Citation Nr: 21032154 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 18-01 699 DATE: May 26, 2021 ORDER Service connection for a psychiatric disability, diagnosed as posttraumatic stress disorder (PTSD), is granted. Service connection for dyspnea is granted. Service connection for sinusitis is granted. Service connection for eczema is granted. Service connection for fibromyalgia is granted. Service connection for irritable bowel syndrome (IBS) is granted. Service connection for traumatic brain injury (TBI) residuals is granted. Service connection for migraine headaches is granted. Service connection for tinnitus is granted. Service connection for hypertension is granted. Service connection for a cervical spine disability, diagnosed as degenerative arthritis and cervicalgia, is granted. Service connection for a lumbar spine disability, diagnosed as degenerative arthritis, is granted. Service connection for a right shoulder disability, diagnosed as degenerative joint disease, is granted. Service connection for a left knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome, is granted. Service connection for a right knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome, is granted. The issue of entitlement to service connection for a left elbow disability is dismissed. REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to service connection for residuals status post cholecystectomy is remanded. Entitlement to service connection for scar from head injury is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a left upper extremity neurological disability (claimed as left carpal tunnel syndrome) is remanded. Entitlement to service connection for a right upper extremity neurological disability (claimed as right carpal tunnel syndrome) is remanded. Entitlement to service connection for bruxism is remanded. Entitlement to an initial compensable rating for broken tooth (#19) due to trauma is remanded. FINDINGS OF FACT 1. The Veteran has a current diagnosis of PTSD in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) that is shown to be a result of combat stressor events. 2. The Veteran's dyspnea was incurred during her active service. 3. The Veteran's sinusitis was incurred during her active service. 4. The Veteran's eczema was incurred during her active service. 5. The Veteran's fibromyalgia was incurred during her active service. 6. The Veteran's IBS was incurred during her active service. 7. The Veteran's TBI residuals are attributable to events that occurred during her active service. 8. The Veteran's migraine headaches were incurred during her active service. 9. The Veteran's tinnitus was incurred during her active service. 10. The Veteran's hypertension was incurred during her active service. 11. The Veteran's cervical spine degenerative arthritis and cervicalgia were incurred during her active service. 12. The Veteran's lumbar spine degenerative arthritis was incurred during her active service. 13. The Veteran's right shoulder degenerative joint disease was incurred during an injury during a period of active duty for training. 14. The Veteran's left knee degenerative joint disease and patellofemoral syndrome were incurred during her active service. 15. The Veteran's right knee degenerative joint disease and patellofemoral syndrome were incurred during her active service. 16. On the record at her February 2020 Board hearing, prior to the promulgation of a decision in the appeal in the matter, the Veteran testified that she wished to withdraw her appeal as to the issue of entitlement to service connection for a left elbow disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disability, diagnosed as PTSD, have been met. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.304(f), 4.125(a) (2020). 2. The criteria for service connection for dyspnea have been met. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 3. The criteria for service connection for sinusitis have been met. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 4. The criteria for service connection for eczema have been met. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 5. The criteria for service connection for fibromyalgia have been met. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 6. The criteria for service connection for IBS have been met. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 7. The criteria for service connection for TBI residuals have been met. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 8. The criteria for service connection for migraine headaches have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 9. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 10. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 11. The criteria for service connection for a cervical spine disability, diagnosed as degenerative arthritis and cervicalgia, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 12. The criteria for service connection for a lumbar spine disability, diagnosed as degenerative arthritis, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 13. The criteria for service connection for a right shoulder disability, diagnosed as degenerative joint disease, have been met. 38 U.S.C. §§ 101(24), 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 14. The criteria for service connection for a left knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 15. The criteria for service connection for a right knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 16. The criteria for withdrawal of the appeal of the issue of entitlement to service connection for a left elbow disability are met. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 19.55 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1988 to December 1988, from February 1989 to March 1990, from April 2003 to June 2003, and from March 2013 to November 2013. She also had additional Reserve service. The Veteran's service personnel records (SPRs) document that she served in Afghanistan from April 2013 to October 2013 and that she received the Afghanistan Campaign Medal for direct participation in combat operations in Afghanistan in direct support of Operation Enduring Freedom (OEF), which verifies her combat service and any events consistent with such service. See 38 U.S.C. § 1154(b). In February 2020, a Travel Board hearing was held before the undersigned Veterans Law Judge, and a transcript of the hearing is associated with the record. The Veteran had also initiated an appeal of the denial of service connection for a thoracic spine disability, for hemorrhoids, and for right ear hearing loss, as well as the denial of a total disability rating based on individual unemployability due to service-connected disabilities (TDIU rating). However, following a February 2018 statement of the case (SOC) addressing these issues, the Veteran did not file a timely substantive appeal. Consequently, these matters are not before the Board. [While the February 2018 SOC also addressed the issue of service connection for a cervical spine disability, this same issue was already addressed by a December 2017 SOC (characterized therein as service connection for cervicalgia), and an appeal of such issue was perfected by the Veteran's submission of a January 2018 VA Form 9. Consequently, the issue of service connection for a cervical spine disability is properly before the Board and will be addressed in the instant decision.] Service Connection Claims Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. "Active military, naval, or air service" includes active duty; any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; or any period of inactive duty for training in which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Some chronic diseases (to include organic diseases of the nervous system such as migraine headaches and tinnitus, cardiovascular-renal disease including hypertension, and arthritis) may be presumed to have been incurred in service if they become manifest to a degree of 10 percent or more within a specified period of time post-service (one year for the aforementioned diseases). 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. When certain chronic diseases are at issue, such as the above-noted diseases or any other disease enumerated at 38 C.F.R. § 3.309(a), see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013), a claimant may establish entitlement to service connection by demonstrating continuity of symptomatology for a condition noted during service or during the presumptive period for which chronicity of the condition is not adequately supported. 1. Service connection for a psychiatric disability, diagnosed as PTSD. The Veteran contends that she currently has a psychiatric disability due to stressful events that occurred during her military service, including combat stressor events during her Afghanistan deployment as well as alleged incidents of military sexual trauma. The medical evidence of record, including a December 2015 PTSD Disability Benefits Questionnaire (DBQ) completed by a private psychologist, shows that the Veteran has a current DSM-5 diagnosis of PTSD. Specifically, the private psychologist listed each of the DSM-5 diagnostic criteria for PTSD and then provided examples of how the Veteran's psychiatric disability picture had met each such criterion during the appeal period. While the evidence of record also contains the report of an October 2015 VA psychiatric examination, wherein a VA examining psychiatrist opined that the Veteran's symptoms did not meet the diagnostic criteria for PTSD under the DSM-5, the Board finds that the October 2015 VA examiner did not discuss any of the DSM-5 diagnostic criteria for PTSD in the examination report or explain why the Veteran did not meet the criteria for such a diagnosis. Therefore, regarding the question of a PTSD diagnosis, the Board finds that the December 2015 PTSD DBQ (which, as noted above, includes a detailed discussion of how the Veteran's disability picture fits into each aspect of the PTSD diagnostic criteria) is the most probative evidence in this matter. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty service treatment records (STRs) include an October 2013 Report of Medical History on which she indicated having a history of depression or excessive worry. Thereafter, during her Reserve service, VA treatment records documented a positive PTSD screen in February 2014 and a diagnosis of PTSD in January 2015 and February 2015. The Veteran indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of nervous trouble, loss of memory, frequent trouble sleeping, having received counseling, depression or excessive worry, and having attempted suicide ("Upon return from deployment Nov 2013, have gone to VA for mental health & social issues to include substance abuse. Have trouble sleeping, on edge, anxiety, re-live my deployment, easily startled, thoughts of suicide often"). Post-service, on the December 2015 PTSD DBQ, it was noted that the Veteran had reported that her symptoms of PTSD began during her deployment to Afghanistan, based upon the timeframe of onset of her nightmares. At a December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of PTSD and provided the following medical opinion: "Given the history and elements of [the Veteran's] PTSD, it is far more likely than not that same is directly and causally related to her military service." For rationale, the private provider noted the Veteran's current symptoms of PTSD and referred to the pertinent STRs in the claims file. In a July 2018 letter, a VA staff psychiatrist noted that the Veteran had been a patient in the VA North Florida/South Georgia Health Care System since January 2015 and had been under psychiatric care in that system for PTSD due to her military experiences. In a September 2018 statement, a fellow soldier described the contrast between the Veteran's behavior prior to her Afghanistan deployment (when she "always had a smile on her face") and after such deployment (when she was "definitely no longer the same person I remember" and was sad, outwardly somber, no longer wanted to interact socially with her peers, and seemed very withdrawn). In a September 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of depression/PTSD, with military sexual trauma and exposure to a combat environment, and provided the following opinion: "It is my opinion that it is extremely likely, if not definite, that [the Veteran's] Mental Health condition was initiated and further aggravated while serving in the military, primarily, her military sexual trauma she endured in early 1990, and her deployment to a combat zone in Afghanistan [in] 2013." For rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, and noted that she had no other known risk factors that may have precipitated her current condition. In a December 2018 statement, the same VA staff psychiatrist who authored the July 2018 letter (noted above) provided the following opinion: "Her [the Veteran's] claimed PTSD is a Direct Cause/Result of her Military Service when deployed to Afghanistan...during Operation Enduring Freedom." For rationale, the VA staff psychiatrist noted reviewing the pertinent evidence of record and her documented military stressors. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her military stressors which the Board finds to be consistent with the circumstances of her combat service. As the evidence of record documents that the Veteran has a current DSM-5 diagnosis of PTSD that is shown to be a result of verified combat stressor events, the Board concludes that service connection for PTSD is warranted. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), 3.304(f), 4.125(a). [The Board also finds that the instant decision applies to and resolves all pending claims of service connection for a psychiatric disability, however diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009).] 2. Service connection for dyspnea. The Veteran contends that she currently has dyspnea due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of dyspnea with associated asthma. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include an October 1989 report of breathing trouble for four days and an assessment of an upper respiratory infection (URI), as well as an October 2013 Report of Medical History on which she indicated having a history of asthma or breathing problems, shortness of breath, bronchitis, and sinusitis. Thereafter, during her Reserve service, VA treatment records documented a diagnosis of possible asthma in January 2015. The Veteran indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of asthma or breathing problems, shortness of breath, bronchitis, wheezing, having been prescribed an inhaler, and sinusitis ("all related to deployment to Kabul, Afghanistan Mar-Nov 2013"). Post-service, at an October 2015 VA respiratory examination, the Veteran reported an onset of dyspnea in April or May of 2013 when she first got to Afghanistan, and that her shortness of breath with exercise and stair climbing had continued since that time. The VA examiner noted that for dyspnea, the etiology was not determined, and a more precise diagnosis could not be rendered "as there is no objective data to support a more definitive diagnosis." At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of dyspnea with associated asthma and provided the following medical opinion: "Diagnosis and onset of this condition which persists to the present during active duty military service should qualify said condition for service connection. This is a permanent condition." For rationale, the private provider noted the Veteran's current symptoms of dyspnea and referred to the pertinent STRs in the claims file. In a September 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of dyspnea and asthma-like symptoms requiring an emergency inhaler, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] exacerbated sinus conditions and dyspnea, were further aggravated while serving in the military, primarily during her deployment to Kabul, Afghanistan [in] 2013." For rationale, W.B. outlined the pertinent evidence of record, noted his review of her pertinent medical history (including her documented reports of breathing problems in October 2013 following her Afghanistan deployment), noted that she had no other known risk factors that may have precipitated her current condition, and cited to an attached Toxic Air Report for Kabul, Afghanistan where the Veteran was deployed. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her exposure to poor air quality while in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private medical providers in December 2015 and September 2018 respectively, indicating a link between the Veteran's currently diagnosed dyspnea and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for dyspnea is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 3. Service connection for sinusitis. The Veteran contends that she currently has sinusitis due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of chronic sinusitis. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include an October 1989 report of breathing trouble for four days and an assessment of a URI; an October 2013 Report of Medical Assessment on which it was noted that she was currently taking Claritin and Zyrtec and that she had had sinusitis during deployment which was recurrent and treated with Sudafed and Zyrtec; and an October 2013 Report of Medical History on which she indicated having a history of asthma or breathing problems, shortness of breath, bronchitis, and sinusitis. Thereafter, during her Reserve service, an April 2014 dental health questionnaire noted that the Veteran had sinus problems. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of asthma or breathing problems, shortness of breath, bronchitis, wheezing, having been prescribed an inhaler, and sinusitis ("all related to deployment to Kabul, Afghanistan Mar-Nov 2013"). Post-service, at an October 2015 VA nose and sinus examination, it was noted that the Veteran had a prior diagnosis of episodic acute sinusitis which was resolved with no sequelae, though she reported that since she had come back from Afghanistan she had "pretty much stayed on" medications such as Claritin, Sudafed, and Zyrtec. The VA examiner noted that there was no physical examination or radiologic evidence for a chronic sinusitis condition, and thus no etiology opinion was rendered. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of chronic sinusitis and provided the following medical opinion: "Diagnosis and onset of this condition which persists to the present during active duty military service should qualify said condition for service connection. This is a permanent condition." For rationale, the private provider noted the Veteran's current symptoms of sinusitis, noted that she had been diagnosed with and treated for this condition during active duty military service, and noted that her condition had persisted to the present without hiatus or interval change. In a September 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of chronic sphenoid sinusitis, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] exacerbated sinus conditions and dyspnea, were further aggravated while serving in the military, primarily during her deployment to Kabul, Afghanistan [in] 2013." For rationale, W.B. outlined the pertinent evidence of record, noted his review of her pertinent medical history (including her documented reports of sinus conditions during her active duty), noted that she had no other known risk factors that may have precipitated her current condition, and cited to an attached Toxic Air Report for Kabul, Afghanistan where the Veteran was deployed. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her exposure to poor air quality while in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private medical providers in December 2015 and September 2018 respectively, indicating a link between the Veteran's currently diagnosed sinusitis and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for sinusitis is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at1363, 1366; 38 C.F.R. § 3.303(a). 4. Service connection for eczema. The Veteran contends that she currently has eczema due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a September 2015 VA skin examination and the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of eczema. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include an April 2003 Report of Medical History on which she indicated having a history of skin diseases ("rash develops on hands periodically"); a March 2013 notation that her smallpox vaccination was being deferred due to a history of eczema; and an October 2013 Report of Medical History on which she indicated having a history of skin diseases ("have eczema blisters on hands & feet"). Thereafter, during her Reserve service, the Veteran indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of skin diseases ("eczema in heat environments, flared up more while deployed to Afghanistan"). Post-service, at the September 2015 VA skin examination, the Veteran was diagnosed with eczema, and she reported that this began on active duty and was aggravated by tension, stress, temperature, itching, and boots ("had to wear thicker socks"). The VA examiner did not provide an opinion regarding the etiology of the Veteran's eczema. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of eczema and provided the following medical opinion: "Diagnosis and onset of this condition which persists to the present during active duty military service should qualify said condition for service connection. This is a permanent condition." For rationale, the private provider noted the Veteran's current symptoms of eczema, noted that she had been diagnosed with and treated for this condition during active duty military service, and noted that her condition had continued with progression to the present. In a September 2018 statement, the Veteran's private treating provider, W.B., D.O. (who also previously treated her in the military) noted the Veteran's current diagnosis of atopic dermatitis in connection with dyshidrotic eczema, and provided the following opinion: "It is my opinion that it is more than likely, if not definite, that [the Veteran's] skin condition was initiated and further aggravated while serving in the military, primarily, during her deployment to a combat zone in Afghanistan [in] 2013, with temperatures reaching extremely high, throughout the deployment, and being under constant stress, which also causes her eczema to flare up." For additional rationale, W.B. outlined the pertinent evidence of record, noted his review of her pertinent medical history (including her documented reports of eczema during her active duty), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her exposure to heat and stress while in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private medical providers in December 2015 and September 2018 respectively, indicating a link between the Veteran's currently diagnosed eczema and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for eczema is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 5. Service connection for fibromyalgia. The Veteran contends that she currently has fibromyalgia due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including an August 2018 statement from a private provider, shows that the Veteran has a current diagnosis of fibromyalgia. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include an April 2003 Report of Medical History on which she indicated having a history of swollen or painful joints, as well as an October 2013 Report of Medical History on which she again indicated having a history of swollen or painful joints. Thereafter, during her Reserve service, she indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of swollen or painful joints. Post-service, at an October 2015 VA Gulf War examination, the VA examiner noted that there was no objective evidence for fibromyalgia for the Veteran and that the criteria for a diagnosis of this condition had not been met. In the August 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of fibromyalgia, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was initiated and further aggravated while serving in the military, primarily, her deployment to Afghanistan in 2013." For rationale, W.B. outlined the pertinent evidence of record, noted his review of her pertinent medical history (including her reports of fibromyalgia-like symptoms in service), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her deployment to Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinion provided by W.B. in August 2018, indicating a link between the Veteran's currently diagnosed fibromyalgia and her military service, is supported by an adequate rationale for the conclusion reached, as such rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords this opinion substantial weight of probative value. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for fibromyalgia is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 6. Service connection for IBS. The Veteran contends that she currently has IBS due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of IBS. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs do not note any reports, findings, diagnosis, or treatment of IBS. Thereafter, during her Reserve service, a February 2014 VA treatment record documented the Veteran's report of diarrhea. She indicated on a March 2014 post-deployment health re-assessment that she was "Bothered a little" by constipation, loose bowels, or diarrhea. She also indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of stomach or intestinal trouble. Post-service, at an October 2015 VA Gulf War examination, the VA examiner noted that there was no objective evidence for IBS for the Veteran and that the criteria for a diagnosis of this condition had not been met. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of IBS, and provided the following medical opinion: "Diagnosis and onset of this condition which persists to the present during active duty military service should qualify said condition for service connection. This is a permanent condition." For rationale, the private provider noted the Veteran's current symptoms of IBS, noted that she had been diagnosed with this condition during active duty military service, and noted that her condition had continued without interval change and without hiatus. In an August 2018 statement, the Veteran's private provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of irritable colon syndrome/diverticulosis with impairment of sphincter control, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was initiated and further aggravated while serving in the military, primarily, her deployment to Afghanistan in 2013[.]" For rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her reports of IBS symptoms in service), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her deployment to Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private medical providers in December 2015 and August 2018 respectively, indicating a link between the Veteran's currently diagnosed IBS and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for IBS is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 7. Service connection for TBI residuals. The Veteran contends that she currently has TBI residuals due to her military service, to include as a result of combat service events during her Afghanistan deployment. [The Veteran has separately sought service connection for migraine headaches and for tinnitus as disabilities which are separate and distinct from her claimed TBI residuals, and consequently those conditions will be addressed in the separately designated sections below.] The medical evidence of record, including the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of TBI residuals (including vertigo and double vision). As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include a January 1990 report of emergency treatment after bumping her head on the frame of a car window the night before, with a diagnosis of headaches status post closed head trauma; an April 2003 Report of Medical History on which she indicated having a history of frequent or severe headache, head injury, and periods of unconsciousness ("All due to car accident on May 31, 2002 " [which was not during an active duty period]); a March 2013 Report of Medical History on which she indicated having a history of frequent or severe headache ("May 31, 2002 car accident, head injury"); and an October 2013 Report of Medical History on which she indicated having a history of frequent or severe headache, a head injury/memory loss/amnesia, and a period of unconsciousness or concussion ("car accident 2002 head trauma"). Thereafter, during her Reserve service, a February 2015 private treatment record documented the Veteran's reported history of falling from her up-armored vehicle in Afghanistan and injuring her back and head. A February 2015 Report of Medical Assessment noted her report of falling out of a vehicle while in Afghanistan, hitting her head and back. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of dizziness, frequent or severe headache, a head injury/memory loss/amnesia, a period of unconsciousness or concussion, and loss of memory ("Car accident in 2002 head hit windshield cervical sprain & concussion. Wearing of ACH on deployment caused massive pain and migraine headaches that continue to this day. Fell out of up-armored SUV in Kabul with full gear on hitting head and back, causing extreme pain & headaches"). Post-service, at an October 2015 VA TBI examination, the Veteran reported having headaches following her May 2002 motor vehicle accident and noted that thereafter her headaches "changed significantly" during her deployment in Afghanistan, but she did not report any other TBI symptoms. The VA examiner concluded that there were no residuals of TBI for the Veteran, and thus no etiology opinion was rendered. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of TBI residuals (including vertigo and double vision), noted that while stationed in Afghanistan she was thrown from a vehicle and sustained head trauma and trauma to her spine, and provided the following medical opinion: "It is more likely than not that the aforementioned is directly and causally related to injury [in service]. It is more likely than not that same is directly and causally related to [the Veteran's] military service. This is a permanent condition." For rationale, the private provider noted the Veteran's current symptoms of TBI residuals and noted that these current residuals were solely related to the injury she described on her Afghanistan deployment (rather than the prior 2002 motor vehicle accident). In a September 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of Meniere's syndrome, left ear hearing impairment with vertigo, and other TBI symptoms such as concentration issues and memory loss, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] . . . Hearing Loss in Left Ear and Vertigo issues were initiated and further aggravated while serving in the military, primarily, her assignment to the Aviation Intermediate Maintenance Department, in 1989-1990, her assignment as a Master-at-Arms (Military Police) from 2011 to 2014[,] and her combat deployment to Afghanistan in 2013 where she encountered explosions and combat fire, almost daily. Due to her vertigo, she also suffered a fall from combat vehicle, while deployed." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her report of a fall in full combat gear from a vehicle while in Afghanistan), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her fall from an up-armored vehicle while wearing combat gear in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in December 2015 and September 2018 respectively, indicating a link between the Veteran's currently diagnosed TBI residuals and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for TBI residuals is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 8. Service connection for migraine headaches. The Veteran contends that she currently has migraine headaches due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of an October 2015 VA headaches examination and the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of migraine headaches. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include a January 1990 report of emergency treatment after bumping her head on the frame of a car window the night before, with a diagnosis of headaches status post closed head trauma; an April 2003 Report of Medical History on which she indicated having a history of frequent or severe headache, head injury, and periods of unconsciousness ("All due to car accident on May 31, 2002 " [which was not during an active duty period]); a March 2013 Report of Medical History on which she indicated having a history of frequent or severe headache ("May 31, 2002 car accident, head injury"); and an October 2013 Report of Medical History on which she indicated having a history of frequent or severe headache, a head injury/memory loss/amnesia, and a period of unconsciousness or concussion ("car accident 2002 head trauma"). Thereafter, during her Reserve service, VA treatment records documented a diagnosis of migraines in January 2015. A February 2015 private treatment record noted an assessment of headache and classical migraine and documented the Veteran's reported history of falling from her up-armored vehicle in Afghanistan and injuring her back and head. A February 2015 Report of Medical Assessment noted her report of falling out of a vehicle while in Afghanistan, hitting her head and back. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of dizziness, frequent or severe headache, a head injury/memory loss/amnesia, a period of unconsciousness or concussion, and loss of memory ("Car accident in 2002 head hit windshield cervical sprain & concussion. Wearing of ACH on deployment caused massive pain and migraine headaches that continue to this day. Fell out of up-armored SUV in Kabul with full gear on hitting head and back, causing extreme pain & headaches"). Post-service, at an October 2015 VA TBI examination, the Veteran reported having headaches following her May 2002 motor vehicle accident and noted that thereafter her headaches "changed significantly" during her deployment in Afghanistan. At the October 2015 VA headaches examination, the Veteran was diagnosed with migraine headaches. She again reported that she began having headaches following her May 2002 motor vehicle accident, and that during her deployment to Afghanistan in 2013 her headaches changed and became worse and more frequent. The VA examiner opined that the Veteran's current migraines were not caused by or a result of the headaches noted in 2002. For rationale, the VA examiner stated: "Her present headaches have nothing to do with the 2002 post traumatic headaches and are completely different. These are migraines and there is no way to know if they are related to her 2013 deployment (as per [V]eteran's history) without merely speculating." At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of migraine headaches and provided the following medical opinion: "Diagnosis and onset of this condition which persists to the present during active duty military service should qualify said condition for service connection. This is a permanent condition." For rationale, the private provider noted the Veteran's current symptoms of migraine headaches, noted that she had been diagnosed with and treated for this condition during active duty military service, and noted that her migraine medication prescription had continued to the present. In a March 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of severe migraines, and provided the following opinion: "It is my opinion that it is more than likely, if not definite, that [the Veteran's] Migraine Headaches were initiated and further aggravated while serving in the military, significantly her deployment to a combat zone in Afghanistan [in] 2013, and are also secondary to her PTSD." For rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of migraine headaches during her active duty), and noted that she had no other known risk factors that may have precipitated her current condition. In a November 2018 statement, W.B. reiterated his prior opinion regarding the Veteran's current diagnosis of migraine headaches as follows: "It is my opinion that it is more than likely, if not definite, that [the Veteran's] Migraine Headaches were initiated and further aggravated while serving in the military, significantly from her deployment to a combat zone in Afghanistan [in] 2013, and can also be secondary to her PTSD...and her TBI[.]" For rationale, W.B. again outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of migraine headaches during her active duty), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her fall from an up-armored vehicle while wearing combat gear in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in December 2015, March 2018, and November 2018 respectively, indicating a link between the Veteran's currently diagnosed migraine headaches and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. The Board finds that the October 2015 VA examiner's opinion regarding a relationship between the Veteran's current migraine headaches and her 2013 deployment is speculative in nature without an adequate rationale, and therefore is entitled to no probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for migraine headaches is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 9. Service connection for tinnitus. The Veteran contends that she currently has tinnitus due to her military service, to include as a result of combat noise exposure during her Afghanistan deployment. The medical evidence of record, including the report of an October 2015 VA audiology examination and the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of tinnitus. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include reference audiograms in April 2003 and March 2013 which both documented her in-service noise exposure; an October 2013 Report of Medical Assessment on which it was noted that she had tinnitus in her right ear; and a reference audiogram in November 2013 which documented her in-service noise exposure. Thereafter, during her Reserve service, she indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of ear trouble ("ear infection while deployed, caused continuous tinnitus in right ear"). Post-service, at the October 2015 VA audiology examination, the Veteran reported constant tinnitus in her right ear that started in 2013. The VA examiner noted being unable to provide a medical opinion regarding the etiology of the Veteran's tinnitus without resorting to speculation, noting: "It is likely/possible that aging, civilian noise exposures, and general health have contributed to her...tinnitus. It would be speculative to allocate a degree of her tinnitus to any or each of these etiologies[.]" At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of tinnitus, and provided the following medical opinion: "It is more likely than not that [the Veteran's]...bilateral tinnitus [is] directly and causally related to the acoustic trauma [in service]; thus it is more likely than not that same is directly and causally related to her military service. This is a permanent condition." For rationale, the private provider noted the Veteran's current symptoms of tinnitus, outlined her military noise exposure in service, and noted that she had suffered from progressive bilateral tinnitus. In a September 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of right ear tinnitus, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] Tinnitus . . . [was] initiated and further aggravated while serving in the military, primarily, her assignment to the Aviation Intermediate Maintenance Department, in 1989-1990, her assignment as a Master-at-Arms (Military Police) from 2011 to 2014[,] and her combat deployment to Afghanistan in 2013 where she encountered explosions and combat fire, almost daily." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history, and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her exposure to loud noise while in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in December 2015 and September 2018 respectively, indicating a link between the Veteran's currently diagnosed tinnitus and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. The Board finds that the October 2015 VA examiner's opinion regarding the etiology of the Veteran's current tinnitus is speculative in nature, and therefore is entitled to less probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for tinnitus is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 10. Service connection for hypertension. The Veteran contends that she currently has hypertension due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a September 2015 VA hypertension examination and the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of hypertension. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs do not note any reports, findings, diagnosis, or treatment of hypertension. Thereafter, during her Reserve service, a February 2015 VA treatment record documented that the Veteran was prescribed Lisinopril for blood pressure. A February 2015 Report of Medical Assessment noted that she was on Lisinopril for high blood pressure. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of high blood pressure ("High Blood Pressure diagnosed upon return from deployment in Nov 2013. Treated at VA.") Post-service, at the September 2015 VA hypertension examination, the Veteran was diagnosed with hypertension, and she reported that she was diagnosed with hypertension when she got back from her Afghanistan deployment in November 2013. The VA examiner opined that the Veteran's hypertension was less likely as not incurred or caused by service. For rationale, the VA examiner noted: "There is no objective evidence of the diagnosis or treatment of chronic HTN [hypertension] during AD [active duty]. Records indicate treatment for HTN [in] 2015. Separation exam [in] 2013 silent for HTN." However, the VA examiner did not note any consideration of the Veteran's verified combat service during her active duty period in 2013 when rendering this opinion. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of hypertension, and provided the following medical opinion: "Diagnosis and onset of this condition which persists to the present during active duty military service should qualify said condition for service connection. This is a permanent condition." For rationale, the private provider noted that the Veteran had been diagnosed with and treated for hypertension during active duty military service, and noted that her condition had persisted to the present without hiatus or interval change. In an August 2019 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of hypertensive vascular disease, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] Hypertension, which is also secondary to PTSD[,] was initiated and further aggravated while serving in the military, primarily, her combat deployment to Afghanistan in 2013 where she encountered explosions and combat fire, and fear of being killed almost daily." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including how she had never had a recorded blood pressure that was considered high until after her active duty period in 2013), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her deployment to Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in December 2015 and August 2019 respectively, indicating a link between the Veteran's currently diagnosed hypertension and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. As noted above, the negative medical opinion provided by the September 2015 VA examiner failed to take into account the Veteran's verified combat service during her active duty period in 2013; as such, the Board finds that this opinion is entitled to less probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for hypertension is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). 11. Service connection for a cervical spine disability, diagnosed as degenerative arthritis and cervicalgia. The Veteran contends that she currently has a cervical spine disability due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of cervical spine degenerative arthritis and cervicalgia. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include a March 2013 Report of Medical History on which she noted the following history: "May 31, 2002 car accident, head injury, cervical sprain" [which was not during an active duty period]; an October 2013 Report of Medical Assessment on which she indicated having neck pain since May 2013; and an October 2013 Report of Medical History on which she noted the following history: "IOTV [Improved Outer Tactical Vest] caused neck & shoulder issues" and "car accident 2002 head trauma neck trauma[.]" Thereafter, during her Reserve service, a February 2015 private treatment record noted an assessment of neck pain and documented the Veteran's reported history of falling from her up-armored vehicle in Afghanistan and injuring her back and head. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of "back pain, neck pain, and knee pain excessive in combat after wearing generation I body armor, gear, & ACH [Advanced Combat Helmet]. All became noticeable & worse during & after deployment Mar-Nov 2013" and "Car accident in 2002 head hit windshield cervical sprain & concussion." Post-service, at a September 2015 VA neck examination, the Veteran was diagnosed with cervical spine strain. She reported that she had a cervical strain and compression from her car accident in 2002. The VA examiner opined that the Veteran did not have a diagnosis of a neck condition that was at least as likely as not incurred in or caused by the neck pain during service. For rationale, the VA examiner noted that the cervical strain secondary to the 2002 motor vehicle accident (which was not during an active duty period) was acute and transitory and had resolved. However, the VA examiner did not note any consideration of the Veteran's verified combat service during her active duty period in 2013 when rendering this opinion. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of cervicothoracic spine pain (cervicalgia) and post-traumatic residual degenerative joint disease and spondylosis of the cervical spine and cervicothoracic regions, noted that while stationed in Afghanistan she was thrown from a vehicle and sustained head trauma and trauma to her spine, and provided the following medical opinion: "It is more likely than not that the aforementioned is directly and causally related to injury [in service]. It is accordingly more likely than not that same is directly and causally related to [the Veteran's] military service. This is a permanent and progressive condition." For rationale, the private provider noted the Veteran's current cervical spine symptoms and how the Veteran had suffered from progressive cervical spine pain since her in-service injury. Private testing (including a July 2016 MRI, July 2018 x-rays, and a September 2018 MRI) showed the presence of degenerative changes and disc space narrowing in the Veteran's cervical spine. In a September 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of cervicalgia, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was further aggravated while serving in the military, primarily, her combat deployment to Afghanistan in 2013 where she was required to wear an Army Combat Helmet (ACH) and IOTV (military plated vest) nearly every day of her tour." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of neck pain during her active duty), and noted that she had no other known risk factors that may have precipitated her current condition. In a September 2019 statement, W.B. reiterated his prior opinion regarding the Veteran's current diagnosis of cervicalgia as follows: "It is my opinion that it is more likely than not, that [the Veteran's] condition was further aggravated while serving in the military, primarily, her deployment to Afghanistan in 2013 where she was required to wear an Army Combat Helmet (ACH) and IOTV Generation I (military plated vest) nearly every day of her tour." For further rationale, W.B. again outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of neck pain during her active duty), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in December 2015, September 2018, and September 2019 respectively, indicating a link between the Veteran's currently diagnosed cervical spine degenerative arthritis and cervicalgia and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. As noted above, the negative medical opinion provided by the September 2015 VA examiner failed to take into account the Veteran's verified combat service during her active duty period in 2013; as such, the Board finds that this opinion is entitled to less probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for a cervical spine disability, diagnosed as degenerative arthritis and cervicalgia, is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). [The Board also finds that the instant decision applies to and resolves all pending claims of service connection for a cervical spine disability, however diagnosed. See Clemons, 23 Vet. App. at 1, 5-6.] 12. Service connection for a lumbar spine disability, diagnosed as degenerative arthritis. The Veteran contends that she currently has a lumbar spine disability due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a September 2015 VA back examination and the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of lumbar spine degenerative arthritis. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include a September 1988 report of middle back pain after tug-of-war and an assessment of low back pain secondary to trauma (with accompanying x-rays noting lumbus vertebra at L5); another September 1988 report of two days of low back pain with sports weekend and an assessment of resolving mechanical low back pain; the report of her March 1990 active duty separation examination which noted post traumatic kyphosis of the upper lumbar spine; an October 2013 Report of Medical Assessment on which she indicated having low back pain during deployment; and an October 2013 Report of Medical History on which she indicated having a history of recurrent back pain. Thereafter, during her Reserve service, the Veteran indicated on a March 2014 post-deployment health re-assessment that she was "Bothered a lot" by back pain. A September 2014 VA lumbar spine MRI revealed mild degenerative disc disease and facet arthrosis. [This September 2014 diagnosis of lumbar spine degenerative disc disease occurred within one year of her discharge from her last period of active duty service in November 2013, thereby triggering the applicability of the chronic disease presumption. See 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309.] A private chiropractor opined in September 2014 that due to years in the military, arthritic changes had progressed in the Veteran's spine. A January 2015 VA treatment record noted chronic low back pain which she reported was due to her combat gear. A February 2015 private treatment record noted an assessment of lumbago and degeneration of lumbar intervertebral disc, and the private provider noted that the Veteran's back pain had started about three months into her combat tour in Afghanistan, and that during this tour she started wearing heavy combat armor and gear and also fell from her up-armored vehicle and injured her back and head which caused a worsening of her back pain with daily physical training ("The most likely explanation of this case is that she had an underlying pre-existing degenerative disc disease that was aggravated by her tour in Afghanistan"). A February 2015 Report of Medical Assessment noted her report of falling out of a vehicle while in Afghanistan, hitting her head and back. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of "back pain, neck pain, and knee pain excessive in combat after wearing generation I body armor, gear, & ACH [Advanced Combat Helmet]. All became noticeable & worse during & after deployment Mar-Nov 2013. Received back brace & knee brace while deployed. Currently seen for back & knee pain" and "Fell out of up-armored SUV in Kabul with full gear on hitting head and back, causing extreme pain & headaches." The report of her February 2015 Reserve separation examination noted lumbar region pain. Post-service, at the September 2015 VA back examination, the Veteran was diagnosed with mild degenerative disc disease of the lumbar spine, and she reported that she had back pain from wearing heavy gear and armor in service. The VA examiner opined that the Veteran's lumbar spine degenerative disc disease was less likely as not incurred in or caused by the lumbago noted during service. For rationale, the VA examiner noted that there was no objective evidence of lumbar spine degenerative disc disease during the Veteran's active duty service (as such condition was found on the September 2014 VA MRI during her Reserve service) and that there was no objective evidence of a chronic back condition during her service (as the lumbago documented during her service is not degenerative disc disease but is simply a term which refers to pain in the lower back). However, the VA examiner did not consider the applicability of the chronic disease presumption for the Veteran's lumbar spine arthritis (which was diagnosed within one year of her discharge from her last period of active duty service, as outlined above) or note any consideration of the Veteran's verified combat service during her active duty period in 2013 when rendering this opinion. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of post-traumatic residual well-advanced degenerative joint disease and osteoarthritis of the lumbar spine (emphasis lumbosacral region), noted that she sustained injury to her lumbar spine while in basic training, and provided the following medical opinion: "It is more likely than not that the aforementioned is directly and causally related to injury [in service]. It is more likely than not that same is directly and causally related to [the Veteran's] military service. This is a permanent condition." For rationale, the private provider noted the Veteran's current lumbar spine symptoms and how her low back pain had become constant since her injury in basic training. Private testing (including a July 2016 MRI and July 2018 x-rays) showed the presence of degenerative changes, disc herniation, spinal stenosis, and facet arthrosis in the Veteran's lumbar spine. In a September 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of lumbar spine degenerative arthritis/osteoarthritis with spinal stenosis and lumbago with desiccation and bulges at L2-L5, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was further aggravated while serving in the military, primarily, her lower back injury which occurred in August of 1988...and her deployment to Afghanistan in 2013 with the wearing of IOTV combat gear, and with the fall out of an up-armored SUV in full gear." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of low back pain during her active duty), and noted that she had no other known risk factors that may have precipitated her current condition. In a May 2019 statement, W.B. reiterated his prior opinion regarding the Veteran's current diagnosis of lumbar spine degenerative arthritis/osteoarthritis with spinal stenosis and lumbago with desiccation and bulges at L2-L5 as follows: "It is my opinion that it is more likely than not, that [the Veteran's] condition was further aggravated while serving in the military, primarily, her lower back injury which occurred in August of 1988...and her deployment to Afghanistan in 2013 with the wearing of IOTV combat gear, and with the fall out of an up-armored SUV in full gear in September 2013." For further rationale, W.B. again outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of low back pain during her active duty), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in September 2014 and February 2015, as well as by the private providers in December 2015, September 2018, and May 2019 respectively, indicating a link between the Veteran's currently diagnosed lumbar spine degenerative arthritis and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. As noted above, the negative medical opinion provided by the September 2015 VA examiner failed to consider the applicability of the chronic disease presumption and also failed to take into account the Veteran's verified combat service during her active duty period in 2013; as such, the Board finds that this opinion is entitled to less probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for a lumbar spine disability, diagnosed as degenerative arthritis, is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). [The Board also finds that the instant decision applies to and resolves all pending claims of service connection for a lumbar spine disability, however diagnosed. See Clemons, 23 Vet. App. at 1, 5-6.] 13. Service connection for a right shoulder disability, diagnosed as degenerative joint disease. The Veteran contends that she currently has a right shoulder disability due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a December 2015 private general medical examination, shows that the Veteran has a current diagnosis of right shoulder degenerative joint disease. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). During a documented period of active duty for training (ACDUTRA) in January 2002, she reported having right shoulder pain for three days with shotgun firing, and she was assessed with a soft tissue injury. Her active duty STRs include an April 2003 Report of Medical History on which she indicated having a history of painful shoulder ("shoulder from shooting shotgun in NEC 9545 school Jan 02") and an October 2013 Report of Medical History on which she indicated having a history of painful shoulder ("IOTV caused neck & shoulder issues"). Thereafter, during her Reserve service, a February 2015 private treatment record noted the Veteran's report of right shoulder pain. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of painful shoulder ("pain in right shoulder since shotgun course in Little Creek, VA Jan-Mar-2002 MA training"). The report of her February 2015 Reserve separation examination noted right shoulder pain. Post-service, at a September 2015 VA shoulder examination, the Veteran was diagnosed with bilateral shoulder strain, and she indicated that she had physical therapy after a shotgun course when she was an MP [military police]. Contemporaneous x-rays of both shoulders in September 2015 were normal. The VA examiner did not provide an opinion regarding the etiology of the Veteran's right or left shoulder disability. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of post-traumatic degenerative joint disease of the right shoulder complicated by instability with danger to spontaneously dislocate, noted that she suffered repetitive trauma to her right shoulder during shotgun training on the range in service, and provided the following medical opinion: "It is more likely than not that the aforementioned is directly and causally related to injury from shot gun shooting as discussed. It is more likely than not that same is directly and causally related to [the Veteran's] military service. This is a permanent and progressive condition." For rationale, the private provider noted the Veteran's current right shoulder symptoms and how she continued to have progressive pain and dysfunction in the right shoulder since her service. In an October 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of chronic bilateral shoulder pain with decreased range of motion; however, W.B. did not indicate whether such pain resulted in functional impairment of earning capacity, which is required to establish "pain alone" as constituting a disability eligible for service connection. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). Nevertheless, W.B. went on to provide the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was initiated during her Active Duty for Training in Law Enforcement Specialist School...during a required Shotgun Certification Course. And the problem was further aggravated while serving on deployment to Afghanistan in 2013, [where] she continually wore Generation 1-IOTV Body Armor, and utilized weapons." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented report of right shoulder injury during her ACDUTRA service in January 2002), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her ACDUTRA injury in January 2002, and she also provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinion provided by the private provider in December 2015, indicating a link between the Veteran's currently diagnosed right shoulder degenerative joint disease and an injury during ACDUTRA, is supported by an adequate rationale for the conclusion reached, as such rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords this opinion substantial weight of probative value. As noted above, the September 2015 VA examiner did not provide an etiology opinion for the Veteran's bilateral shoulder strain. In addition, W.B.'s October 2018 opinion did not clearly identify a right shoulder disability which would be eligible for service connection, and therefore his opinion is entitled to no probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for a right shoulder disability, diagnosed as degenerative joint disease, is warranted on a direct basis. 38 U.S.C. §§ 101(24), 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). [The Board also finds that the instant decision applies to and resolves all pending claims of service connection for a right shoulder disability, however diagnosed. See Clemons, 23 Vet. App. at 1, 5-6.] 14. Service connection for a left knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome. The Veteran contends that she currently has a left knee disability due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a December 2015 private general medical examination and a March 2018 statement from a private provider, shows that the Veteran has a current diagnosis of left knee degenerative joint disease and patellofemoral syndrome. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). During a documented period of ACDUTRA in May 2004, it was noted that she had sprained her left knee in a 2002 motor vehicle accident [which was not during an active duty period] and that an MRI of her left knee at that time showed a pre-patella contusion. Her active duty STRs include a March 2013 Report of Medical History on which she indicated having a history of knee trouble ("May 31, 2002 car accident, head injury, cervical sprain, ankle & knee sprain"); an October 2013 Report of Medical Assessment on which she indicated having bilateral knee pain during deployment, exacerbated with wearing heavy gear; and an October 2013 Report of Medical History on which she indicated having a history of knee trouble ("bad knees car accident in 2002 caused bad left knee Running agitates knees"). Thereafter, during her Reserve service, a February 2015 private treatment record noted the Veteran's report of pain in the knees. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of knee trouble ("back pain, neck pain, and knee pain excessive in combat after wearing generation I body armor, gear, & ACH [Advanced Combat Helmet]. All became noticeable & worse during & after deployment Mar-Nov 2013. Received back brace & knee brace while deployed. Currently seen for back & knee pain"). The report of her February 2015 Reserve separation examination noted bilateral knee pain. Post-service, at a September 2015 VA knee examination, the Veteran was diagnosed with bilateral knee strain. The VA examiner opined that the Veteran's current bilateral knee strain was less likely as not caused by service. For rationale, the VA examiner noted that there was no objective evidence of a chronic left or right knee condition during active duty and that the 2002 left knee strain (which was not during an active duty period) was acute and transitory and had resolved. However, the VA examiner did not note any consideration of the Veteran's verified combat service during her active duty period in 2013 when rendering this opinion. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of post-traumatic residual degenerative joint disease of the left knee complicated by bilateral meniscus tears, noted that she had injured her left knee during PT training while in Afghanistan, and provided the following medical opinion: "It is more likely than not that the aforementioned is directly and causally related to injury [in service]. It is more likely than not that same is directly and causally related to [the Veteran's] military service. This is a permanent and progressive condition that will more likely than not require surgery to resolve or partially resolve." For rationale, the private provider noted the Veteran's current left knee symptoms and how she continued to have pain in her left knee since her service. In a March 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of bilateral knee pain and patellofemoral syndrome, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was initiated during her military duty, during each and every physical fitness activity during Active Duty for Training and periods of Inactive Duty Training. And the problem with her knees was further aggravated while serving on deployment to Afghanistan in 2013, [where] she continually wore Generation 1-IOTV Body Armor, maintaining physical fitness standards daily, by utilizing the gym and even was given a knee brace by the TMC (Troop Medical Clinic) at Camp Eggers in Kabul, Afghanistan." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of bilateral knee pain during her active service), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in December 2015 and March 2018 respectively, indicating a link between the Veteran's currently diagnosed left knee degenerative joint disease and patellofemoral syndrome and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. As noted above, the negative medical opinion provided by the September 2015 VA examiner failed to take into account the Veteran's verified combat service during her active duty period in 2013; as such, the Board finds that this opinion is entitled to less probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for a left knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome, is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). [The Board also finds that the instant decision applies to and resolves all pending claims of service connection for a left knee disability, however diagnosed. See Clemons, 23 Vet. App. at 1, 5-6.] 15. Service connection for a right knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome. The Veteran contends that she currently has a right knee disability due to her military service, to include as a result of combat service events during her Afghanistan deployment. The medical evidence of record, including the report of a December 2015 private general medical examination and a March 2018 statement from a private provider, shows that the Veteran has a current diagnosis of right knee degenerative joint disease and patellofemoral syndrome. As noted above, the Veteran's combat service has been verified, along with any events consistent with such service. See 38 U.S.C. § 1154(b). Her active duty STRs include a March 2013 Report of Medical History on which she indicated having a history of knee trouble ("May 31, 2002 car accident, head injury, cervical sprain, ankle & knee sprain"); an October 2013 Report of Medical Assessment on which she indicated having bilateral knee pain during deployment, exacerbated with wearing heavy gear; and an October 2013 Report of Medical History on which she indicated having a history of knee trouble ("bad knees car accident in 2002 caused bad left knee Running agitates knees"). Thereafter, during her Reserve service, a February 2015 private treatment record noted the Veteran's report of pain in the knees. A February 2015 Report of Medical Assessment noted her report of a pulled or strained tendon in her right leg/knee/calf. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of knee trouble ("back pain, neck pain, and knee pain excessive in combat after wearing generation I body armor, gear, & ACH [Advanced Combat Helmet]. All became noticeable & worse during & after deployment Mar-Nov 2013. Received back brace & knee brace while deployed. Currently seen for back & knee pain"). The report of her February 2015 Reserve separation examination noted bilateral knee pain. Post-service, at a September 2015 VA knee examination, the Veteran was diagnosed with bilateral knee strain. The VA examiner opined that the Veteran's current bilateral knee strain was less likely as not caused by service. For rationale, the VA examiner noted that there was no objective evidence of a chronic left or right knee condition during active duty. However, the VA examiner did not note any consideration of the Veteran's verified combat service during her active duty period in 2013 when rendering this opinion. At the December 2015 private general medical examination, a private diagnostic consultant, who was a chiropractic physician, noted the Veteran's current diagnosis of post-traumatic residual degenerative joint disease of the right knee complicated by lateral meniscus tear, noted that she had injured her right knee during PT training while in Afghanistan, and provided the following medical opinion: "It is more likely than not that the aforementioned is directly and causally related to injury [in service]. It is more likely than not that same is directly and causally related to [the Veteran's] military service. This is a permanent and progressive condition that will more likely than not require surgery to resolve or partially resolve." For rationale, the private provider noted the Veteran's current right knee symptoms and how she continued to have pain in her right knee since her service. In a March 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of bilateral knee pain and patellofemoral syndrome, and provided the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was initiated during her military duty, during each and every physical fitness activity during Active Duty for Training and periods of Inactive Duty Training. And the problem with her knees was further aggravated while serving on deployment to Afghanistan in 2013, [where] she continually wore Generation 1-IOTV Body Armor, maintaining physical fitness standards daily, by utilizing the gym and even was given a knee brace by the TMC (Troop Medical Clinic) at Camp Eggers in Kabul, Afghanistan." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history (including her documented reports of bilateral knee pain during her active service), and noted that she had no other known risk factors that may have precipitated her current condition. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. The Board finds that the favorable medical opinions provided by the private providers in December 2015 and March 2018 respectively, indicating a link between the Veteran's currently diagnosed right knee degenerative joint disease and patellofemoral syndrome and her military service, are each supported by an adequate rationale for the conclusion reached, as each rationale took into account the pertinent circumstances of her service (to include her verified combat service and the pertinent STRs outlined above). Therefore, the Board affords these opinions substantial weight of probative value. As noted above, the negative medical opinion provided by the September 2015 VA examiner failed to take into account the Veteran's verified combat service during her active duty period in 2013; as such, the Board finds that this opinion is entitled to less probative weight. In light of the foregoing, and after resolving all doubt in the Veteran's favor, the Board concludes that service connection for a right knee disability, diagnosed as degenerative joint disease and patellofemoral syndrome, is warranted on a direct basis. 38 U.S.C. §§ 1110, 1131, 1154(b), 5107(b); Holton, 557 F.3d at 1363, 1366; 38 C.F.R. § 3.303(a). [The Board also finds that the instant decision applies to and resolves all pending claims of service connection for a right knee disability, however diagnosed. See Clemons, 23 Vet. App. at 1, 5-6.] Withdrawn Claim 16. Entitlement to service connection for a left elbow disability. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the Veteran or by her authorized representative. 38 C.F.R. § 19.55. On the record at her February 2020 Board hearing, prior to the promulgation of a decision in the appeal in the matter, the Veteran testified that she wished to withdraw her appeal as to the issue of entitlement to service connection for a left elbow disability. The transcript demonstrates that the Veteran was advised of the consequences of withdrawing the appeal of this issue, that the Veteran and her representative participated in a meaningful manner in the hearing, and that they were aware of the consequences of withdrawal of the claim at the time. The Board finds that the Veteran's withdrawal with regard to the aforementioned issue was explicit, unambiguous, and done with a full understanding of the consequences of such action. Given these circumstances, the Board finds that the Veteran met the requirements necessary for an effective oral withdrawal of the issue of entitlement to service connection for a left elbow disability. Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018). As the Veteran has knowingly and voluntarily withdrawn the appeal of this issue in accordance with 38 C.F.R. § 19.55, there remains no allegation of error of fact or law for the Board to address. Accordingly, the Board does not have jurisdiction to review the appeal of this issue, and the appeal in this matter must be dismissed. REASONS FOR REMAND As an initial matter, in multiple statements, the Veteran's private treating provider (W.B., D.O.) indicated that he had treated the Veteran from the time of her military service until the present. On remand, all available treatment records from W.B. should be obtained and associated with the claims file. In addition, the most recent VA treatment record in the claims file which was retrieved by VA is dated in November 2015. Thereafter, the Veteran herself submitted VA treatment records dating up to January 2020. On remand, all outstanding VA treatment records must be associated with the claims file. Furthermore, at her February 2020 Board hearing, the Veteran's representative indicated that the Veteran would prefer any necessary examinations to be scheduled with a contract provider at a location other than the Gainesville, Florida VA Medical Center (VAMC). On remand, the Board will request for this arrangement to be implemented for any necessary examinations (as outlined below). 1. Entitlement to service connection for left ear hearing loss. The Veteran contends that she currently has left ear hearing loss due to her military service, to include as a result of combat noise exposure during her Afghanistan deployment. During the appeal period, at an October 2015 VA audiology examination, audiometric testing did not show a hearing loss disability for VA purposes in the left ear in accordance with 38 C.F.R. § 3.385. Thereafter, it was indicated at a December 2015 private general medical examination that the Veteran did have left ear hearing loss, but it was not noted whether the referenced testing conformed to the requirements of 38 C.F.R. § 3.385. The Veteran also underwent private audiometric testing in October 2018, but it is not clear from the test report whether such testing conformed to the requirements of 38 C.F.R. § 3.385. At her February 2020 hearing, the Veteran testified that she currently has hearing loss in her left ear. On remand, after all outstanding treatment records have been associated with the claims file, an examination should be scheduled [at a location other than the Gainesville VAMC] to determine whether the Veteran has a hearing loss disability for VA purposes in her left ear in accordance with 38 C.F.R. § 3.385. If and only if this disability is shown on such examination and/or by any newly received evidence dated at any time during the appeal period, then a medical opinion should be provided to address whether such disability is related to any incident of her military service (with consideration of her verified combat service and all pertinent STRs). 2. Entitlement to service connection for residuals status post cholecystectomy. The Veteran contends that she currently has residuals due to a cholecystectomy which she alleges took place during a period of active duty. She also contends that such residuals may have worsened as a result of combat service events during her Afghanistan deployment. The Veteran's STRs indicate on multiple occasions (including on Reports of Medical History in January 2004 and July 2004) that she had her gallbladder removed in December 1991 at Glens Falls Hospital in New York. However, at a post-service September 2015 VA gallbladder examination, the Veteran indicated that her gallbladder had been removed laparoscopically while on active duty. At a September 2015 VA scars examination, it was noted that she had two linear laparoscopic scars, status post cholecystectomy. On remand, the records documenting her cholecystectomy surgery should be obtained and associated with the claims file in order to verify the exact date of such surgery. At her February 2020 Board hearing, the Veteran testified with regard to her current gastrointestinal issues and indicated that she could not differentiate between her symptoms of IBS [for which service connection is being granted in the instant decision] and her cholecystectomy residuals. She also provided competent and credible testimony about her deployment to Afghanistan which the Board finds to be consistent with the circumstances of her combat service. On remand, after all outstanding treatment records have been associated with the claims file, a new examination should be scheduled [at a location other than the Gainesville VAMC] to address the nature of any current residuals status post cholecystectomy and whether any such residuals are related to any incident of the Veteran's military service (with consideration of her verified combat service and all pertinent STRs). 3. Entitlement to service connection for scar from head injury. The Veteran contends that she currently has a scar due to a head injury during a period of active duty. The Veteran's active duty STRs include a January 1990 report of emergency treatment after bumping her head on the frame of a car window the night before, with a diagnosis of headaches status post closed head trauma; an April 2003 Report of Medical History on which she indicated having a history of frequent or severe headache, head injury, and periods of unconsciousness ("All due to car accident on May 31, 2002 " [which was not during an active duty period]); a March 2013 Report of Medical History on which she indicated having a history of frequent or severe headache ("May 31, 2002 car accident, head injury"); and an October 2013 Report of Medical History on which she indicated having a history of frequent or severe headache, a head injury/memory loss/amnesia, and a period of unconsciousness or concussion ("car accident 2002 head trauma"). Thereafter, during her Reserve service, a February 2015 private treatment record documented the Veteran's reported history of falling from her up-armored vehicle in Afghanistan and injuring her back and head. A February 2015 Report of Medical Assessment noted her report of falling out of a vehicle while in Afghanistan, hitting her head and back. She indicated on a February 2015 Report of Medical History at the time of her Reserve retirement that she had a history of dizziness, frequent or severe headache, a head injury/memory loss/amnesia, a period of unconsciousness or concussion, and loss of memory ("Car accident in 2002 head hit windshield cervical sprain & concussion. Wearing of ACH on deployment caused massive pain and migraine headaches that continue to this day. Fell out of up-armored SUV in Kabul with full gear on hitting head and back, causing extreme pain & headaches"). Post-service, at a September 2015 VA scars examination, it was noted that the Veteran had a left lateral forehead laceration scar, which she reported was diagnosed on active duty. The examination summary noted that such scar was from a motor vehicle accident (MVA), though the nature and timing of such accident were not specified. At her February 2020 Board hearing, the Veteran provided credible testimony about her fall from an up-armored vehicle while wearing combat gear in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. She also testified that as a result of this accident, she had a laceration on the back of her head and her helmet flipped off. On remand, after all outstanding treatment records have been associated with the claims file, a new examination should be scheduled [at a location other than the Gainesville VAMC] to address the nature of any current head scars (including on the back of the Veteran's head) and whether any such scars are related to any incident of the Veteran's military service (with consideration of her verified combat service and all pertinent STRs). 4. Entitlement to service connection for a left shoulder disability. The Veteran contends that she currently has a left shoulder disability due to her military service, to include as a result of combat service events during her Afghanistan deployment. The Veteran's active duty STRs include an October 2013 Report of Medical History on which she indicated having a history of painful shoulder ("IOTV caused neck & shoulder issues"). Post-service, at a September 2015 VA shoulder examination, the Veteran was diagnosed with bilateral shoulder strain, and she indicated that she had physical therapy after a shotgun course when she was an MP [military police]. Contemporaneous x-rays of both shoulders in September 2015 were normal. The VA examiner did not provide an opinion regarding the etiology of the Veteran's left shoulder disability. In an October 2018 statement, the Veteran's private treating provider, W.B., D.O., (who also previously treated her in the military) noted the Veteran's current diagnosis of chronic bilateral shoulder pain with decreased range of motion; however, W.B. did not indicate whether such pain resulted in functional impairment of earning capacity, which is required to establish "pain alone" as constituting a disability eligible for service connection. See Saunders, 886 F.3d at 1356, 1367-68. Nevertheless, W.B. went on to provide the following opinion: "It is my opinion that it is more likely than not, that [the Veteran's] condition was initiated during her Active Duty for Training in Law Enforcement Specialist School...during a required Shotgun Certification Course. And the problem was further aggravated while serving on deployment to Afghanistan in 2013, [where] she continually wore Generation 1-IOTV Body Armor, and utilized weapons." For further rationale, W.B. outlined the pertinent evidence of record, noted his familiarity with the Veteran's history due to having examined her often while she was under his care, noted his review of her pertinent medical history, and noted that she had no other known risk factors that may have precipitated her current condition. However, as noted above, W.B.'s October 2018 opinion did not clearly identify a left shoulder disability which would be eligible for service connection. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. On remand, after all outstanding treatment records have been associated with the claims file, a new examination should be scheduled [at a location other than the Gainesville VAMC] to address the nature of any current left shoulder disability (to include pain alone resulting in functional impairment of earning capacity) and whether any such disability is related to any incident of the Veteran's military service (with consideration of her verified combat service and all pertinent STRs). 5. Entitlement to service connection for a left upper extremity neurological disability (claimed as left carpal tunnel syndrome). The Veteran contends that she currently has a left upper extremity neurological disability due to her military service (to include as a result of combat service events during her Afghanistan deployment) or as secondary to her cervical spine disability [for which service connection is being granted in the instant decision]. During her Reserve service, it was noted on a February 2015 Report of Medical Assessment that she had carpal tunnel in both wrists. Post-service, at a September 2015 VA peripheral nerves examination, the Veteran was diagnosed with bilateral carpal tunnel syndrome. She reported that such disability was due to active duty service "from typing as a yeoman." The VA examiner did not provide an opinion regarding the etiology of the Veteran's bilateral carpal tunnel syndrome. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. She also testified that she may have been misdiagnosed with carpal tunnel syndrome and alleged that her upper extremity radiculopathy symptoms could be due to her cervical spine disability. On remand, after all outstanding treatment records have been associated with the claims file, a new examination should be scheduled [at a location other than the Gainesville VAMC] to address the nature of any current left upper extremity neurological disability and whether any such disability is related to any incident of the Veteran's military service (with consideration of her verified combat service and all pertinent STRs) or secondary to her now service-connected cervical spine disability. 6. Entitlement to service connection for a right upper extremity neurological disability (claimed as right carpal tunnel syndrome). The Veteran contends that she currently has a right upper extremity neurological disability due to her military service (to include as a result of combat service events during her Afghanistan deployment) or as secondary to her cervical spine disability [for which service connection is being granted in the instant decision] or her right shoulder disability [for which service connection is being granted in the instant decision]. The Veteran's active duty STRs include an October 2013 Report of Medical Assessment on which it was noted that she had intermittent n/t [numbness/tingling] in her right hand, as well as an October 2013 Report of Medical History on which she indicated having a history of numbness or tingling ("Had tingling in right arm for 1st 3 months deployed"). Thereafter, during her Reserve service, it was noted on a February 2015 Report of Medical Assessment that the Veteran had carpal tunnel in both wrists. Post-service, at a September 2015 VA peripheral nerves examination, the Veteran was diagnosed with bilateral carpal tunnel syndrome. She reported that such disability was due to active duty service "from typing as a yeoman." The VA examiner did not provide an opinion regarding the etiology of the Veteran's bilateral carpal tunnel syndrome. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about the combat gear that she wore and carried in Afghanistan which the Board finds to be consistent with the circumstances of her combat service. She also testified that she may have been misdiagnosed with carpal tunnel syndrome and alleged that her upper extremity radiculopathy symptoms could be due to her cervical spine disability. She further testified that she experiences radiating pain down from her shoulder on the right-hand side. On remand, after all outstanding treatment records have been associated with the claims file, a new examination should be scheduled [at a location other than the Gainesville VAMC] to address the nature of any current right upper extremity neurological disability and whether any such disability is related to any incident of the Veteran's military service (with consideration of her verified combat service and all pertinent STRs) or secondary to her now service-connected cervical spine disability or her now service-connected right shoulder disability. 7. Entitlement to service connection for bruxism. The Veteran contends that she currently has bruxism due to her military service (to include as a result of combat service events during her Afghanistan deployment) or as secondary to her psychiatric disability [for which service connection is being granted in the instant decision]. At a post-service September 2015 VA dental and oral examination, it was noted: "No history of bruxism is recorded, although [V]eteran reports occasional bruxism along with her PTSD." The VA examiner did not provide an opinion regarding the etiology of the Veteran's bruxism. At her February 2020 Board hearing, the Veteran provided competent and credible testimony about her deployment to Afghanistan which the Board finds to be consistent with the circumstances of her combat service. She also testified that she first noticed her bruxism while she was deployed and coming home, and that she thought it was just stress-related. On remand, after all outstanding treatment records have been associated with the claims file, a new examination should be scheduled [at a location other than the Gainesville VAMC] to address the nature of any current bruxism and whether such disability is related to any incident of the Veteran's military service (with consideration of her verified combat service and all pertinent STRs) or secondary to her now service-connected psychiatric disability. 8. Entitlement to an initial compensable rating for broken tooth (#19) due to trauma. The Veteran contends that she is entitled to an initial compensable rating for her service-connected broken tooth (#19) due to trauma. The record reflects that the Veteran most recently underwent a VA dental and oral examination in September 2015. Thereafter, at her February 2020 Board hearing, she testified that she now has gum problems all the time where the crown is. On remand, after all outstanding treatment records have been associated with the claims file, a new examination should be scheduled [at a location other than the Gainesville VAMC] to ascertain the current level of severity of the Veteran's service-connected broken tooth (#19) due to trauma, as there is an indication that the condition may have worsened since her last VA examination. The examiner should consider all applicable rating criteria, as during the pendency of the instant appeal, VA revised the criteria for rating dental and oral disabilities, effective September 10, 2017. See 82 Fed. Reg. 36,080-083 (Aug. 3, 2017). The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers who have treated her for her claimed disabilities remaining on appeal at any time during the appeal period, including from W.B., D.O. [the full name of this provider is identified in his submitted statements which are noted above] and from Glens Falls Hospital. Make two requests for the authorized records from each identified provider, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records for the period from November 2015 to the present. 3. After all requested records have been associated with the claims file, schedule the Veteran for examinations [at a location other than the Gainesville VAMC] by appropriate clinicians (or telehealth interviews if feasible) to determine the nature and etiology of any current left ear hearing loss disability, residuals status post cholecystectomy, head injury scars (including on the back of her head), left shoulder disability, left upper extremity neurological disability, right upper extremity neurological disability, and bruxism, and to determine the current severity of her service-connected broken tooth (#19) due to trauma. The electronic claims file must be made available to the examiners for review in conjunction with the examinations. All necessary tests should be performed, and the results reported. (a.) For the claimed left ear hearing loss: i. The examiner must first determine whether the Veteran has a hearing loss disability for VA purposes in the left ear in accordance with 38 C.F.R. § 3.385, by conducting all necessary testing as well as evaluating any newly received pertinent evidence dated at any time during the appeal period. ii. If and only if the answer to (i) is that the Veteran has a hearing loss disability in the left ear for VA purposes, then the examiner must provide an opinion as to whether it is at least as likely as not that such disability began during the Veteran's active service (or within one year of service discharge), or is otherwise related to any incident of her military service (with specific consideration given to her verified combat service and all pertinent STRs). (b.) For each residual status post cholecystectomy, head injury scar (including on the back of her head), and left shoulder disability (to include pain alone which results in functional impairment of earning capacity) diagnosed at any time during the period of the current claim, the examiner must provide an opinion as to whether it is at least as likely as not that such disability began during the Veteran's active service (or within one year of service discharge), or is otherwise related to any incident of her military service (with specific consideration given to her verified combat service and all pertinent STRs). (c.) For each left upper extremity neurological disability diagnosed at any time during the period of the current claim, the examiner must provide an opinion as to whether it is at least as likely as not that such disability: i. began during the Veteran's active service (or within one year of service discharge), or is otherwise related to any incident of her military service (with specific consideration given to her verified combat service and all pertinent STRs), or ii. is either caused by or aggravated beyond its natural progression (i.e., any increase in severity beyond the natural progression of the condition) by the Veteran's service-connected cervical spine disability. (d.) For each right upper extremity neurological disability diagnosed at any time during the period of the current claim, the examiner must provide an opinion as to whether it is at least as likely as not that such disability: i. began during the Veteran's active service (or within one year of service discharge), or is otherwise related to any incident of her military service (with specific consideration given to her verified combat service and all pertinent STRs), or ii. is either caused by or aggravated beyond its natural progression (i.e., any increase in severity beyond the natural progression of the condition) by the Veteran's service-connected cervical spine disability, or iii. is either caused by or aggravated beyond its natural progression (i.e., any increase in severity beyond the natural progression of the condition) by the Veteran's service-connected right shoulder disability. (e.) For the Veteran's bruxism, the examiner must provide an opinion as to whether it is at least as likely as not that such disability: i. began during the Veteran's active service (or within one year of service discharge), or is otherwise related to any incident of her military service (with specific consideration given to her verified combat service and all pertinent STRs), or ii. is either caused by or aggravated beyond its natural progression (i.e., any increase in severity beyond the natural progression of the condition) by the Veteran's service-connected psychiatric disability. (f.) For the Veteran's service-connected broken tooth (#19) due to trauma, all pertinent symptomatology and findings must be reported in detail. Any appropriate DBQ should be filled out for this purpose, if possible. The examiner should consider all applicable rating criteria during the appeal period (including the versions of the dental and oral rating criteria effective prior to and since September 10, 2017). A complete rationale for all opinions must be provided. If the clinician(s) cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician(s) must provide the reasons why an opinion would require speculation. The clinician(s) must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician(s) must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular clinician. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. B. Yantz, Counsel The Board's decision in this case is binding only with respect to the instant matters decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.