1997 to March 1998.

Regarding the other issues on appeal, in January 2021 the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of August 2020, September 2020, and October 2020 RO decisions. In February 2021, the RO issued the HLR decision on appeal, which considered the evidence of record at the time of the prior decisions.

In his September 2021 VA Forms 10182, Decision Review Request: Board Appeal (Notice of Disagreement), for this appeal, the Veteran elected the Hearing docket. A Board hearing was held on May 8, 2025, and was conducted by the undersigned Veterans Law Judge (VLJ). Therefore, the Board may only consider the evidence of record at the time of the August 2020, September 2020, October 2020, and July 2021 RO decisions with respect to the issues decided in each of those decisions, 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 RO 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.

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

Regarding the issues remanded herein, any evidence the Board could not consider will be considered by the RO in the adjudication of those issues. 38 C.F.R. § 3.103(c)(2)(ii).

At the May 2025 Board hearing, the undersigned VLJ took testimony as to claims for entitlement to service connection for tinnitus and entitlement to service connection for migraines, which were denied in the February 2021 HLR decision. However, a review of the record reveals that the Veteran did not include those issues on his September 2021 VA Forms 10182 for this appeal. Accordingly, he did not initiate appellate review of those denied claims to the Board. See 38 U.S.C. § 7105. Consequently, the claims are not before the Board at this time, and the Board will not discuss them in this decision.

The undersigned VLJ also took testimony at the May 2025 Board hearing as to the issues of entitlement to an earlier effective date for the grant of a 10 percent rating for left knee strain, limitation of flexion, and whether a rating reduction for limitation of left knee extension effective September 11, 2020, was proper. Although the Veteran did not specifically list those issues on his September 2021 VA Forms 10182 for this appeal, they are part of this appeal as part of the appeals for higher initial ratings for the service-connected left knee disability. Consequently, the Board will discuss those issues as part of the increased rating appeal in this decision.

Finally, in the October 2020 rating decision, the RO made the favorable finding that the Veteran has been diagnosed with a left shoulder disability, as "VA Medical Center Miami treatment records note treatment of chronic changes involving the AC joint, shoulder." In the February 2021 HLR decision on appeal, the RO "overturned" that favorable finding, explaining that there is no left shoulder complaint noted in the Veteran's VA treatment records. The Board agrees with the RO's action in the February 2021 HLR decision. The VA treatment records include a September 2014 X-ray report that includes findings of chronic changes involving the right AC joint. There are no medical treatment records for consideration indicating that the Veteran was treated for a left shoulder disability, such as chronic changes involving the left AC joint. As such, the favorable finding in the October 2020 rating decision is clearly and unmistakably erroneous, as it clearly misinterpreted the September 2014 X-ray as pertaining to the left shoulder rather than the right shoulder and because there are no records showing a left shoulder disability. Because the finding in the October 2020 rating decision is clearly and unmistakably erroneous, the Board is not bound by it. See 38 C.F.R. § 3.104(c).

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to address any specific contentions regarding the case as raised directly by the Veteran or reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed).

Withdrawn Issues

1. Entitlement to service connection for pseudofolliculitis barbae

2. Entitlement to service connection for right lower extremity radiculopathy

3. Entitlement to a higher rating for right knee instability

4. Entitlement to a higher rating for right patellofemoral pain syndrome

The Board may dismiss any appeal which does not allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn by an appellant or their representative as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205.

In this case, at the May 2025 Board hearing, the Veteran asked to withdraw the appeals seeking entitlement to service connection for pseudofolliculitis barbae, entitlement to service connection for right lower extremity radiculopathy, entitlement to a higher rating for right knee instability, and entitlement to a higher rating for right patellofemoral pain syndrome. The withdrawal was explicit and unambiguous, as the Veteran specifically expressed agreement with the withdrawal of those issues as individually identified. In addition, the withdrawal was done with a full understanding of the consequences of such action. The Veteran was assisted by his representative in withdrawing the issues. The representative is an attorney accredited with VA. The Veteran and the representative continued the appeal of the remaining issues and presented relevant argument and testimony as to those remaining issues but did not present further argument or testimony as to the withdrawn issues once withdrawal was requested. Such action reflects knowledge and understanding that a withdrawal of the appeals as to those issues has the effect of removing the issues from the Board's consideration. See Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018).

Therefore, the Board finds that the appeals seeking entitlement to service connection for pseudofolliculitis barbae, entitlement to service connection for right lower extremity radiculopathy, entitlement to a higher rating for right knee instability, and entitlement to a higher rating for right patellofemoral pain syndrome have been withdrawn and that there remain no allegations of errors of fact or law for appellate consideration as to those issues. 38 C.F.R. § 20.205. Accordingly, the Board does not have jurisdiction to review the appeals, and the appeals as to those issues are dismissed.

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.
Board finds that the appeals seeking entitlement to service connection for pseudofolliculitis barbae, entitlement to service connection for right lower extremity radiculopathy, entitlement to a higher rating for right knee instability, and entitlement to a higher rating for right patellofemoral pain syndrome have been withdrawn and that there remain no allegations of errors of fact or law for appellate consideration as to those issues. 38 C.F.R. § 20.205. Accordingly, the Board does not have jurisdiction to review the appeals, and the appeals as to those issues are dismissed.

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, 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 also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 C.F.R. § 1110 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

1. Entitlement to service connection for generalized anxiety disorder and major depressive disorder

The Veteran seeks to be service connected for acquired psychiatric disabilities, which he claimed as anxiety and depression.

The Board concludes that the probative evidence is at least in approximate balance as to whether the Veteran's currently diagnosed generalized anxiety disorder and major depressive disorder began during his active service.

In July 2020, a VA examiner diagnosed the Veteran with PTSD, major depressive disorder, generalized anxiety disorder, and alcohol use disorder in partial remission. She opined that the Veteran's generalized anxiety disorder and major depressive disorder were at least as likely as not incurred in or caused by an in-service event. As a rationale for that opinion, she explained that the evidence indicates that the Veteran's psychological symptoms were not present at the time of his entrance into active service and that they appear to have begun while on active duty, as is evidenced by his service treatment records, which document that he presented with depression, nervousness, performance issues, sleep difficulties, and decreased concentration. Although some of those symptoms could have been related to or aggravated by concerns about his father, who was in ill health at the time, the Veteran's psychological symptoms have persisted to the present despite his father having passed away years ago. The Board finds the examiner's opinion to be probative because it was based on an accurate history and the examiner's expertise as a psychologist. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). The service treatment records show that in February 1998 the Veteran presented with reports of depression, nervousness, and lack of motivation with concern over his father's health. The examiner explained that those symptoms at least as likely as not marked the onset of the Veteran's current generalized anxiety disorder and major depressive disorder, as the Veteran's symptoms have persisted even after the death of his father.

In view of the foregoing, the Board finds the evidence to at least be in approximate balance as to whether the Veteran's current generalized anxiety disorder and major depressive disorder had their onset during his active service. Accordingly, after resolving any remaining doubt in the Veteran's favor, the Board finds that service connection for generalized anxiety disorder and major depressive disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for sleep apnea

3. Entitlement to service connection for chronic fatigue syndrome

4. Entitlement to service connection for bilateral hearing loss

The Veteran seeks to be service connected for sleep apnea, chronic fatigue syndrome, and bilateral hearing loss. At the May 2025 Board hearing, he testified that he was diagnosed with
as to whether the Veteran's current generalized anxiety disorder and major depressive disorder had their onset during his active service. Accordingly, after resolving any remaining doubt in the Veteran's favor, the Board finds that service connection for generalized anxiety disorder and major depressive disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for sleep apnea

3. Entitlement to service connection for chronic fatigue syndrome

4. Entitlement to service connection for bilateral hearing loss

The Veteran seeks to be service connected for sleep apnea, chronic fatigue syndrome, and bilateral hearing loss. At the May 2025 Board hearing, he testified that he was diagnosed with sleep apnea in late 2019 or early 2020 through a sleep study that was ordered due to his complaints of being constantly tired. Regarding the claimed chronic fatigue syndrome, he testified that he is in constant pain, has nightmares, and is always tired due to lack of sleep. Regarding his claimed bilateral hearing loss, he testified that he was diagnosed with hearing loss "quite a few years ago" and that he was exposed to loud noises in service from weapons firing on the BRM field. He also testified that he believes he has hearing loss due to sinus problems he had after spending the night in a foxhole during training.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that there is no probative evidence that the Veteran has a current diagnosis of sleep apnea, chronic fatigue syndrome, or bilateral hearing loss or that he has had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Regarding the claimed chronic fatigue syndrome and sleep apnea, the medical treatment records for consideration show that the Veteran has reported fatigue and difficulty sleeping, but they do not show that he has been diagnosed with chronic fatigue syndrome or sleep apnea. Although the Veteran is considered competent to report symptoms like fatigue and difficulty sleeping, he is not considered competent to diagnose specific conditions such as chronic fatigue syndrome and sleep apnea. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In addition, although the Veteran is considered competent to report prior diagnoses by a medical professional, the medical evidence of record does not substantiate his assertion in that regard, and he as not submitted or identified other evidence that might substantiate his assertions that he has been diagnosed with sleep apnea. Without competent evidence of such diagnoses, the Board finds that his assertions are not probative in establishing a current diagnosis of chronic fatigue syndrome or sleep apnea.

Regarding the claimed bilateral hearing loss, 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 of 500, 1,000, 2,000, 3,000 and 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the thresholds for at least 3 of these frequencies are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

The medical treatment records for consideration do not include any testing that shows the Veteran had a hearing loss disability in either ear during or in temporal proximity to the review period. The results of testing conducted at a July 2020 VA hearing loss and tinnitus examination were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 15 20 20 20

LEFT 15 10 15 20 20

Speech audiometry using the Maryland CNC word list revealed speech recognition scores of 98 percent in the right ear and 96 percent in the left ear. The audiometric and speech recognition findings at the July 2020 VA examination do not reflect a right or left ear hearing loss disability for VA purposes, as defined in 38 C.F.R. § 3.385.

LEFT 15 10 15 20 20

Although the Veteran is considered competent to report symptoms such as difficulty hearing, he is not considered competent to diagnose a hearing loss disability for VA purposes, as doing so requires specific testing and the knowledge and expertise to interpret the result of such testing. See Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d at 1376-77. In addition, although the Veteran is considered competent to report a prior diagnosis of bilateral hearing loss by a medical professional, the medical evidence of record does not substantiate his assertion in that regard. In fact, the July 2020 VA examination shows that the Veteran did not have a hearing loss disability for VA purposes in either ear at the time of the examination. The Veteran has not submitted or identified other evidence that might substantiate his assertions. Without competent evidence of such a diagnosis, the Board finds that his assertions are not probative in establishing a current diagnosis of bilateral hearing loss.

The Veteran was not provided a VA examination as to his claims for entitlement to service connection for chronic fatigue syndrome and sleep apnea. Although medically competent evidence is not always required to trigger VA's duty to assist in providing a VA examination, conclusory generalized lay statements do not suffice to meet the standard of 38 C.F.R. § 3.159(c)(4)(i)(B), as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010); Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010).

In this case, the only evidence of record at the time of issuance of the October 2020 rating decision, which was subsequently subject to higher-level review, that might have indicated that the Veteran may have had a current disability of chronic fatigue syndrome and/or sleep apnea was the Veteran's general assertion on his claims form seeking service connection. The Veteran did not submit or identify medical records suggesting that he may have a diagnosis of chronic fatigue syndrome or sleep apnea. Accordingly, the Board finds that there was no evidence establishing a sufficient indication at the time the October 2020 rating decision was issued that the Veteran had a current disability of chronic fatigue syndrome or sleep apnea such that the Veteran's lay statements, even when considered with the other evidence of record, triggered VA's duty to assist in providing an examination.

As discussed above, in the absence of proof of a current disability, there can be no valid claim for service connection. Brammer, 3 Vet. App. at 225. Accordingly, without evidence of a current disability of chronic fatigue syndrome, sleep apnea, or bilateral hearing loss, the Board need not address the other elements of service connection. In view of the foregoing, the Board concludes that the evidence for and against the claims is not in approximate balance, but rather weighs against the claims. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 999 F.3d. 1391 (Fed. Cir. 2021).

5. Entitlement to service connection for a disability claimed as sciatic nerve (neck condition)

6. Entitlement to service connection for a left shoulder disability

7. Entitlement to service connection for left upper extremity radiculopathy

8. Entitlement to service connection for right upper extremity radiculopathy

9. Entitlement to service connection for a left hip disability

10. Entitlement to service connection for a right hip disability

11. Entitlement to service connection for left lower extremity radiculopathy

8. Entitlement to service connection for right upper extremity radiculopathy

9. Entitlement to service connection for a left hip disability

10. Entitlement to service connection for a right hip disability

11. Entitlement to service connection for left lower extremity radiculopathy

The Veteran seeks to be service connected for a disability that he claimed as "sciatic nerve (neck condition), and for a left shoulder disability, left upper extremity radiculopathy, right upper extremity radiculopathy, a left hip disability, a right hip disability, and left lower extremity radiculopathy. At the May 2025 Board hearing, the Veteran testified that the claimed disabilities are related to an in-service injury he sustained when someone fell on top of him while he was performing wall climb training during field exercises. He also testified that he believes that some of the disabilities may be the result of overcompensation due to his service-connected right knee disability.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that there is no probative evidence that the Veteran has a current diagnosis of sciatic nerve disability, a neck disability, a left shoulder disability, left upper extremity radiculopathy, right upper extremity radiculopathy, a left hip disability, a right hip disability, or left lower extremity radiculopathy or that he has had such a diagnosis at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321.

The medical treatment records for consideration do not show treatment for or a diagnosis of the claimed disabilities. The Veteran had no radicular pain or other signs or symptoms due to radiculopathy at a September 2014 VA back conditions examination. Although the Veteran is considered competent to report pain and other symptoms observable through the sense, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), he is not considered competent to diagnose a particular disability, as he has not been shown to possess the medical knowledge and expertise required to do so. See Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d at 1376-77. Accordingly, his assertions are not probative in establishing the existence of a current disability. As such, the Board finds that there is no probative evidence for consideration showing that the Veteran has a current disability related to the claimed sciatic nerve disability, neck disability, left shoulder disability, left upper extremity radiculopathy, right upper extremity radiculopathy, left hip disability, right hip disability, and left lower extremity radiculopathy.

In addition, the Board further finds that even if there were probative evidence of a current disability, there is no probative evidence for consideration showing an in-service event, injury, or disease to which the claimed disabilities might be related. The service treatment records show that the Veteran reported knee pain in September 1997 and December 1997. They do not document the specific injury the Veteran reported at the May 2025 Board hearing, and they do not show that he reported symptoms related to the neck, left shoulder, upper extremities, or hips, or left lower extremity radiculopathy symptoms during his active service. The Veteran is competent to report current and prior symptoms, but is not competent to relate his current symptoms to a particular cause, as providing such a nexus opinion requires medical knowledge and expertise that he has not been shown to possess. See Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d at 1376-77. Therefore, his testimony at the hearing is not probative in establishing a nexus between any current disability and an in-service injury.

The Veteran was not provided VA examinations as to these claims. The only evidence of record at the time of issuance of the October 2020 rating decision, which was subsequently subject to higher-level review, indicating that the Veteran may have had a current disability relating to the claims was the Veteran's general assertion on his claims form seeking service connection. The Veteran did not submit or identify medical records suggesting that he may have a diagnosis for the disabilities. He also did not identify an in-service event, injury, or disease to which the claimed disabilities might be related prior to issuance of the October 2020 rating decision. Accordingly, the Board finds that there was no evidence establishing a sufficient indication at the time the October 2020 rating decision was issued that the Veteran had a current disability related to
. The only evidence of record at the time of issuance of the October 2020 rating decision, which was subsequently subject to higher-level review, indicating that the Veteran may have had a current disability relating to the claims was the Veteran's general assertion on his claims form seeking service connection. The Veteran did not submit or identify medical records suggesting that he may have a diagnosis for the disabilities. He also did not identify an in-service event, injury, or disease to which the claimed disabilities might be related prior to issuance of the October 2020 rating decision. Accordingly, the Board finds that there was no evidence establishing a sufficient indication at the time the October 2020 rating decision was issued that the Veteran had a current disability related to the claimed sciatic nerve disability, neck disability, left shoulder disability, left upper extremity radiculopathy, right upper extremity radiculopathy, left hip disability, right hip disability, and left lower extremity radiculopathy such that the Veteran's lay statements, even when considered with the other evidence of record, triggered VA's duty to assist in providing an examination. There also was no evidence of a possible link between his active service and a current disability.

Finally, the Veteran first raised the theory that his claimed disabilities are related to the in-service wall climbing injury or may be secondary to his service-connected right knee disability at the May 2025 Board hearing, which was held only after the October 2020 rating decision was issued. Because there was no pre-decisional error on the part of the RO to satisfy VA's duty to assist in providing an examination or opinion to address that theory, the Board will not remand the issue to obtain an examination or opinion based on it. See 38 C.F.R. § 20.802(a).

In summary, there is no probative evidence for consideration showing that the Veteran had a disability related to the claimed as sciatic nerve (neck condition), a left shoulder disability, left upper extremity radiculopathy, right upper extremity radiculopathy, a left hip disability, a right hip disability, or left lower extremity radiculopathy at any time during or proximate to the pendency of the claim; that any such disabilities had their onset during his active service; or that any such disabilities are otherwise related to an in-service event, injury, or disease. In view of the foregoing, the Board concludes that the evidence for and against the claims is not in approximate balance, but rather weighs against the claims. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776.

12. Entitlement to service connection for hypertension

The Veteran seeks to be service connection for hypertension. At the May 2025 Board hearing, he testified that he was diagnosed with hypertension around 2017 when he first started getting treatment at VA. He stated that even with medications he was still having high blood pressure, which he attributed to "probably due to lack of, some lack of sleep and also my weight". He also testified that he believes that he would be more active and healthy if not for issues with his back and knees.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service event, injury, or disease.

The Board concludes that, although the medical treatment records show that the Veteran has a current diagnosis of hypertension, the evidence for consideration persuasively weighs against finding that the disability began during active service, or is otherwise related to an in-service injury, event, or disease.

The service treatment records do not show a diagnosis of hypertension or blood pressure readings that meet the criteria for a diagnosis of hypertension under VA's regulatory definition. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). The Veteran has not asserted that his hypertension was first diagnosed during active service or within one year of his separation from active service. Rather, he has reported that the disability was diagnosed nearly two decades after his separation from active service. Accordingly, there is no probative evidence for consideration showing that the Veteran's hypertension was diagnosed during service or within one year from his separation from active service.

Although the Veteran believes that his hypertension may have been caused or aggravated by his service-connected disabilities, to include with obesity acting as an intermediate step, he is not considered competent to provide a nexus opinion on the matter because he has not been shown to have the medical knowledge and expertise required to do so. Therefore, his assertions are not probative in establishing a nexus between his hypertension and his active service or in establishing that his hypertension was caused or
year of his separation from active service. Rather, he has reported that the disability was diagnosed nearly two decades after his separation from active service. Accordingly, there is no probative evidence for consideration showing that the Veteran's hypertension was diagnosed during service or within one year from his separation from active service.

The Veteran was not provided a VA examination as to his claimed hypertension. As stated above, the evidence of record at the time of issuance of the October 2020 rating decision did not suggest that there was an in-service event, injury, or disease to which the claimed hypertension might be related. Furthermore, the Veteran presented no specific contentions identifying such an in-service event, injury, or disease prior to issuance of the October 2020 rating decision. Accordingly, the Board finds that there was no evidence establishing a sufficient indication of an in-service event, injury, or disease at the time the October 2020 rating decision to trigger VA's duty to assist in providing an examination.

In addition, the Veteran first raised the theory that his claimed hypertension is secondary to his service-connected disabilities at the May 2025 Board hearing, which was held only after the October 2020 rating decision was issued. Because there was no pre-decisional error on the part of the RO to satisfy VA's duty to assist in providing an examination or opinion to address that theory, the Board will not remand the issue to obtain an examination or opinion based on it. See 38 C.F.R. § 20.802(a).

In summary, there is no probative evidence for consideration showing that the Veteran's hypertension began during his active service or may otherwise be related to an in-service event, injury, or disease. In view of the foregoing, the Board concludes that the evidence for and against the claim is not in approximate balance, but rather weighs against the claim. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776.

Increased Ratings

1. Entitlement to an initial rating in excess of 10 percent prior to September 11, 2020, and a compensable initial rating from that date for limitation of left knee extension

2. Entitlement to a compensable initial rating prior to September 11, 2020, and an initial rating in excess of 10 percent from that date for left knee strain

The Veteran seeks higher initial ratings for limitation of left knee extension and for left knee strain. The applicable review period is from June 18, 2019, the effective date for the award of service connection for those disabilities, through September 16, 2020, the date of notification of the September 2020 rating decision, which was subsequently subject to higher-level review. See 38 C.F.R. § 3.400. At the May 2025 Board hearing, the Veteran testified that his left knee has worsened since he was last examined by VA in September 2020. However, he has not presented any specific contentions as to why he believes higher ratings are warranted during the review period. The representative argued at the May 2025 Board hearing that the 10 percent initial rating for left knee strain, limitation of flexion, should have been awarded as of the date of the claim rather than as of the date of a September 2020 VA examination. The representative also argued that the rating for limitation of left knee extension should not have been reduced in the September 2020 rating decision.

Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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).

When after careful consideration of all procurable and
determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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).

When after careful consideration of all procurable and assembled data, 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. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999).

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

The Veteran's service-connected left knee disability is currently rated as noncompensable prior to September 11, 2020, and at 10 percent from that date under 38 C.F.R. § 4.71a, Diagnostic Code 5299-5260. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. In this case, the use of Diagnostic Code 5299-5260 reflects that the Veteran's specific service-connected condition is an unlisted condition and that a diagnostic code was therefore "built-up" using 52, the two digits used for disabilities of the musculoskeletal system, and 99. Id. The Veteran's left knee strain has been rated using the criteria listed under Diagnostic Code 5260, which pertains to limitation of flexion of the leg.

The Veteran's service-connected left knee disability is also currently rated at 10 percent prior to September 11, 2020, and noncompensable from that date under 38 C.F.R. § 4.71a, Diagnostic Code 5261, which pertains to limitation of extension of the leg.

Also relevant to this decision is 38 C.F.R. § 4.71a, Diagnostic Code 5257, which pertains to other impairment of the knee and provides ratings for recurrent subluxation and lateral instability. Under Diagnostic Code 5257, as
's left knee strain has been rated using the criteria listed under Diagnostic Code 5260, which pertains to limitation of flexion of the leg.

Also relevant to this decision is 38 C.F.R. § 4.71a, Diagnostic Code 5257, which pertains to other impairment of the knee and provides ratings for recurrent subluxation and lateral instability. Under Diagnostic Code 5257, as in effect during the review period, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257.

According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree.

In addition, previous versions of VA's Adjudication Procedures Manual (M21-1) stated that findings from joint stability testing performed at VA examinations are to be used in evaluating the severity of subluxation or instability. Thus, a finding of 1+ (0-5 mm) instability is considered "slight," 2+ (5-10 mm) instability is considered "moderate," and 3+ (10-15 mm) instability is considered "severe." Although the Board is not bound by provisions in the M21-1, it will consider these provisions in assessing whether the Veteran in this case is entitled to a separate rating under Diagnostic Code 5257 for his left knee strain.

Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347 (2018).

Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees.

The Board will first discuss whether higher ratings were warranted based on the record. The Board will then discuss whether the rating reduction made in the September 2020 rating decision was proper.

Increased Ratings

The Board finds that the evidence for consideration persuasively weighs in favor of an initial rating of 40 percent for limitation of left knee extension from August 21, 2019, to September 10, 2020. However, the evidence for consideration persuasively weighs against initial ratings in excess of 10 percent prior to August 21, 2019; 40 percent from August 21, 2019, to September 10, 2020; and noncompensable from September 11, 2020, for limitation of left knee extension and against a compensable initial rating prior to September 11, 2020, and an initial rating in excess of 10 percent from that date for left knee strain, limitation of flexion.

The medical treatment records for consideration show that the Veteran reported left knee pain. However, they do not include range-of-motion measurements or other descriptions of the Veteran's service-connected left knee disability that are relevant to the rating criteria or might suggest that higher initial ratings are warranted.

A July 2019 VA knee and lower leg conditions examiner opined that the Veteran would have left knee flexion to 85 degrees and extension to 0 degrees during flare-ups. This is the most limited range of motion at the July 201
of left knee extension and against a compensable initial rating prior to September 11, 2020, and an initial rating in excess of 10 percent from that date for left knee strain, limitation of flexion.

A July 2019 VA knee and lower leg conditions examiner opined that the Veteran would have left knee flexion to 85 degrees and extension to 0 degrees during flare-ups. This is the most limited range of motion at the July 2019 VA examination. Flexion limited to 85 degrees and extension to 0 degrees does not meet the criteria for a compensable rating under Diagnostic Codes 5260 and 5261. As such, the July 2019 VA examination reflects that the Veteran was entitled to no more than the currently assigned single 10 percent rating under either Diagnostic Code 5260 or Diagnostic Code 5261 based on painful motion that was noncompensable under the relevant diagnostic codes for limited motion.

An August 2019 VA knee and lower leg conditions examiner opined that the Veteran would have left knee flexion to 60 degrees and extension to 40 degrees during flare-ups. This is the most limited range of motion at the August 2019 VA examination. Extension limited to 40 degrees warrants a 40 percent rating under Diagnostic Code 5261. Therefore, the Board finds that the Veteran's rating under Diagnostic Code 5261 must be increased from 10 percent to 40 percent effective August 26, 2019, the date of the August 2019 VA examination and the first date that limitation of extension warranting such a higher rating is shown in the record. Swain v. McDonald, 27 Vet. App. 219, 224 (2015); see also 38 C.F.R. § 3.400(o)(2). The Veteran's limitation of left knee flexion to 60 degrees warrants a noncompensable rating under Diagnostic Code 5260. The Veteran's 40 percent rating under 5261 contemplates his pain and loss of motion. Therefore, a separate 10 percent rating under Diagnostic Code 5260 pursuant to 38 C.F.R. § 4.59 is not warranted. See 38 C.F.R. § 4.14.

A September 11, 2020, VA knee and lower leg conditions examiner opined that the Veteran would have left knee flexion to 75 degrees and extension to 0 degrees during flare-ups and on repeated use over time. This is the most limited range of motion at the September 11, 2020, VA examination. Flexion limited to 75 degrees and extension to 0 degrees does not meet the criteria for a compensable rating under Diagnostic Codes 5260 and 5261. As such, the September 11, 2020, VA examination reflects that the Veteran was entitled to no more than the currently assigned single 10 percent rating under either Diagnostic Code 5260 or Diagnostic Code 5261 based on painful motion that was noncompensable under the relevant diagnostic codes for limited motion from September 11, 2020, the date of the VA examination.

A September 14, 2020, VA knee and lower leg conditions examiner opined that the Veteran would have left knee flexion to 80 degrees and extension to 0 degrees during flare-ups and on repeated use over time. This is the most limited range of motion at the September 14, 2020, VA examination. Flexion limited to 80 degrees and extension to 0 degrees does not meet the criteria for a compensable rating under Diagnostic Codes 5260 and 5261. As such, the September 14, 2020, VA examination reflects that the Veteran was entitled to no more than the currently assigned single 10 percent rating under either Diagnostic Code 5260 or Diagnostic Code 5261 based on painful motion that was noncompensable under the relevant diagnostic codes for limited motion.

Regarding Diagnostic Code 5257, the Board acknowledges the Veteran's report at the August 2019 VA examination that his left knee at times gives way when he stands up, as well as his report at the September 11, 2020, VA examination that he has a "giving out" feeling in his left knee. Objective stability testing at the VA examinations was negative and did not reveal instability. The VA examiners all indicated that the Veteran does not have a history of recurrent subluxation or lateral instability in the left knee. The Board reiterates that objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257 as in effect during the review period. See English, 30 Vet. App. at 352-53. However, given the vague nature of the Veteran's statements as to instability, which indicate that the knees feel as though they are unstable or will give way but do not establish that they have actually been unstable or given way to a measurable or quantifiable degree, the Board relies on the results of objective testing at the VA examinations and the VA examiner's finding that the Veteran does not have a history of recurrent subluxation or lateral instability. The Board therefore concludes that the Veteran did not have the sort of recurrent subluxation or lateral instability that would warrant a compensable rating under Diagnostic Code 5257 during the review period.

Rating Reduction

A veteran's disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. See 38 U.S.C. § 1155; see also Greyzck v. West, 12 Vet. App. 288, 292 (1999).

Certain due process procedures described in 38 C.F.R. § 3.105(e) must be followed where a reduction in rating of a service-connected disability or employability status is considered warranted and the lower rating would result in a reduction or discontinuance of compensation payments currently being made. In this case, the reductions made in the September 2020 rating decision did not result in a reduction or discontinuance of compensation payments being made. Therefore, VA was not obligated to follow the procedures described under 38 C.F.R. § 3.105(e) prior to reducing the Veteran's rating for limitation of left knee extension under 38 C.F.R. § 3.105(e). See also Stelzel v. Mansfield, 508 F.3d 1345, 1349 (Fed. Cir. 2007). As such, the Board will not further discuss the procedural requirements under 38 C.F.R. § 3.105(e).

In rating reduction cases, VA must establish, by an approximate balance in the evidence, that the reduction was warranted. Brown v. Brown, 5 Vet. App. 413, 421 (1993); Kitchens v. Brown, 7 Vet. App. 320, 324 (1995). A reduction in rating must be based upon review of the entire history of the disability. Brown, 5 Vet. App. at 420; see also 38 C.F.R. §§ 4.1, 4.2, 4.10. VA must then ascertain whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based on thorough and adequate examinations. Faust v. West, 13 Vet. App. 342, 349 (2000). Finally, it must be determined whether the improvement reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. Brown, 5 Vet. App. at 421.

The criteria governing rating reductions for service-connected disabilities is found in 38 C.F.R. § 3.344. The provisions of 38 C.F.R. §§ 3.344(a) and (b) apply to ratings that have continued for five years or more. However, in this case, the Veteran's 10 percent rating for left knee limitation of extension was in effect for less than 5 years when it was decreased to noncompensable. Therefore, the provisions of 38 C.F.R. §§ 3.344(a) and (b) do not apply. Instead, reexamination disclosing improvement will suffice to warrant a rating reduction. See 38 C.F.R. § 3.344(c).

General VA regulations, including 38 C.F.R. §§ 4.1, 4.2, and 4.13, apply to all rating reductions, regardless of whether the rating was in effect for five years or more. See Brown,
. However, in this case, the Veteran's 10 percent rating for left knee limitation of extension was in effect for less than 5 years when it was decreased to noncompensable. Therefore, the provisions of 38 C.F.R. §§ 3.344(a) and (b) do not apply. Instead, reexamination disclosing improvement will suffice to warrant a rating reduction. See 38 C.F.R. § 3.344(c).

General VA regulations, including 38 C.F.R. §§ 4.1, 4.2, and 4.13, apply to all rating reductions, regardless of whether the rating was in effect for five years or more. See Brown, 5 Vet. App. at 420-21. 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history. 38 C.F.R. § 4.2 establishes that it is the responsibility of the rating specialist to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in the use of descriptive terms. Additionally, in any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but that such improvement reflects improvement in ability to function under ordinary conditions of life and work. Brown, 5 Vet. App. at 420-21.

The September 2019 rating decision granted a 10 percent rating for left knee strain, limitation of extension, and a noncompensable rating for left knee strain, limitation of flexion, based on the July 2019 VA examination, which, as stated above, shows that the Veteran's left knee extension and flexion were both limited to noncompensable degrees under Diagnostic Codes 5260 and 5261. The findings at the July 2019 VA examination therefore showed that a single 10 percent rating was warranted under either Diagnostic Code 5260 or Diagnostic Code 5261 based on painful motion that was noncompensable under the relevant diagnostic codes for limited motion. The September 2019 rating decision assigned the single 10 percent rating under Diagnostic Code 5261.

As discussed above, the August 2019 VA examination reflects limitation of left knee extension that warrants a higher rating under Diagnostic Code 5261. However, it also reflects that the Veteran continued to have a noncompensable degree of limitation of flexion in the left knee under Diagnostic Code 5260.

The September 2020 rating decision simultaneously reduced the Veteran's rating for left knee strain, limitation of extension, to noncompensable and increased the Veteran's rating for left knee strain, limitation of flexion, effective September 11, 2020, based on the VA examination of that date. As discussed above, at that examination the Veteran's left knee extension and flexion were both limited to noncompensable degrees under Diagnostic Codes 5260 and 5261.

The Board concludes that the evidence of record at the time of the rating reduction showed an improvement in the Veteran's left knee strain such that the reduction was proper. The August 2019 VA examiner opined that the Veteran would have left knee flexion to 60 degrees and extension to 40 degrees during flare-ups. However, when the Veteran was next reexamined, the September 11, 2020, VA examiner opined that the Veteran would have left knee flexion to 75 degrees and extension to 0 degrees during flare-ups and on repeated use over time. The September 11, 2020, VA examiner's assessment is indicative of an actual improvement in the Veteran's condition under the ordinary conditions of life and work and not merely a difference in the thoroughness of the examinations, as the August 2019 VA examiner and the September 11, 2020, VA examiner both examined the Veteran's left knee using the same tests and criteria and both interviewed the Veteran and considered the Veteran's responses to questioning in reaching their conclusions. As such, it was appropriate for the RO to reduce the Veteran's rating so that he would have a single 10 percent rating under Diagnostic Code 5260 or Diagnostic Code 5261 pursuant to 38 C.F.R. § 4.59. Therefore, the evidence persuasively weighs in favor of finding that the reduction in the rating for limitation of left knee extension was proper, and the rating is not restored.

Other Matters and Conclusion

The Veteran's initial rating of 10 percent under
2019 VA examiner and the September 11, 2020, VA examiner both examined the Veteran's left knee using the same tests and criteria and both interviewed the Veteran and considered the Veteran's responses to questioning in reaching their conclusions. As such, it was appropriate for the RO to reduce the Veteran's rating so that he would have a single 10 percent rating under Diagnostic Code 5260 or Diagnostic Code 5261 pursuant to 38 C.F.R. § 4.59. Therefore, the evidence persuasively weighs in favor of finding that the reduction in the rating for limitation of left knee extension was proper, and the rating is not restored.

Other Matters and Conclusion

The Veteran's initial rating of 10 percent under Diagnostic Code 5260 was assigned from September 11, 2020, the date of the first of the two September 2020 VA examinations. The Board is cognizant that the effective date for an increased rating depends on when the change in disability level can be ascertained and is not assigned mechanically as of the date of an examination showing an increase. Swain, 27 Vet. App. at 224; see also 38 C.F.R. § 3.400(o)(2). In this case, the evidence for consideration dating prior to September 11, 2020, does not show that the criteria for a 10 percent initial rating under Diagnostic Code 5260 were met prior to the September 11, 2020, VA examination. Therefore, the evidence for consideration does not show that an increase in disability may be ascertained prior to September 11, 2020, such that the 10 percent initial rating may be assigned from an earlier date.

Neither the Veteran nor his representative raised any other issues with regard to the ratings for the service-connected left knee disability, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017).

In conclusion, the Board concludes that the criteria for entitlement to a higher initial rating of 40 percent for limitation of left knee extension are met from August 21, 2019, to September 10, 2020. However, the criteria for higher initial rating for the service-connected left knee disability have not otherwise been met. Therefore, to the extent that the Veteran seeks higher initial ratings than those assigned previously and those assigned herein, there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and, to that extent, the appeal must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th 776.

3. Entitlement to a TDIU

The Veteran seeks entitlement to a TDIU. The issue was raised as part of the appeal for higher initial ratings for the service-connected left knee disability. Therefore, the review period for entitlement to a TDIU is from June 18, 2019, the effective date for the award of service connection for the service-connected left knee disability, through October 15, 2020, the date of notification of the RO decision, which was subsequently subject to higher-level review. See 38 C.F.R. § 3.400.

Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a Veteran is unable to secure and follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component is met when the Veteran is unemployed or marginally employed. Marginal employment generally shall be deemed to exist when the Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a). Marginal employment includes employment in a protected environment, such as a family business or sheltered workshop, which involves a lower-income position that, due to the Veteran's service-connected disabilities, is shielded in some respect from competition in the employment market. LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024). Consideration shall be given in all claims to the nature of the employment and the reason
employment generally shall be deemed to exist when the Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a). Marginal employment includes employment in a protected environment, such as a family business or sheltered workshop, which involves a lower-income position that, due to the Veteran's service-connected disabilities, is shielded in some respect from competition in the employment market. LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024). Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a).

The non-economic component of the phrase "unable to secure and follow a substantially gainful occupation" includes consideration of the Veteran's history, education, skill, and training; whether the Veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the Veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Ray, 31 Vet. App. at 73.

The Board is not permitted to consider advancing age or a nonservice-connected disability when determining entitlement to a TDIU. 38 C.F.R. §§ 3.341(a), 4.16, 4.19.

A TDIU does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In this regard, entitlement to a TDIU is a legal determination, not a medical one. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Medical examiners may provide evidence regarding functional and occupational impairment, but the Board must decide whether a Veteran may "secure and follow a substantially gainful occupation" based on all evidence of record. See Delrio v. Wilkie, 32 Vet. App. 232, 243 (2019).

The Veteran had the following service-connected disabilities during the review period: generalized anxiety disorder and major depressive disorder; right knee instability; right patellofemoral pain syndrome; left knee strain, limitation of flexion; limitation of left knee extension; and three surgical scars, right knee.

For the reasons that follow, the Board finds that entitlement to a TDIU is not warranted.

On an April 2020 VA Form 21-8940, Veteran's Application for Increased Compensation based on Unemployability, the Veteran reported that he has a high school education and that he last work as an auto mechanic until May 2017. In August 2020, his former employer submitted a VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, on which it confirmed that the Veteran worked as an auto mechanic from April 2004 to May 2017 and that he stopped working because he was "unable to perform work duties properly."

Regarding mental limitations due to the service-connected generalized anxiety disorder and major depressive disorder, the July 2020 VA psychiatric examination indicates that the Veteran had psychiatric symptoms that affected his concentration, productivity, and social functioning during the review period. Those symptoms include depressed mood, anxiety, chronic sleep impairment, and disturbance of motivation and mood. The Veteran also reported intrusive thoughts, low energy and irritability. The July 2020 VA examiner marked that the Veteran's overall occupational and social impairment due to his service-connected major depressive disorder is most appropriately characterized as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care, and conversation.

Some of the Veteran's psychiatric symptoms, including sleep impairment and anxiety would cause difficulties with concentration and changes in the workplace and would therefore preclude work that requires completing complex, multi-step tasks and work of an inconsistent nature. The other symptoms, including disturbances in motivation and mood and difficulty with social interaction, would affect the Veteran's ability to work closely with supervisors, coworkers,
, low energy and irritability. The July 2020 VA examiner marked that the Veteran's overall occupational and social impairment due to his service-connected major depressive disorder is most appropriately characterized as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care, and conversation.

Some of the Veteran's psychiatric symptoms, including sleep impairment and anxiety would cause difficulties with concentration and changes in the workplace and would therefore preclude work that requires completing complex, multi-step tasks and work of an inconsistent nature. The other symptoms, including disturbances in motivation and mood and difficulty with social interaction, would affect the Veteran's ability to work closely with supervisors, coworkers, and the general public. Thus, from a psychiatric standpoint, he was limited to simple, routine work that does not involve frequent interactions with supervisors, coworkers or the general public and that instead is performed in a mostly solitary manner.

Regarding physical limitations from the service-connected left and right knee disabilities, the Veteran reported at the July 2019 VA knee and lower leg conditions examination that he has daily intermittent knee pain with prolonged standing and walking. He also reported knee stiffness. The examiner indicated that the Veteran would have physical limitation with prolonged standing and walking due to his service-connected knee disabilities. At the August 2019 VA knee and lower leg conditions examination, the Veteran reported sharp pain and stiffness in his knees that affects all of his activities of daily living. He told the examiner that he could no longer work as an auto mechanic because he cannot get on the ground, bend his knees, lift equipment and parts, and move around. At the September 11, 2020, VA knee and lower leg conditions examination, the Veteran reported knee pain when walking, lying down, and changing positions. Due to his knee symptoms, he is unable to jog or to walk or stand for long periods, and he does not believe he would be able to bend or lie on the ground to work on cars. At the September 14, 2020, VA knee and lower leg conditions examination, he reported limited range of motion, swelling, and constant pain, and that he cannot bend or kneel for long periods of time. On an Individual Unemployability Statement form, the September 14, 2020, VA examiner opined that, despite his service-connected knee disabilities, the Veteran could perform light work. The form defines "light work" as "Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible, which the defined as exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects."

The Board finds the September 14, 2020, VA examiner's opinion on the Veteran's overall ability to perform exertional activities to be probative because it is based on an examination of the Veteran and on the examiner's knowledge and expertise as a medical professional regarding the functional impact of disabilities such as the Veteran's service-connected knee disabilities. It is also not inconsistent with the other evidence for consideration, to include the July 2019, August 2019, and September 11, 2020, VA examinations. Accordingly, the Board finds that, despite his service-connected knee disabilities, the Veteran would be able to perform physical occupational tasks involving light lifting of no more than 20 pounds, standing or walking for up to 6 hours out of an 8-hour workday, and sitting for up to 6 hours of an 8-hour workday. The Board additionally finds the Veteran credible in his report of difficulty with kneeling and bending due to his service-connected knee disabilities. Therefore, he would additionally be limited to work that does not involve frequent kneeling or bending of the knees.

There is no indication in the record that the Veteran's service-connected scars caused functional limitations during the review period. The Veteran reported no such limitations at a September 2020 VA scars/disfigurement examination, and the examiner who conducted that examination indicated that the scars do not impact the Veteran's ability to work.

In summary, the evidence shows that, due to his service-connected disabilities, the Veteran was limited
8-hour workday, and sitting for up to 6 hours of an 8-hour workday. The Board additionally finds the Veteran credible in his report of difficulty with kneeling and bending due to his service-connected knee disabilities. Therefore, he would additionally be limited to work that does not involve frequent kneeling or bending of the knees.

In summary, the evidence shows that, due to his service-connected disabilities, the Veteran was limited to light work that does not involve frequent kneeling or bending at the knee, is simple and routine in nature, that does not involve frequent interactions with supervisors, coworkers or the general public. Such an occupational profile would still allow for a wide range of light unskilled or semiskilled work, such as inspection work, assembly work, and sorting work, which is performed in a solitary manner and involves simple and repetitive tasks that do not often change.

The Board has considered the Veteran's level of education. See 38 C.F.R. § 4.16. The Veteran has a high school education. Such a level of education is not inconsistent with an ability to perform work of an unskilled or semiskilled nature, such as inspection work, assembly work, and sorting work, which does not require special training and can be learned at the job site.

The Board has also considered the Veteran's work history. The Veteran has a long history of working as an auto mechanic, which he has reported involves too much kneeling and bending at the knees for him to continue performing. The Board does not question the Veteran in his assertion that the duties of an auto mechanic are beyond his physical capabilities in view of his service-connected left and right knee disabilities. However, there are many other substantially gainful occupations that he Veteran could secure and follow. In addition, the Board finds that the Veteran's lack of other work prior to and during the review period would not, in itself, prevent him from transitioning to an unskilled or semiskilled occupation that does not involve duties requiring frequent kneeling and bending the knees, or from securing or following an unskilled or semiskilled occupation, which do not require special training and can be learned on the job site.

In summary, the evidence for consideration does not show that the Veteran was unable to secure or follow a substantially gainful occupation due to his service-connected disabilities during the review period. Thus, the Board concludes that the evidence for and against the appeal is not in approximate balance, but rather weighs against the appeal. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776.

REASONS FOR REMAND

1. Entitlement to service connection for PTSD is remanded.

A February 2021 VA examiner diagnosed the Veteran with PTSD and attributed that PTSD to the Veteran's reported in-service stressors related to witnessing a fellow servicemember being run over by a Humvee and witnessing another servicemember attempt or commit suicide. Service connection for PTSD requires credible supporting evidence that a claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). In this case, the record does not show that appropriate efforts have been made to corroborate the Veteran's reported stressors despite the Veteran providing additional dates and details in October 2019 and October 2020 at the RO's request. A remand is required to allow VA to attempt to corroborate the Veteran's reported stressors.

2. Entitlement to service connection for a lumbar spine disability is remanded.

The Veteran was provided a VA examination as to his claimed lumbar spine disability in September 2014. He told the examiner that during his active service he injured his lower back and went to the medic, who treated him with Motrin. He further told the examiner that he has experienced recurrent low back pain since then. The examiner diagnosed the Veteran with degenerative arthritis of the spine and opined that the disability was less likely than not incurred in or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner stated that the Veteran was treated for lower back complaints once in service for an acute and transient lower back condition "with no evidence that he developed a chronic lower back condition during active duty." The examiner's rationale is based entirely on a lack of contemporaneous medical treatment records and does not reflect consideration of the Veteran's reports of
service he injured his lower back and went to the medic, who treated him with Motrin. He further told the examiner that he has experienced recurrent low back pain since then. The examiner diagnosed the Veteran with degenerative arthritis of the spine and opined that the disability was less likely than not incurred in or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner stated that the Veteran was treated for lower back complaints once in service for an acute and transient lower back condition "with no evidence that he developed a chronic lower back condition during active duty." The examiner's rationale is based entirely on a lack of contemporaneous medical treatment records and does not reflect consideration of the Veteran's reports of recurrent low back pain since the in-service lower back injury. The opinion is therefore inadequate for adjudication purposes. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical evidence does not, in and of itself, render lay evidence not credible). As such, the issue must be remanded so that an addendum opinion may be obtained. See 38 C.F.R. § 20.802(a).

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

The Veteran was provided a VA examination as to his claimed right shoulder disability in September 2014. He told the examiner he developed right shoulder pain doing physical training during his active service, and that he has experienced recurrent right shoulder pain since then. The examiner diagnosed the Veteran with degenerative arthritis of the right shoulder and opined that the disability was less likely than not incurred in or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner stated that there is no documentation in the service treatment records supporting the development of a chronic right shoulder condition during active service. The examiner's rationale is based entirely on a lack of contemporaneous medical treatment records and does not reflect consideration of the Veteran's reports of in-service right shoulder pain during physical training and recurrent right shoulder pain since then. The opinion is therefore inadequate for adjudication purposes. See Buchanan, 451 F.3d at 1337. As such, the issue must be remanded so that an addendum opinion may be obtained. See 38 C.F.R. § 20.802(a).

4. Entitlement to service connection for a left ankle disability is remanded.

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

The Veteran seeks to be service connected for left and right ankle disabilities, which he claimed as secondary to his service-connected right knee disability. He was provided a VA examination as to his claimed bilateral ankle disability in July 2019. The examiner diagnosed the Veteran that bilateral ankle sprain and opined that the disability is less likely than not proximately due to or the result of the Veteran's service-connected right knee disability. However, the examiner did not provide an opinion as to whether the Veteran's service-connected right knee disability may have aggravated his bilateral ankle disability. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). Therefore, the issues must be remanded so that an addendum opinion may be obtained. See 38 C.F.R. § 20.802(a).

6. Entitlement to service connection for erectile dysfunction is remanded.

The Veteran seeks to be service connected for erectile dysfunction, which he claimed as secondary to his service-connected right knee disability. He was provided a VA examination as to his claimed erectile dysfunction in June 2021. He told the examiner that his erectile dysfunction began in 2017 and was due to constant anxiety and PTSD. The examiner opined that the disability at least as likely as not was incurred in or caused by an in-service injury. However, the Board finds that the examiner's opinion is not probative because it is not supported by appropriate rationale. Specifically, in support of the opinion the examiner merely recorded the Veteran's lay assertions without providing any analysis or exercising independent judgment. The examiner also cited to a study that investigated the prevalence of erectile dysfunction among combat veterans. The Veteran has not asserted, and the record does not show, and he is a combat veterans. As such, it is not clear how the study is relevant in the Veteran's case. Because the opinion is not probative, the issue must be remanded so that an addendum opinion may be obtained. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Attempt to corroborate the Veteran's in-service stressors, including witnessing a fellow servicemember being
opinion the examiner merely recorded the Veteran's lay assertions without providing any analysis or exercising independent judgment. The examiner also cited to a study that investigated the prevalence of erectile dysfunction among combat veterans. The Veteran has not asserted, and the record does not show, and he is a combat veterans. As such, it is not clear how the study is relevant in the Veteran's case. Because the opinion is not probative, the issue must be remanded so that an addendum opinion may be obtained. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Attempt to corroborate the Veteran's in-service stressors, including witnessing a fellow servicemember being run over by a Humvee and witnessing a fellow servicemember attempt or commit suicide. If more details are needed, contact the Veteran to request the information.

2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's diagnosed degenerative arthritis of the lumbar spine and/or degenerative of the right shoulder at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) had its onset during his active service or is other related to an in-service event, injury, or disease.

The opinion regarding the Veteran's lumbar spine must reflect consideration of the Veteran's December 1997 complaint of low back pain and of the Veteran's report to the September 2014 VA examiner that he has experienced recurrent low back pain since then.

The opinion regarding the Veteran's right shoulder must reflect consideration of the veteran's report to the September 2014 VA examiner that he developed right shoulder pain doing physical training during his active service, and that he has experienced recurrent right shoulder pain since then.

In providing the requested opinions, consider the Veteran's description of the in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of the current disability, this should be noted. Stated another way, do the Veteran's reports about the symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?

This remand is interlocutory in nature, and the Board intimates no opinion as to the credibility of the Veteran's lay reports as to the onset and continuity of his low back and right shoulder symptoms. See Miller v. Wilkie, 32 Vet. App. 249, 259-62 (2020) (A medical opinion may inform the Board's understanding of the medical feasibility and credibility of lay statements). The examiner may determine those reports to be noncredible based on factors such as internal consistency, facial plausibility, and consistency with other information submitted on behalf of the Veteran. See Caluza v. Brown, 7 Vet. App. 498 (1995). The examiner may also consider a lack of contemporaneous medical treatment records documenting complaints or treatment for the reported symptoms. However, the examiner may not rely solely on a lack of such records. In other words, a lack of contemporaneous medical treatment records must be considered only in conjunction with other credibility factors. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical evidence does not, in and of itself, render lay evidence not credible).

3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's diagnosed bilateral ankle sprain is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) due to or aggravated by a service-connected disability.

The opinion must reflect consideration of the Veteran's testimony at a May 2025 Board of Veterans' Appeals hearing that he believes his service-connected right knee disability has caused him to have an altered gait, which in turn caused or aggravated his bilateral ankle strain. The private treatment records note that the Veteran presented with a limping and antalgic gait at times.

Aggravation is defined as any worsening of the disease. Causation and aggravation must be addressed separately. The examiner must note that an opinion to the effect that one disability "is not caused by or a result of" another disability does not answer the question of aggravation and will necessitate a further opinion. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013).

4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's diagnosed erectile dysfunction is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) due to or aggravated by a service-connected disability.

The opinion must
.

The opinion must reflect the Veteran's reports at a July 2021 VA male reproductive organ conditions examination that his erectile dysfunction began in 2017 and was due to constant anxiety and PTSD. The Veteran is currently service connected for generalized anxiety disorder and major depressive disorder.

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. J. Anthony, 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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