PSYCHOSIS

MARTIN B. PETERS · 2026 · Case ID: A26040132

MIXED

Summary

The veteran, who served from April 1980 to April 2006, including service in the Southwest Asia theater of operations, appeals a Department of Veterans Affairs Regional Office decision. The veteran sought service connection for a psychiatric disorder, obstructive sleep apnea (OSA), sinusitis, bilateral pes planus, rhinitis, right knee disability, right ankle disability, left ankle disability, and right shoulder disability. The Board granted service connection for OSA but denied service connection for the psychiatric disorder and increased ratings for rhinitis, right knee disability, right ankle disability, left ankle disability, and right shoulder disability. The Board remanded the claims for sinusitis and bilateral pes planus due to conflicting medical evidence regarding current diagnoses and the need for further clarification. For the denied claims, the Board found that the evidence did not establish a current psychiatric disorder incurred in service, that rhinitis did not result in polyps during the period on appeal, and that the claimed range of motion limitations for the knees, ankles, and shoulder did not meet the criteria for increased evaluations. The Board relied on the findings of fact and conclusions of law, including specific range of motion measurements and the absence of objective evidence for certain conditions, to support its decisions.

Rationale

No current psychiatric diagnosis; Not incurred in or resulting from service

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250626-560530

Full Decision Text

Citation Nr: A26040132
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250626-560530
DATE: April 29, 2026

ORDER

Service connection for a psychiatric disorder is denied.

Service connection for obstructive sleep apnea (OSA) is granted.

An initial evaluation in excess of 10 percent for non-allergic rhinitis is denied.

An evaluation in excess of 10 percent for a right knee anterior cruciate ligament (ACL) tear (hereinafter referred to as "right knee disability") is denied.

A compensable initial evaluation for right knee ACL tear with arthritis and limitation of extension (hereinafter referred to as "right knee limitation of extension") is denied.

An initial evaluation in excess of 10 percent for a right ankle disability is denied.

An initial evaluation in excess of 10 percent for a left ankle disability is denied.

An evaluation in excess of 20 percent for a right shoulder bursitis with rotator cuff tear, impingent syndrome, and glenohumeral joint arthritis (hereinafter referred to as a "right shoulder disability") is denied.

REMANDED

Entitlement to service connection for sinusitis is remanded.

Entitlement to service connection for bilateral pes planus is remanded.

FINDINGS OF FACT

1. The evidence does not show that the Veteran has a current psychiatric diagnosis that was incurred in or resulted from service.

2. The evidence demonstrates that the Veteran's current OSA had its onset during active duty service.

3. During the period on appeal, the Veteran's service-connected rhinitis did not result in polyps.

4. The Veteran's right knee disability manifests with flexion limited to 80 degrees, at the worst, after considering pain and additional limitations during flare-ups and after repeated use over time.

5. The Veteran's right knee disability manifests with extension limited to 5 degrees, at the worst, after considering pain and additional limitations during flare-ups and after repeated use over time.

6. The Veteran's right and left ankles had plantar flexion limited to 45 degrees and dorsiflexion limited to 20 degrees.

7. The Veteran's right shoulder is his major/dominant hand.

8. The Veteran's right shoulder disability manifested with flexion to 90 degrees and abduction to 90 degrees after considering pain and additional limitations during flare-ups and after repeated use over time.

CONCLUSIONS OF LAW

1. The criteria to establish service connection for a psychiatric disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria to establish service connection for OSA are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for an initial evaluation in excess of 10 percent for rhinitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.97, Diagnostic Code (DC) 6522.

4. The criteria for an evaluation in excess of 10 percent for the right knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, DC 5010-5260.

5. The criteria for a compensable initial evaluation for right knee limitation of extension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, DC 5010-5261.

6. The criteria for an initial evaluation in excess of 10 percent for a right ankle disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 5271.

7. The criteria for an initial evaluation in excess of 10 percent for a left ankle disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 5271.

8. The criteria
1.

6. The criteria for an initial evaluation in excess of 10 percent for a right ankle disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 5271.

7. The criteria for an initial evaluation in excess of 10 percent for a left ankle disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 5271.

8. The criteria for an evaluation in excess of 20 percent for a right shoulder disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 5010-5201.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from April 1980 to April 2006 with service in the Southwest Asia theater of operations.

This case comes before the Board of Veterans' Appeals (Board) from an April 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), hereinafter the Agency of Original Jurisdiction (AOJ). In June 2025, the Veteran submitted a timely Board Appeal: Notice of Disagreement (NOD), VA Form 10182, identifying issues decided in that decision, and electing the Evidence Submission docket. Because the Veteran elected the Evidence Submission docket, the Board may only consider the evidence of record at the time of the notification of the AOJ decision on appeal (April 30, 2025), as well as any evidence submitted by the Veteran with and within 90 days of receipt of the instant VA Form 10182 in this case (June 26, 2025, through September 24, 2025). 38 C.F.R. § 20.303. The Board cannot consider (1) evidence submitted during the period after the AOJ promulgated and issued the decision on appeal and before receipt of the VA Form 10182 (May 1, 2025, through June 25, 2025), or (2) evidence submitted more than 90 days after receipt of the VA Form 10182 (on or after September 25, 2025). Id. If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300.

With regard to the remanded claim, any evidence that is not considered by the Board at this time will be considered by the AOJ upon readjudication of this claim.

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016).

Service Connection Claims

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

The United States Court of Appeals for Veterans Claims (Court) has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet
service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

The United States Court of Appeals for Veterans Claims (Court) has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Court recently held disability for VA purposes includes any condition that results in functional impairment of earning capacity. Martinez-Bodon v. Wilkie, 38 Vet. App. 393 (2020).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).

A lay person is competent to report on the onset and reoccurrence of current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board must determine on a case-by-case basis whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

Psychiatric Disorder

Service connection under any theory requires a current disability, or a functional impairment in earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In this case, the evidence is sparse as to any complaint of, treatment for, or diagnosis of a psychiatric disorder. In fact, at the March 2025 VA examination, the Veteran denied receiving any type of mental health treatment other than being prescribed Ambien for sleep. He stated that he did not have any mental problem related to any type of traumatic event. The only thing he could relate to a psychiatric disorder in any way was night sweats. He stated that he actually did not equate them to mental trauma, but that a psychiatrist said that it could be due to some kind of trauma.

The Board acknowledges that a March 2025 VA Form 21-0781, Statement in Support of Claim for PTSD, reflects the Veteran's report of a false flag terrorist attack in the summer of 1995 as a traumatic event. However, at the March 2025 VA examination, he described this incident and stated that he thought of that incident often, but just as a memory.

The March 2025 VA examiner found that the Veteran did not have symptoms that met the DSM-5 diagnostic criteria for PTSD or any other mental disorder. The Veteran stated that he averaged about six hours of sleep, was "in the best health [he had] been in years," ate well, had a "wonderful" mood, and was always happy.

As no current disability is shown any time during or approximate to the pendency of the claim as of the rating decision on appeal, service connection must be denied at this time. See 38 C.F.R. § 3.303; see also Brammer, supra; McClain v. Nicholson, 21 Vet. App. 319 (2007) (the requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary's adjudication of the claim."); Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 404 (2020), aff'd sub nom. Martinez-Bodon v. McDonough, 28 F.4th 1241, 1247 (Fed. Cir. 2022) (a valid DSM-5 diagnosis is required because 38 C.F.R. §§ 4.125 and 4.130 require such a DSM-5 diagnosis as a precondition for compensation, rendering Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) inapplicable in psychiatric service connection claims).

Because the threshold element of a current disability is not met in this case, it is unnecessary to address the remaining elements necessary to establish the service connection claim. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence is against the Veteran's psychiatric disorder claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

OSA

As an initial matter, the AOJ made a favorable findings of a current diagnosis of OSA and conceded participation in a toxic exposure risk activity (TERA), specifically exposure to burn pit and other toxins as well as exposure to fuels, fumes, oils, solvents, and lubricants. See April 2025 rating decision.

Turning to the evidence in this case, a May 2013 VA treatment record noted that a sleep study indicated severe sleep apnea.

In a September 2024 letter, L.M.H. stated that he had known the Veteran for 28 years and lived with him from September 1996 to August 1997. He stated that the Veteran was always a very heavy snorer and would often stop breathing for abnormal periods of time during his sleep.

In September 2024, T.L. stated that he shared sleeping arrangements with the Veteran for many months while deployed to Italy between November 1997 and January 1998. He stated that, while sleeping, the Veteran snored loudly and constantly. He noticed that on many occasions, the Veteran's breathing stopped for as long as 10 seconds. He would have to shake the Veteran aggressively to get him to breathe or to try to stop his snoring.

An October 2024 VA examination report reflects review of the claims file and a diagnosis of OSA. The Veteran reported an onset in 2011 with abnormal breathing during sleep. The examiner opined that the OSA was at least as likely as not incurred in or caused by sleep apnea during service as VA literature found that sleep apnea was prevalent the highest among Gulf War veterans when compared to other veteran groups, although the Veteran's records did not indicate a sleep apnea diagnosis during service. No rationale was provided addressing this specific Veteran's specific medical history or background.

An August 2024 private report of consultation and examination by Dr. M.T. reflects that the Veteran had a history of heavy snoring and cessation of respirations during sleep during his time on active duty. These symptoms persisted without hiatus to the present. He was diagnosed with OSA, which had an onset during active duty military service, which persisted to the present. Specifically, she stated that it had an onset during deployment to the Southwest Asia theater of military operations.

A February 2025 VA examination report reflects review of the claims file and a diagnosis of OSA with an onset in 2011. The examiner opined that it was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran. A thorough review of medical literature failed to demonstrate a causal relationship between the TERA and OSA. OSA was the most common sleep-related breathing disorder, which caused a veteran to repeatedly stop and start breathing while sleeping. It occurred when the throat muscles intermittently relax and block his airway during sleep. The Veteran's risk factors and the more
.

The Board finds that service connection is warranted on a direct basis after review of all of the evidence, both lay and medical.

The most recent VA opinion from February 2025 only addressed whether the Veteran's OSA had a relationship to the conceded TERA. The examiner did not address whether it was incurred during service, other than the conceded TERA.

The Board acknowledges the October 2024 VA opinion that it was at least as likely as not incurred in or caused by sleep apnea during service. However, this opinion was based on general VA literature that found that sleep apnea was most prevalent among Gulf War veterans, and not the specific facts and circumstances of the Veteran. The examiner did not consider his medical history, his statements regarding onset, or the circumstances of his military service.

The private August 2024 examiner found that the Veteran's OSA had an onset during deployment, which persisted to the present. This report by itself may not be sufficient to support the Veteran's claim. However, the lay statements by L.M.H. and T.L. corroborate the finding of an in-service incurrence of OSA symptoms, specifically of loud and constant snoring and cessation of breathing while sleeping. Notably, the Veteran's symptoms were noted to begin in the 1990s by those individuals, not during his later period in Southwest Asia, which is what Dr. M.T. ultimately concluded. This calls into question whether Dr. M.T. actually reviewed the Veteran's claims file, although one may be able to reconcile this incongruity by noting that Dr. M.T. noted that he had a history of abnormal heavy snoring and breathing cessation during service which has persisted without hiatus to the present, notwithstanding the minor factual inaccuracy regarding when such symptoms began during service.

Overall, the evidence appears to demonstrate that the Veteran's symptoms began during service, as noted by T.L. and L.M.H., and that such symptoms persisted until diagnosis of OSA in 2013, approximately 7 years after discharge from service. Although the Veteran may not have been officially diagnosed with OSA until years after separation from service, the totality of the evidence, both medical and lay evidence, demonstrates a relative equipoise regarding whether the Veteran's OSA symptoms began during service. In this regard, the Board therefore gives the benefit of the doubt to the Veteran on this point. As such, the Board finds the evidence is at least in approximate balance as to whether the Veteran's OSA had an onset during service.

Accordingly, the Board concludes that the Veteran's OSA was incurred in active service; thus, the criteria for direct service connection are met. See 38 C.F.R. § 3.303. In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

Higher Evaluation Claims

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or
service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, are to be avoided. 38 C.F.R. § 4.14.

Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet. App. 119 (1999). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

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).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range
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.").

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).

Non-Allergic Rhinitis

By way of procedural history, the Veteran's rhinitis service connection claim was submitted in September 2024, and granted in the April 2025 rating decision on appeal. Therefore, the appeal is for an initial increased evaluation from the April 2025 rating decision that awarded service connection. See Fenderson, supra.

The Veteran's rhinitis is assigned an initial evaluation of 10 percent. See 38 C.F.R. § 4.97, DC 6522.

Under DC 6522, a 10 percent rating is assigned for allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. A 30 percent rating is assigned for allergic or vasomotor rhinitis with polyps. See 38 C.F.R. § 4.97.

In his June 2025 VA Form 10182, the Veteran contended that a 20 percent evaluation was appropriate for his non-allergic rhinitis. The Board notes that a 20 percent evaluation is not available under DC 6522.

Turning to the evidence, a February 2025 VA examination report reflects review of the claims file and a diagnosis of non-allergic rhinitis. The Veteran's current symptoms were left-sided nasal congestion, runny nose, post-nasal drip, and cough. He had greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, but no nasal polyps.

Based on the evidence of record, the Board finds that an initial evaluation in excess of 10 percent is not warranted. The only other evaluation available above 10 percent is 30 percent, which requires rhinitis with polyps. However, the evidence does not indicate that the Veteran has any nasal polyps.

In analyzing this case, the Board considered the Veteran's competent statements regarding observable symptoms and contentions. However, he has not provided any lay statements regarding nasal polyps.

The Board finds the February 2025 VA examination report to be adequate and highly probative regarding the current manifestations and severity of the Veteran's rhinitis, as it was based on examination and review of the record. Additionally, there is no competent evidence contradicting this evidence.

Accordingly, the Board concludes that an initial evaluation in excess of 10 percent for non-allergic rhinitis is not warranted under DC 6522.

Finally, neither the Veteran nor his representative has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

Right Knee Disability Limitation of Flexion and Limitation of Extension

By way of procedural history, the Veteran submitted a service connection claim for the right knee disability in June 2006, which the AOJ granted in an October 2006 rating decision, assigning a noncompensable initial evaluation, effective May 1, 2006. The Veteran then submitted an increased rating claim in September 2024. The AOJ increased the evaluation to 10 percent, effective October 20, 2023, and granted service connection for the right knee limitation of flexion in the April 2025 rating decision currently on appeal. Accordingly, the Board has considered the evidence since September 23, 2023, with this increased evaluation claim for the right knee disability. See 38 C.F.R. § 3.400(o); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). However, the appeal for the right knee limitation of extension is for an initial increased evaluation from the April 2025 rating decision that awarded service connection. See Fenderson, supra.

Relevant to this appeal, the Veteran is in receipt of a 10 percent evaluation for a right knee disability under DC 5010-5260. He is also in receipt of a noncompensable initial evaluation for right knee limitation of extension under DC 5010-5261. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27.

In this case, DC 5010 is used to evaluate post-traumatic arthritis. Post-traumatic arthritis is rated on the basis of limitation of motion, dislocation, or other specified instability under the affected joint. If there are two or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25.

Therefore, the hyphenated DCs reflect that DC 5260 was applied to evaluate the post-traumatic arthritis under DC 5010 for the right knee disability, specifically limitation of flexion. Additionally, DC 5261 was applied to evaluate the post-traumatic arthritis under DC 5010 for right knee limitation of extension.

In rating knee disabilities, separate ratings for the Veteran's knee disabilities are possible for: (1) limitation of flexion; (2) limitation of extension; (3) recurrent subluxation or instability; and (4) signs and symptoms associated with the dislocation or removal of semilunar cartilage. VAOPGCPREC 9-98 (63 Fed. Reg. 56,704 (1998)) and 23-97 (62 Fed. Reg. 63, 604 (1997)); Lyles v. Shulkin, 29 Vet. App. 107, 115-16 (2017).

The rating criteria for limitation of flexion of the knee is found at 38 C.F.R. § 4.71a, DCs 5260. This DC provides that flexion of either leg that is limited to 60 degrees is noncompensable, flexion limited to 45 degrees merits a 10 percent rating, limitation of flexion to 30 degrees warrants a 20 percent evaluation, and a 30 percent evaluation requires that flexion be limited to 15 degrees. For rating purposes, normal range of motion (ROM) of the knee is from zero to 140 degrees. 38 C.F.R. § 4.71a, Plate II.

The rating criteria for limitation of extension of the knee is found at 38 C.F.R. § 4.71a, DCs 5261. This provision provides that 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, and a 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

The
The rating criteria for limitation of extension of the knee is found at 38 C.F.R. § 4.71a, DCs 5261. This provision provides that 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, and a 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

The criteria for DC 5257 provides that a 10 percent rating is assigned for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane, crutch, walker) or bracing for ambulation; a 20 percent rating is assigned for sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace or assistive device (e.g., cane, crutch, walker) for ambulation, or unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane, crutch, walker) or bracing for ambulation; and a 30 percent rating is assigned for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane, crutch, walker) and bracing for ambulation. See 82 Fed. Reg. 76453 (Nov. 30, 2020); 38 C.F.R. § 4.71a, DC 5257.

A rating may also be assigned for patellar instability. For patellar instability, a 10 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker; a 20 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker; and a 30 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note (1) following the criteria provides, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2) following the criteria provides a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). See 38 C.F.R. § 4.71a, DC 5257 (2022).

DC 5258 provides a 20 percent rating for semilunar, dislocated cartilage with frequent episodes of "locking," pain, and effusion into the joint. DC 5259 provides for a 10 percent rating for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a.

Turning to the evidence, an August 2024 private report of consultation and examination by Dr. M.T. reflects the Veteran's report of intermittent right knee pain which intensified with walking, transition to other positions, and rising from a seated position. On examination, he had flexion to 80 degrees with pain and "adequate" extension.

A February 2025 VA examination report reflects review of the claims file and a diagnosis of right knee joint osteoarthritis and right knee ACL tear. Current symptoms included sharp pain when turning a certain way and stepping down, which also occurred when getting up from sitting down. He worried about potential falls as it affected his ability to walk long distances or stand long periods of time. He reported flare-ups that occurred several times a month, which the Veteran described as moderate. They lasted three to five minutes, were precipitated after the knee locked up, and alleviated by walking it off. The Veteran had instability or recurrent subluxation of the knee, specifically in that he felt like the knee locked or stuck which caused significant pain. He did not have a history of frequent effusion
file and a diagnosis of right knee joint osteoarthritis and right knee ACL tear. Current symptoms included sharp pain when turning a certain way and stepping down, which also occurred when getting up from sitting down. He worried about potential falls as it affected his ability to walk long distances or stand long periods of time. He reported flare-ups that occurred several times a month, which the Veteran described as moderate. They lasted three to five minutes, were precipitated after the knee locked up, and alleviated by walking it off. The Veteran had instability or recurrent subluxation of the knee, specifically in that he felt like the knee locked or stuck which caused significant pain. He did not have a history of frequent effusion of the knee. Active ROM testing revealed flexion to 130 degrees and extension to 0 degrees with pain with flexion. Passive ROM was the same as active ROM with pain with flexion. He had pain with active and passive motion and with non-weightbearing that caused functional loss. There was no additional loss of function or ROM after three repetitions. The Veteran was not being examined immediately after repeated use over time or during a flare-up. Procured evidence did not suggest that pain, fatigability, weakness, lack of endurance, and incoordination significantly limited functional ability with repeated use over time. Procured evidence suggested that pain significantly limited functional ability with flare-ups with estimated flexion to 120 degrees and estimated extension to 5 degrees. He did not have ankylosis, recurrent subluxation or persistent instability, or an incomplete or partial ligament tear that was not repaired. He did not require a prescription for any assistive device for ambulation. He did not have recurrent patellar instability, a tibial or fibular impairment, or any meniscal condition. X-rays revealed mild degenerative joint disease (DJD) of the medial and lateral compartments of the right knee with extensive arterial sclerotic change noted in the popliteal artery.

Based on the foregoing evidence, the Board finds that an evaluation in excess of 10 percent under DC 5260 is not warranted in this case. The Veteran was found to have flexion to 80 degrees, at the worst, (see August 2024 private report) which is associated with a noncompensable evaluation. In fact, the 10 percent was based on x-ray evidence of post-traumatic arthritis and painful motion of the knee. In order to receive a higher evaluation under DC 5260, the evidence must demonstrate flexion limited to 30 degrees. The evidence does not indicate that flexion was so severely limited at any point in time during the appeal period.

Therefore, the Board reflects that 10 percent evaluation under DC 5260 is appropriate, even after factoring in pain and other functional impairments during repeated use and/or flare-up.

With regards to DC 5261, the estimated extension was to 5 degrees after considering flare-ups. Therefore, a noncompensable evaluation is appropriate for right knee limitation of extension. See 38 C.F.R. §§ 4.7, 4.59, 4.71a, DC 5261. A separate compensable evaluation is not warranted for painful motion, as such would be considered pyramiding. See Petitti v. McDonald, 27 Vet. App. 415 (2015) (holding section 4.59 does not stand alone but instead works as a bridge with the limitation-of-motion diagnostic codes when a compensable rating under those diagnostic codes is not warranted).

The Board acknowledges the Veteran's description of locking up or sticking at times. However, he was found not to have recurrent subluxation or lateral instability or patellar instability. Subjective feelings of locking or sticking are not the same as the impairment evaluated by DC 5257.

The other DCs that apply to the knee and leg were also considered. However, the evidence does not demonstrate ankylosis (DC 5256), dislocation of the semilunar cartilage (DC 5258), removal of the semilunar cartilage (DC 5259), impairment of the tibia or fibula (DC 5262), or genu recurvatum (DC 5263).

In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra.

Right and Left Ankle Disabilities

By way of procedural history, the Veteran's right and left ankle service connection claims were
8), removal of the semilunar cartilage (DC 5259), impairment of the tibia or fibula (DC 5262), or genu recurvatum (DC 5263).

In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra.

Right and Left Ankle Disabilities

By way of procedural history, the Veteran's right and left ankle service connection claims were submitted in September 2024, and granted in the April 2025 rating decision on appeal. Therefore, the appeal is for initial increased evaluations from the April 2025 rating decision that awarded service connection. See Fenderson, supra.

In his June 2025 VA Form 10182, the Veteran contended that a 40 percent evaluation was appropriate for his right and left ankle disabilities. A 40 percent evaluation requires ankylosis under DC 5270.

The Veteran is in receipt of initial evaluations of 10 percent for his right and left ankle disabilities, effective October 20, 2023, under DC 5271.

Under DC 5271, moderate limitation of motion of the ankle is defined as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion and warrants a 10 percent rating. Marked limitation of motion of the ankle is defined as less than 5 degrees dorsiflexion or less than 10 degrees of plantar flexion and warrants a 20 percent rating.

For purposes of VA compensation, normal dorsiflexion of the ankle is zero to 20 degrees, and normal ankle plantar flexion is zero to 45 degrees. See 38 C.F.R. § 4.71a, Plate II.

Turning to the evidence, an August 2024 private report of consultation and examination by Dr. M.T. reflects daily right ankle pain that intensified with walking and standing. The Veteran reported giving out, which inverted his foot without control, causing him to stumble and trip. On examination, he had mild decreased ROM with dorsiflexion, plantar flexion, inversion, and eversion.

A February 2025 VA examination report reflects review of the claims file and a diagnosis of a bilateral ankle and foot ligament disorder. His current symptoms included significant pain and "catching" when standing up. When sitting and moving, he sometimes felt a sharp pain. He felt that his side stability was bad and would often roll his ankle just walking through the house. He did not report flare-ups or any functional loss or impairment. He did not have a history of instability of the ankle. He had normal ROM bilaterally with plantar flexion to 45 degrees and dorsiflexion to 20 degrees. Passive ROM was the same as active ROM. There was no evidence of pain, crepitus, localized tenderness or pain on palpation. There was no additional loss of function or ROM after three repetitions. He was not being examined immediately after repeated use over time. Procured evidence did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time. He did not have ankylosis. X-rays of the right and left ankles were negative.

Based on the evidence, initial evaluations in excess of 10 percent are not warranted for his right and left ankle disabilities. The August 2024 private report does not contain specific measurements for ROM. At the February 2025 VA examination, he had dorsiflexion to 20 degrees and plantar flexion to 45 degrees bilaterally, which is defined as moderate, thus warranting 10 percent evaluations.

Therefore, the Board finds that initial evaluations in excess of 10 percent are not warranted for the right and left ankle disabilities. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.7. 4.71a, DC 5271.

Additionally, the Board considered whether a higher rating may be available under other diagnostic codes available. However, the evidence does not indicate that the Veteran has ankylosis of the ankle (DC 5270) or of the subastragalar or tarsal joint (DC 5272), malunion of the os calcis or astragalus (DC 5273), or astragalectomy (DC 5274). Thus, the other diagnostic codes are not applicable here.

In so reaching the
not warranted for the right and left ankle disabilities. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.7. 4.71a, DC 5271.

In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra.

Right Shoulder Disability

By way of procedural history, the Veteran submitted a service connection claim for the right shoulder disability in June 2006, which the AOJ granted in an October 2006 rating decision, assigning a 10 percent initial evaluation, effective May 1, 2006. In additional to claims for temporary total ratings in November 2006 and October 2009, the Veteran submitted an increased rating claim in September 2024. The AOJ increased the evaluation to 20 percent, effective October 20, 2023. Accordingly, the Board has considered the evidence since September 23, 2023, with this increased evaluation claim for the right shoulder disability. See 38 C.F.R. § 3.400(o); Gaston, supra.

In his June 2025 VA Form 10182, the Veteran contended that a 40 percent evaluation was appropriate for his right shoulder disability.

Relevant to this appeal, the Veteran is assigned a 20 percent evaluation for his right shoulder disability under DC 5010-5201. As stated above, hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27.

The AOJ rated the Veteran's right shoulder disability using the criteria under DC 5201 for limitation of motion of the arm. Therefore, the hyphenated DC reflects that the General Rating Formula was applied through DC 5201 to evaluate the post-traumatic arthritis under DC 5010.

Shoulder disabilities are evaluated under 38 C.F.R. § 4.71, DCs 5200 to 5203. These Codes provide differing evaluations depending on which limb is disabled, differentiating between the major/dominant limb and the minor/nondominant limb. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. The Veteran is right hand dominant; thus, his right shoulder disabilities shall be evaluated under the major/dominant limb criteria.

DC 5201 evaluates limitation of motion of the arm. The criteria provide that limitation of motion of the arm at the shoulder level is rated 20 percent for the major shoulder and 20 percent for the minor shoulder. Limitation of motion of the arm midway between the side and shoulder level is rated as 30 percent for the major shoulder and 20 percent for the minor shoulder. Limitation of motion of the arm to 25 degrees from the side is rated as 40 percent for the major shoulder and 30 percent for the minor shoulder. 38 C.F.R. § 4.71a. Midway between side and shoulder level is flexion and/or abduction limited to 45 degrees and that at shoulder level is flexion and/or abduction limited to 90 degrees.

Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 degrees to 180 degrees, abduction from 0 degrees to 180 degrees, external rotation from 0 degrees to 90 degrees, and internal rotation from 0 degrees to 90 degrees. 38 C.F.R. § 4.71, Plate I.

Turning to the evidence in this case, an August 2024 private report of consultation and examination by Dr. M.T. reflects that the Veteran suffered from daily right shoulder pain which intensified with reaching and overhead activity. On examination, he had abduction with pain to 75 degrees.

A February 2025 VA examination report reflects review of the claims file and a diagnosis of right glenohumeral joint osteoarthritis and bursitis with rotator cuff tear
degrees to 180 degrees, abduction from 0 degrees to 180 degrees, external rotation from 0 degrees to 90 degrees, and internal rotation from 0 degrees to 90 degrees. 38 C.F.R. § 4.71, Plate I.

A February 2025 VA examination report reflects review of the claims file and a diagnosis of right glenohumeral joint osteoarthritis and bursitis with rotator cuff tear and impingement syndrome. Current symptoms included limited ROM above the head and frequent aches and pains. The Veteran reported flare-ups of the shoulder several times a day, which were moderate in severity and lasted several hours. Flare-ups were precipitated by overuse and reaching with the arm, and alleviated by rest and ibuprofen. Active ROM of the right shoulder revealed flexion to 130 degrees and abduction to 130 degrees with pain with flexion and abduction. Passive ROM was the same as active ROM with pain with flexion and abduction. There was pain with active and passive motion and with nonweight-bearing that caused functional loss. He had localized tenderness or pain on palpation anterior right shoulder that was moderate in severity. There was no additional loss of function or ROM after three repetitions. The Veteran was not being examined immediately after repeated use over time or during a flare-up. Procured evidence did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time; but revealed that pain significantly limited functional ability with flare-ups, resulting in estimated flexion to 90 degrees and abduction to 90 degrees.

X-rays revealed status post operation involving the greater tuberosity of the right shoulder and moderately advanced DJD of the glenoid-humeral joint. He did not have ankylosis. He did not have shoulder instability, dislocation, or labral pathology. He did not have mechanical symptoms or current residuals of recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint. He did not have any clavicle, scapula, acromioclavicular (AC) joint and sternoclavicular joint conditions. He did not have any condition or impairment of the humerus. Degenerative or post-traumatic arthritis of the right shoulder was documented by imaging studies.

A February 2025 VA treatment record reflects limited active ROM due to pain with forward flexion of the right shoulder to 150 degrees and abduction to 100 degrees. The Veteran could not get midline for internal rotation

As stated above, the Veteran's right shoulder is his major or dominant limb. Thus, initially, in addressing the Veteran's rating under DC 5201, the Board notes that a higher evaluation of 30 percent is warranted only if the Veteran has flexion and/or abduction limited to 45 degrees. The evidence in this case demonstrates that, at the worst, the Veteran had flexion and abduction to 90 degrees after considering pain.

The Board acknowledges that the August 2024 private report reflects abduction with pain to 75 degrees. However, the subsequent two examinations reveal abduction to 90 degrees during flare-ups and abduction to 100 degrees due to pain, both in February 2025. Therefore, the August 2024 abduction result appears to be an anomaly that is not consistent with the remainder of the evidence. More importantly, it is not clear from the report itself whether all measurements and examinations complied with regulatory requirements.

Accordingly, the Board cannot find that a 30 percent evaluation DC 5201 is assignable for the right shoulder disability in this case.

Additionally, the Board considered whether a higher rating may be available under other diagnostic codes available. However, the evidence does not indicate that the Veteran has ankylosis of scapulohumeral articulation (DC 5200), other impairment of the humerus (DC 5202), or impairment of the clavicle or scapula (DC 5203). Thus, the other diagnostic codes are not applicable here.

In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra.

REASONS
the Veteran has ankylosis of scapulohumeral articulation (DC 5200), other impairment of the humerus (DC 5202), or impairment of the clavicle or scapula (DC 5203). Thus, the other diagnostic codes are not applicable here.

In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra.

REASONS FOR REMAND

Under the AMA, if the Board identifies a duty to assist error that existed at the time of the AOJ's decision on the claim under review, the claim must be returned for correction of the error and readjudication. 38 C.F.R. §§ 3.2601(g), 20.802. As the Board has identified duty to assist errors that occurred prior to the rating decision on appeal, the issue discussed below must be remanded.

Sinusitis

The AOJ conceded that the Veteran participated in a toxic exposure risk activity (TERA) during service, specifically exposure to burn pit and other toxins based on verified service in the Southwest Asia theater of operation, as well as exposure to fuels, fumes, oils, solvents, and lubricants based on his military occupation specialty (MOS) of fuels craftsman.

Unfortunately, the evidence is conflicting as to whether the Veteran has a current diagnosis of sinusitis. Dr. M.T. found that the Veteran had sinusitis, while the February 2025 VA examiner found no objective evidence for chronic sinusitis.

Therefore, a new VA examination is required in order to clarify and confirm whether the Veteran has a diagnosis of sinusitis.

Bilateral Pes Planus

Similarly, the evidence is conflicting as to whether the Veteran has a diagnosis of bilateral pes planus. The August 2024 private report of consultation and examination by Dr. M.T. reflects that the examination was positive for pes planus. However, the October 2024 VA examiner found no diagnosis of pes planus. The March 2025 addendum did not re-examine the Veteran, but rather stated that the prior VA examination did not reveal pes planus.

Therefore, a new VA examination is required in order to clarify and confirm whether the Veteran has a diagnosis of bilateral pes planus.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination with an appropriate clinician in order to determine whether the Veteran's claimed sinusitis is related to service. The claims file must be made available to, and reviewed by, the examiner in conjunction with the examination. All tests deemed necessary should be conducted and the results reported in detail.

During the examination, the examiner must obtain an extensive and detailed medical history of the claimed sinusitis and any associated symptoms, including onset of symptoms and the medical course of those symptoms.

After review of the record and examination of the Veteran, the examiner should confirm whether or not the Veteran has a diagnosis of sinusitis.

*The examiner should consider and address the August 2024 private report noting a diagnosis of sinusitis and the February 2025 VA examiner's finding of no objective evidence of chronic sinusitis.*

Thereafter, the examiner must then opine whether it began in service, within one year of discharge therefrom, or is otherwise related to military service, to include exposures to burn pit and other toxins, fuels, fumes, oils, solvents, and lubricants.

In addressing the Veteran's toxic exposures, the examiner is asked to consider total potential exposure through all applicable military deployments and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The examiner must also address any lay statements regarding onset of his symptomatology and the continuity of symptomatology since onset and/or since discharge from service.

All findings should be reported in detail, and all opinions must be accompanied by a clear rationale.

2. Schedule the Veteran for an examination with an appropriate clinician in order to determine whether the Veteran's claimed bilateral pes planus is related to service or a service-connected disability. The claims file must be made available to, and reviewed by, the examiner in conjunction with the examination. All tests deemed necessary should be conducted and the results reported in detail.

During the examination, the examiner must obtain an extensive and detailed medical history of the claimed pes planus and associated symptoms, including onset of symptoms and the medical course of those symptoms.

After review of the record and examination of the Veteran, the examiner should confirm whether or not the Veteran has a diagnosis of bilateral pes planus.

Thereafter, the examiner must then opine
.

After review of the record and examination of the Veteran, the examiner should confirm whether or not the Veteran has a diagnosis of bilateral pes planus.

Thereafter, the examiner must then opine whether it began in service, within one year of discharge therefrom, or is otherwise related to military service.

If a direct relationship is not found, the examiner must then opine whether the Veteran's bilateral pes planus is (a) caused by; or (b) aggravated (i.e., worsened) by his service-connected disabilities.

*The Veteran is service connected for a right shoulder disability, tinnitus, right and left upper extremity idiopathic peripheral neuropathy, right and left lower extremity idiopathic peripheral neuropathy with restless leg syndrome, right knee disability with limitation of flexion and extension, bilateral plantar fasciitis, right and left ankle disabilities, right and left foot Morton's neuroma, non-allergic rhinitis, left shoulder bursitis, right and left hallux valgus, right and left hammer toes, bilateral hearing loss, granulomatous disease, right foot scar, and chronic headaches, and OSA (granted herein).*

All findings should be reported in detail, and all opinions must be accompanied by a clear rationale. The examiner is reminded that a separate and distinct opinions with supporting rationale are required for all theories of entitlement addressed, including secondary causation and secondary aggravation.

MARTIN B. PETERS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Lee, Jane R.

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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