Citation Nr: 21024588 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 20-11 065 DATE: April 23, 2021 ORDER New and material evidence not having been received, the petition to reopen the claim of entitlement to service connection for bilateral hearing loss is denied. New and material evidence not having been received, the petition to reopen the claim of entitlement to service connection for a right knee disorder is denied. Entitlement to service connection for a right ankle disorder is denied. REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right hip disorder is remanded. FINDINGS OF FACT 1. The August 1996 rating decision denying the Veteran’s claim of entitlement to service connection for bilateral hearing loss is final; new and material evidence has not been received to reopen the claim. 2. The July 2014 rating decision denying the Veteran’s claim of entitlement to service connection for a right knee disorder is final; new and material evidence has not been received to reopen the claim. 3. The preponderance of the evidence of record is against finding that the Veteran has had a right ankle disorder at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The August 1996 rating decision denying the Veteran’s claim of entitlement to service connection for bilateral hearing loss is final; new and material evidence has not been received and the claim of entitlement to service connection for bilateral hearing loss is not reopened. 38 U.S.C. §§ 5107, 5108, 7105; 38 C.F.R. § 3.156. 2. The July 2014 rating decision denying the Veteran’s claim of entitlement to service connection for a right knee disorder is final; new and material evidence has not been received and the claim of entitlement to service connection for a right knee disorder is not reopened. 38 U.S.C. §§ 5107, 5108, 7105; 38 C.F.R. § 3.156. 3. The criteria for service connection for a right ankle disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1976 to August 1989. These matters come before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). New and Material Evidence Governing regulations provide that an appeal consists of a timely filed notice of disagreement in writing and, after a statement of the case has been furnished, a timely filed substantive appeal. 38 C.F.R. § 20.200. Rating actions from which an appeal is not timely perfected become final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. A final decision cannot be reopened unless new and material evidence is presented. 38 U.S.C. § 5108. The Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. Knightly v. Brown, 6 Vet. App. 200 (1994). New evidence means existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and it must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The United States Court of Appeals for Veterans Claims (Court) has emphasized that the final sentence of 38 C.F.R. § 3.156 (a), especially the phrase “raise[s] a reasonable possibility of substantiating the claim,” does not create a third element or separate determination in the reopening process, but is a component of the question of what is new and material evidence. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010) (noting that 38 U.S.C. § 5108 requires only new and material evidence to reopen). Shade further held that 38 C.F.R. § 3.156 “suggests a standard that would require reopening if newly submitted evidence, combined with VA assistance and considering the other evidence of record, raises a reasonable possibility of substantiating the claim[.]” Id. Further, the Board should not focus solely on whether the evidence remedies the principal reason for denial in the last prior decision, and regulations do not require new and material evidence as to each previously unproven element of a claim. Id. Rather, the Board should focus on whether the evidence, taken together, could at least trigger the duty to assist by providing a medical opinion. Id., see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Court has elaborated on what constitutes “new and material evidence.” New evidence is not that which is cumulative of other evidence already present in the record. In determining whether new and material evidence has been submitted, the Board must consider the specific reasons for the prior denial. Evans v. Brown, 9 Vet. App. 273, 283 (1996). See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Only evidence presented since the last final denial on any basis (either upon the merits of the case, or upon a previous adjudication that no new and material evidence has been presented) will be evaluated in the context of the entire record. Evans, 9 Vet. App. at 273. Under VA law, impaired hearing is considered a disability when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Pure tone thresholds above 20 decibels indicate some hearing loss, irrespective of whether it is severe enough to qualify as a disability for VA compensation purposes. See Hensley v. Brown, 5 Vet. App. 155 (1993). Therefore, while the Veteran might experience some hearing loss, that hearing loss might not be severe enough to warrant the determination that it is a hearing loss disability governed by 38 C.F.R. § 3.385, which would be the first threshold to qualify for service connection for the claimed disorder. When all the evidence is assembled, the Secretary is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Bilateral Hearing Loss The Veteran asserts that he experiences bilateral hearing loss which is related to in-service hazardous noise exposure. In the alternative, the Veteran asserts that his bilateral hearing loss is related to, or the result of, his service-connected tinnitus. Service connection for bilateral hearing loss was denied in an August 1996 rating decision as the evidence did not show that the Veteran experienced bilateral hearing loss for VA purposes nor was there any evidence of this disorder during service. See rating decision, August 19, 1996. Evidence considered in the August 1996 rating decision included the Veteran’s service treatment records. Although notified of the denial in an August 1996 letter, the Veteran did not initiate an appeal. 38 C.F.R. §§ 20.200. Moreover, no additional evidence was received within the one-year appeal period. See 38 C.F.R. § 3.156(b). Therefore, the August 1996 rating decision is final. The evidence received since the August 1996 rating decision, which is the last final denial, includes updated treatment records, examinations and a journal article about the acceleration of age-related hearing loss by early noise exposure. The treatment records and medical journal article do not speak to a diagnosis of the Veteran’s claimed bilateral hearing loss for VA purposes or relate his claimed disorder to service in any way. For example, the June 2014 examiner diagnosed the Veteran with hearing loss in the right ear at a level that is not considered a disability for VA purposes and impaired hearing in the left ear that did not meet the criteria to be considered a disability for VA purposes. See Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ), June 28, 2014. To the extent that the Veteran asserts that he has this condition and has stated that his bilateral hearing loss was related to his active service, he has made these assertions prior to the last final denial of this claim. Thus, his statements are not new evidence. The new evidence does not contain any material evidence, as none of the evidence is sufficient to substantiate the claim. Here, the Board is cognizant that the Veteran has advanced a theory of entitlement by stating that his bilateral hearing loss is related to his active service, as the Veteran is service-connected for tinnitus, therefore in-service exposure to hazardous noise levels has been conceded, and his hearing loss should be service-connected on that basis. See Appellant’s Brief, received by VA October 11, 2020. Again, these contentions are not new evidence. The Veteran does not have hearing loss for VA purposes as defined under 38 C.F.R. § 3.385. The new evidence does not contain any material evidence, as none of the evidence is sufficient to substantiate the claim. A new etiological theory of entitlement does not constitute a new claim. See Ashford v. Brown, 10 Vet. App. 120, 123 (1997). The Board has also considered whether 38 C.F.R. § 3.156(c) pertains to this claim. Subsection (c)(1) of the regulation demands that, “at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim.” 38 C.F.R. § 3.156(c)(1). Here, service personnel records were associated with the file after the issuance of the August 1996 rating decision. However, these records are not relevant to the instant claim as they do not reflect audiometric results and do not establish that the Veteran has current hearing loss for VA purposes under 38 C.F.R. § 3.385. As such, VA did not have to reconsider the Veteran’s claim, as the official service department records had been associated with the claims file when VA first decided the claim. After a review of the record, the Board notes that the Veteran has not submitted any new medical evidence relevant to this claim and has only advanced a new theory of entitlement. As previously stated, merely presenting a new legal theory of entitlement is not new and material evidence. See Ashford, 10 Vet. App. at 123. New and material evidence must be submitted following the prior final denial of service connection, despite the change in theory of entitlement. As such, this theory standing alone is not new and material evidence. Therefore, the Board finds that the evidence received since the August 1996 rating decision is cumulative or redundant of the evidence of record at the time of the prior decision and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection. Consequently, new and material evidence has not been received to reopen such claim and the Veteran’s appeal must be denied. 2. Right Knee Disorder The Veteran asserts that he experiences a right knee disorder which is related to an in-service fall. Specifically, the Veteran’s attorney asserts that “trivial” in-service injuries lead to the Veteran developing degenerative changes years later, and that osteoarthritis is often asymptomatic for years after it starts. See Appellant’s Brief, received by VA October 11, 2020. Service connection for a right knee disorder was denied in a July 2014 rating decision as the evidence did not show that the Veteran right knee disorder (osteoarthritis) was related to his active service. See rating decision, July 2, 2014. Evidence considered in the July 2014 rating decision included the Veteran’s service treatment records, service personnel records and a VA examination report. Although notified of the denial in a July 2014 letter, the Veteran did not initiate an appeal. 38 C.F.R. §§ 20.200. Moreover, no additional evidence was received within the one-year appeal period, and no additional service records (warranting reconsideration of the claim) have been received at any time. See 38 C.F.R. § 3.156 (b), (c). Therefore, the July 2014 rating decision is final. The evidence received since the July 2014 rating decision, which is the last final denial, includes medical treatment records. The medical records do not speak to the etiology of the Veteran’s claimed right knee disorder or relate his claimed disorder to service in any way. For example, while VA treatment records showed bilateral knee pain and bilateral knee osteoarthritis, the records did not speak to the etiology of the Veteran’s claimed right knee disorder or relate his claimed disorder to service in any way. See VA treatment records, February 4, 2019. To the extent that the Veteran asserts that he has right knee condition is related to his active service, he has made these assertions prior to the last final denial of this claim. Thus, his statements are not new evidence. The new evidence does not contain any material evidence, as none of the evidence is sufficient to substantiate the claim. Therefore, the Board finds that the evidence received since the July 2014 rating decision is cumulative or redundant of the evidence of record at the time of the prior decision and does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection. Consequently, new and material evidence has not been received to reopen such claim and the Veteran’s appeal must be denied. Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A disability may also be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). 3. Right Ankle Disorder The Veteran asserts that he experiences a right ankle disorder which is related to his active service. Specifically, the Veteran’s attorney asserts that “trivial” in-service injuries lead to the Veteran developing degenerative changes years later, and that osteoarthritis is often asymptomatic for years after it starts. See Appellant’s Brief, received by VA October 11, 2020. The Veteran’s service treatment records are negative for complaints, treatments or diagnose related to the right ankle. The service treatment records do show that the Veteran fell off a ladder on his right foot, that his foot and toes hurt, and that two of his toes were swollen. X-rays were negative for any ankle or foot abnormalities. See service treatment records, July 30, 1989. He was placed on light duty for a week due to a diagnosed right foot contusion/bruised foot. See service treatment records, July 31, 1989. The Veteran’s post-service VA medical records show a complaint of bilateral ankle pain, but do not show a diagnosis of a chronic right ankle disorder. See VA treatment records, March 9, 2018. Upon a thorough review of the evidence, the Board finds that at no time since the filing of his claim and throughout its pendency has the Veteran had a current right ankle disability for VA compensation purposes. A September 2019 examination showed that the Veteran’s right ankle was normal, and he did not experience a chronic right ankle disorder. See Ankle Conditions DBQ, September 17, 2019. Additionally, the Veteran’s September 2019 VA examination revealed normal findings of painless motion, normal function, and usage of the right ankle. The Board notes a current disability is always required in order to establish service connection. See Brammer v. Derwinski, supra. With regard to the claimed bilateral hand cramps there is not sufficient evidence to show that the Veteran has had a right ankle disorder during the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board acknowledges the Court’s holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis of a right ankle disorder. See Saunders v. Wilkie, 886 F.3d. 1356 (2018). In addition, the Veteran did not complain of right ankle pain at separation, and his only documented right lower extremity issues were related to his right foot, and not his right ankle. The Veteran has not alleged manifestations of similar severity, frequency and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020). The Board has considered the Veteran’s lay statements in support of his claim. In multiple statements, the Veteran related that he believed that he experienced a right ankle disorder that was related to his service. A statement submitted on behalf of the Veteran related that the Veteran slid off a plane wing and landed on his right ankle, injuring it, and was then placed on light duty for a week and was unable to climb following the accident. See lay statement by J.M., received by VA December 14, 2016. Although laypersons are competent to provide opinions on some medical issues, as to the specific issues in this case, diagnosing a right ankle disorder, this issue falls outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (laypersons not competent to diagnose cancer). As a layperson, the Veteran has not been shown to possess the medical expertise to diagnose the claimed chronic disorder and its etiology. The claims file does not contain any medical examinations diagnosing the Veteran with the disorder or linking his self-reported symptoms to his active service. In sum, there is no evidence, medical or otherwise, to support the Veteran’s statements. Thus, as previously stated, the medical evidence of record is only against the Veteran’s service connection claim. The Board notes that the Veteran’s representative submitted an articles about nature of osteoarthritis and the ligament connection to osteoarthritis. Medical treatise evidence can, in some circumstances, constitute competent medical evidence. See 38 C.F.R. §§ 3.159(a)(1) (competent medical evidence may include statements contained in authoritative writings such as medical and scientific articles and research reports and analyses). However, treatise evidence must "not simply provide speculative generic statements not relevant to the [claimant]'s claim." Wallin v. West, 11 Vet. App. 509, 514 (1998). Instead, the treatise evidence, "standing alone," must discuss "generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion." Id. (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)); see also Libertine v. Brown, 9 Vet. App. 521, 523 (1996) (medical treatise evidence must demonstrate connection between service incurrence and present injury or condition); Beausoleil v. Brown, 8 Vet. App. 459, 463(1996) (generic statement about the possibility of a link between chest trauma and restrictive lung disease is too general and inconclusive); Mattern v. West, 12 Vet. App. 222, 227 (1999) (generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive (quoting Sacks, supra)). In this case, the articles submitted by the Veteran’s representative provided only general information as to the development and treatment of osteoarthritis. It is not accompanied by any corresponding clinical evidence specific to the Veteran and does not suggest a generic relationship between the Veteran's claimed right ankle disorder and service with a degree of certainty such that, under the facts of this specific case, reflects plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. As such, the Board finds this information to not be relevant as to the matters for consideration and, therefore, is not probative to this case. Wallin, supra; Sacks, supra. Accordingly, the claim must be denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the claim, the doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. The claim of entitlement to service connection for a right ankle disorder is denied. REASONS FOR REMAND 1. Obstructive Sleep Apnea The Veteran contends that his obstructive sleep apnea is related to his active service. In the alternative, the Veteran argues that his obstructive sleep apnea is due to the weight gain he experienced while in active service, or was aggravated by such weight gain. See Attorney Statement, received by VA March 4, 2020. The General Counsel of VA has provided guidance that, while obesity is not a disease or injury for which service connection may be granted, it can provide a causal connection between two diseases. VAOPGRPREC 1-2017. In other words, VA has acknowledged that if a service-connected disability causes obesity, and that obesity then causes or aggravates another condition, that other condition may be secondarily service-connectable. The Veteran’s service personnel records show that he was administratively discharged from the military for failure to perform satisfactorily on the weight management program since October 1988. See service personnel records, August 9, 1989. The Veteran’s records show that he is currently service-connected for tinnitus. In this case, the Veteran has reported that he experienced hypersomnolence during service and was separated from service due to weight gain. The post-service clinical records show that the Veteran experienced obstructive sleep apnea. See VA treatment records, Sleep Study Report, December 1, 2018. The Veteran has not been afforded a VA examination to address this issue. As, such a remand is required for an etiology opinion. McLendon v. Nicholson, supra. 2. Headaches The Veteran contends that his headaches is related to his active service, to include as secondary to his service-connected tinnitus. The Veteran’s records show that he is currently service-connected for tinnitus. In this case, the Veteran has reported that he experienced headaches during service and following separation from active service. The post-service clinical records show that the Veteran was diagnosed with headaches and migraine headaches. See VA treatment records, March 18, 2019; July 15, 2019. The Veteran’s attorney has also asserted that research indicated a link between tinnitus and headaches. See attorney statement, received by VA May 11, 2020. The Veteran has not been afforded a VA examination to address this issue. As, such a remand is required for an etiology opinion. McLendon v. Nicholson, supra. 3. Left Knee Disorder The Veteran seeks service connection for a left knee disorder, which he asserts is the result of a right ankle injury that he experienced in active service. Specifically, the Veteran’s attorney asserts that “trivial” in-service injuries lead to the Veteran developing degenerative changes years later, and that osteoarthritis is often asymptomatic for years after it starts. See Appellant’s Brief, received by VA October 11, 2020. In a December 2016 statement, the Veteran asserted that he injured his knees while working on fighter aircraft as he was constantly on his knees. The Veteran’s service treatment are negative for complaints, treatments or diagnoses related to a left knee disorder. The service treatment records do show that the Veteran fell off a ladder on his right foot, that his foot and toes hurt, and that two of his toes were swollen. X-rays were negative for any ankle or foot abnormalities, and the Veteran did not complain of any knee issues related to the fall. See service treatment records, July 30, 1989. He was placed on light duty for a week due to a diagnosed right foot contusion/bruised foot. See service treatment records, July 31, 1989. In a July 1989 Report of Medical History, the Veteran denied having a trick or locked knee. He also denied that he ever had any illnesses or injuries other than those already noted and that he had not consulted or been treated by clinics, physicians, healers or other practitioners within the past five years for other than minor illnesses. In this case, the Veteran has reported that he experienced knee problems during service and following separation from active service. The Veteran's DD Form 214 lists his military occupational specialty as tactical aircraft maintenance technician. The post-service clinical records show that the Veteran was diagnosed with knee osteoarthritis. As, such a remand is required for an etiology opinion. McLendon v. Nicholson, supra. 4. Right Hip Disorder The Veteran seeks service connection for a right hip disorder, which he asserts is the result of a right ankle injury that he experienced in active service. Specifically, the Veteran’s attorney asserts that “trivial” in-service injuries lead to the Veteran developing degenerative changes years later, and that osteoarthritis is often asymptomatic for years after it starts. See Appellant’s Brief, received by VA October 11, 2020. In a December 2016 statement, the Veteran indicated that his right hip was damaged by compensating for his knee. In this case, the Veteran has reported that he experienced right problems during service and following separation from active service. Service treatment records do reflect that the Veteran fell of a ladder onto his right foot in July 1989. The post-service clinical records show that the Veteran complained of right hip pain. As, such a remand is required for an etiology opinion. McLendon v. Nicholson, supra. The matters are REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination so as to determine the nature and etiology of his claimed obstructive sleep apnea. The record should be made available to the examiner. All necessary tests should be conducted, and the results reported. The need for a physical examination is left to the discretion of the examiner. Following review of the record and examination of the Veteran, the examiner should provide an opinion as to the following questions: (A) Is it at least as likely as not (50 percent probability or greater) that any current obstructive sleep apnea is related to the Veteran’s service? (B) Is it as least as likely as not (50 percent probability or greater) that the Veteran’s obesity was caused or aggravated by his service-connected tinnitus? (C) If the answer to (B) is yes, then is it as likely as not that the Veteran’s obstructive sleep apnea was caused by, is related to, was aggravated by (i.e. worsened), or is otherwise etiologically related to the Veteran’s obesity? The examiner should elicit a full history from the Veteran and the lay statements of record. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided. 3. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination so as to determine the nature and etiology of his claimed headaches. The record should be made available to the examiner. All necessary tests should be conducted, and the results reported. The need for a physical examination is left to the discretion of the examiner. Following review of the record and examination of the Veteran, the examiner should provide an opinion as to the following questions: (A) Is it at least as likely as not (50 percent probability or greater) that any current headaches is related to the Veteran’s service? (B) Is it as least as likely as not (50 percent probability or greater) that the Veteran’s headaches were caused by, is related to, was aggravated by (i.e. worsened), or is otherwise etiologically related to the Veteran’s service-connected tinnitus? The examiner should specifically address the Veteran’s arguments that research supports a link between headaches and tinnitus. The examiner should elicit a full history from the Veteran and the lay statements of record. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided. 4. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination so as to determine the nature and etiology of his claimed left knee disorder. The record should be made available to the examiner. All necessary tests should be conducted, and the results reported. The need for a physical examination is left to the discretion of the examiner. Following review of the record and examination of the Veteran, the examiner should provide an opinion as to the following questions: (A) List all diagnosis(es) related to the left knee disorder that have been present at any time since January 2017. (B) Is it at least as likely as not (50 percent probability or greater) that any current left knee disorder is related to the Veteran’s service, to include an in-service fall from a ladder? The examiner should specifically address the Veteran’s contention that he worked on his knees repairing aircraft during service and that resulted in his current knee disorder. The examiner should elicit a full history from the Veteran and the lay statements of record. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided. 5. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination so as to determine the nature and etiology of his claimed right hip disorder. The record should be made available to the examiner. All necessary tests should be conducted, and the results reported. The need for a physical examination is left to the discretion of the examiner. Following review of the record and examination of the Veteran, the examiner should provide an opinion as to the following questions: (A) List all diagnosis(es) related to the right hip disorder that have been present at any time since January 2017. (B) Is it at least as likely as not (50 percent probability or greater) that any current right hip disorder is related to the Veteran’s service, to include an in-service fall from a ladder? The examiner should elicit a full history from the Veteran and the lay statements of record. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lech, 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.