Citation Nr: 25003532 Decision Date: 03/12/25 Archive Date: 03/13/25 DOCKET NO. 18-30 989 DATE: March 12, 2025 ORDER Entitlement to service connection for psoriatic arthritis is denied. Entitlement to a certificate for financial assistance in the purchase of an automobile or adaptive equipment is denied. FINDINGS OF FACT 1. Psoriatic arthritis did not develop in service and is not otherwise causally related to service, was not present within the first post-service year, and was not caused or aggravated by service-connected asthma or sleep apnea. 2. The Veteran's service-connected disabilities do not involve the physical loss or permanent loss of use of either of his hands or either of his feet, permanent impairment of vision in both eyes to the specified degree necessary for the award of adaptive equipment, scar formation resulting from burn injury, or ankylosis of his knees or hips. CONCLUSIONS OF LAW 1. The criteria for service connection for psoriatic arthritis have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for entitlement to a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment, or for adaptive equipment only, have not been met. 38 U.S.C. §§ 3901, 3902, 5107; 38 C.F.R. §§ 3.102, 3.808, 17.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training (ACDUTRA) in the United States Army National Guard from June 1987 to August 1987. He has achieved veteran status by virtue of the award of service connection for disabilities stemming from his period of ACDUTRA, including asthma. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In a July 2021 decision, the Board denied the claims. The Veteran appealed the July 2021 Board decision to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a January 2023 Order implementing a December 2022 Joint Motion for Partial Remand (JMPR), the Court vacated the July 2021 decision, in part, and remanded the appeal to the Board. In June 2023 and August 2024, the Board remanded the claims and the appeal has been returned to the Board for further review. As the Board determined in its August 2024 decision, development required by the December 2022 JMPR with regard to obtaining records appears to have been substantially completed. The parties to the December 2022 JMPR noted that there was no follow-up to an initial request for mental health records from the Nebraska Department of Correctional Services after an initial May 2008 request. The Board included a further attempt to obtain those records in its June 2023 remand instructions. In June 2023, the Veteran was sent a letter requesting that he provide authorization to obtain records of treatment from the Nebraska Department of Correction Services. However, the Veteran provided no authorization. An August 2023 VA internal email informs that mail sent to the Veteran in June 2023 and July 2023 were returned despite the most recent address of the Veteran being used. An attempt to contact the Veteran in August 2023 was unsuccessful. A CLEAR report to identify a current address of the Veteran was run. The Board notes that the Veteran has a duty to assist and cooperate with VA in developing evidence; the duty to assist is not a one-way street. Wood v. Derwinski, 1 Vet. App. 190 (1991); Hayes v. Brown, 5 Vet. App. 60 (1993) (VA's duty to assist is not a one-way street; if a veteran wants help, he cannot passively wait for it in those circumstances where his own actions are essential in obtaining evidence); see also Hyson v. Brown, 5 Vet. App. 262, 265 (1993) (holding that "[i]n the normal course of events, it is the burden of the veteran to keep VA apprised of his whereabouts"). Absent the Veteran's cooperation, the Board does not find that further efforts are required to obtain mental health records from the Nebraska Department of Correctional Services. Adjudicative Considerations In making determinations, VA is responsible for ascertaining whether the evidence supports the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt rule does not apply. Id.; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and it must provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. In determining the weight to be assigned to evidence, credibility can be affected by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self- interest, malingering, desire for monetary gain, and witness demeanor. Caluza v. Brown, 7 Vet. App. 498, 511, 512 (1995), aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996). 1. Entitlement to service connection for psoriatic arthritis The Veteran contends, in effect, that service connection is warranted for psoriatic arthritis as directly related to service or as related to service-connected asthma and sleep apnea. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303 (d). The claimant bears the burden of presenting and supporting a claim for benefits. 38 U.S.C. § 5107 (a); Fagan v. Shinseki, 573 F.3d 1282, 128688 (Fed. Cir. 2009). To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as opposed to merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service (or during any applicable presumptive period) is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b). The term "chronic disease" refers to those diseases, such as arthritis, listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101 (3); 38 C.F.R. § 3.309 (a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, the law provides that, where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. § § 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Objective indications of a qualifying chronic disability include both signs and symptoms, in the medical sense of objective evidence perceptible to an examining physician, and other non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Upon VA examination in November 2020 to address claimed osteoarthritis and/or psoriatic arthritis, the examiner noted that treatment records reflected ongoing treatment for osteoarthritis with home exercise and over-the-counter medications, as well as records over the past seven years reflecting taking Humira injections for psoriatic arthritis. The examiner opined that it was not at least as likely as not that these conditions were incurred in or caused by claimed in-service injury, event, or illness, explaining, "[d]uring service, osteoarthritis and/or psoriatic arthritis, was acute only. There is no evidence of chronicity of care and symptoms are subjective only. A nexus has not been established." This November 2020 opinion is not supported by the record because the Veteran's service treatment records do not reflect any findings or diagnosis of osteoarthritis or psoriatic arthritis. Accordingly, the November 2020 opinion addressing the question of a direct link to service for psoriatic arthritis is inadequate. A medical opinion is inadequate if it relies on an inaccurate factual basis. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The November 2020 examiner also opined that it was not at least as likely as not that the Veteran's psoriatic arthritis was caused by the Veteran's restrictive lung disease, explaining that the conditions were "not medically related" with psoriatic arthritis, which was "a separate entity entirely," and "a thorough review of medical literature failed to demonstrate a causal relationship." The examiner also stated that the Veteran's psoriatic arthritis was not aggravated by steroid medication taken to treat the Veteran's asthma, and on this basis opined that the Veteran's asthma had not aggravated his psoriatic arthritis. The parties to the December 2022 JMPR, in pertinent part, vacated that portion of the July 2021 Board decision which denied entitlement to service connection for osteoarthritis and psoriatic arthritis, and required actions consistent with the JMPR. These actions included obtaining and reviewing potentially relevant records, including records that had been indicated but had not been associated with the claims file, adequately considering private medical records reflecting diagnosed arthritis of the spine, and providing an analysis to support its opinion which adequately addressed evidence of diagnosis and treatment for psoriatic arthritis and osteoarthritis. In its June 2023 remand, the Board required that an adequate examination be obtained addressing the specific facts of the case, beyond merely noting that medical literature did not support a relationship between medication to treat the Veteran's service-connected asthma and his claimed arthritic conditions. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (a medical opinion that relies on the absence of general medical literature supporting nexus without discussing the specific facts of the case is inadequate). Upon VA contract psoriatic arthritis examination in November 2023, the examiner reviewed the record and conducted an in-person examination. The examiner noted that the Veteran reported having psoriatic arthritis since about 2009, or over twenty years after service separation in March 1987. The examiner reviewed service treatment records and post-service records which did not indicate the presence of psoriatic arthritis until around 2009. On these bases, the examiner concluded that it was not at least as likely as not that the Veteran's psoriatic arthritis was incurred in or caused by an in-service injury, event, or illness, or was otherwise due to his time in service. The November 2023 examiner also considered questions of psoriatic arthritis being caused or aggravated (worsened) by service-connected asthma or sleep apnea. The examiner referenced medical knowledge from the Mayo Clinic informing that psoriatic arthritis occurred "when the immune system attacks healthy cells and tissue" with resulting joint inflammation and overproduction of skin cells. The examiner further noted that genetics, physical trauma, or environmental factors such as viral or bacterial infection may play a role, but that there was "no known mechanism by which asthma with secondary sleep apnea would cause psoriatic arthritis." On these bases, the examiner opined that it was not at least as likely as not that the Veteran's asthma with sleep apnea had caused his psoriatic arthritis. The examiner also considered the Veteran's steroid use for treatment of his asthma but observed that there was no known mechanism by which steroid use would contribute to developing psoriatic arthritis. On this basis, the examiner opined that it was not at least as likely as not that the Veteran's steroid use for his asthma has aggravated (worsened) his psoriatic arthritis. A VA examination to address psoriatic arthritis was scheduled in February 2024, but the Veteran failed to show for that examination without good cause provided for his failure to show. Prior to that scheduled examination, a VA examination had been scheduled for January 2024 to address psoriatic arthritis, but that examination had been cancelled at the request of the examination site. Where a veteran submits a service connection claim with evidence of a disability and evidence of participation in a TERA during active military service and such evidence is not sufficient to establish service connection for the disability, the Secretary shall provide the veteran with a medical examination and secure a nexus opinion, unless the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. 8 U.S.C. §§ 101(38), 1710(e)(1)(C), 1119. The Veteran is service connected for asthma based on symptoms presenting in service. These presenting symptoms are evidence of possible TERA in service, notwithstanding the Veteran's brief service with listed stationing only in Omaha, Nebraska and Fort Knox, Kentucky. Accordingly, notwithstanding the Veteran's failure to show for the scheduled January 2024 examination, in August 2024 the Board remanded the claim for a TERA Memorandum, and if in-service TERA were found, for a new examination to address the likelihood of a causal link between any identified in-service TERA and claimed psoriatic arthritis. An August 2024 VA TERA Memorandum found that the Veteran was not exposed to TERA during service. There was no Individual Longitudinal Exposure Record (ILER) entry for the Veteran, with no identified associated activity carried out by the Veteran while on active duty involving toxic exposure to occupational or environmental hazards. The Veteran's service was also too early for him to have had Persian Gulf War Service consistent with 38 U.S.C. § 1117 and 38 C.F.R. § 3.317(e)(2). Evidence of toxic exposures associated with 38 C.F.R. § 3.320 and/or Section 1119 was also not found. In the absence evidence supporting participation in TERA, a VA examination addressing the likelihood of claimed psoriatic arthritis being causally associated with TERA was not required. The Board has carefully reviewed the record, and finds the evidence is consistent with and supportive of the November 2023 VA examination opinions against claimed psoriatic arthritis having onset in service or being caused by an in-service injury, event, or illness; and against the psoriatic arthritis otherwise being due to his time in service, with the evidence not supporting psoriatic arthritis being shown in service or for years following service or being linked to service; and against claimed psoriatic arthritis having been caused or aggravated by service-connected asthma with secondary sleep apnea. The examiner's opinions are well-supported by facts and medical knowledge, and competent, credible countervailing evidence is not presented. In an April 2023 brief, the Veteran's authorized representative pointed to an April 2015 VA treatment note informing of mobility issues due to arthritis and bursitis in the left shoulder; an October 2015 private treatment note finding osteoarthritis of the spine with radiculopathy; a May 2021 VA treatment record noting generalized joint pain which the Veteran then reported had been present for more than 20 years; and an August 2018 private treatment note identifying (among other conditions) osteoarthritis, psoriatic arthritis, sciatica, spinal stenosis, bursitis in the left shoulder, and arthritis associated with the hands. While these noted treatment records serve to support the presence of arthritis including psoriatic arthritis within the claim period, they fail to support psoriatic arthritis in service or a causal link to service or a link between service-connected disability and psoriatic arthritis based on causation or aggravation. Even if the Veteran's report at the May 2021 VA treatment is taken as completely accurate, 20 years prior to 2021 would be 2001, which would still be over a decade following service, and hence that statement fails to support the presence of painful joints in service or in years immediately following service. In an April 2019 submission, the Veteran stated the following: August 1987, a medical board in Ft. Knox, KY moved to discharge me from active duty service for a Restrictive Lung Disease. At some point the military +/or (sic) medical board changed Restrictive Lung Disease to Asthma. At some point, the asthma became so bad doctors began administering steroids. In conjunction with asthma, I developed chronic bronchitis and was diagnosed with COPD. Instead of 1-2 steroidal injections per year, I was given 4 or more to assist with breathing. There is scientific and empirical truth that large or extreme amounts of steroids cause Avascular Necrosis and stenosis in the spine. I contend the diagnosis in 1987 and the treatments since directly caused Avascular Necrosis, Spinal Stenosis, and Osteoporosis. I have had sciatic nerves affected to a degree that I could not sit longer than 30 minutes at a time and was heavily dosed with opioids for the extreme pain of Avascular Necrosis, Spinal Stenosis, Osteoporosis, Psoriatic Arthritis and Osteoarthritis. For the sake of my lungs, my back and hips were destroyed as a consequence of excessive use of steroids. Thus, the Veteran contends, in effect, that his service-connected asthma was in some manner associated with chronic bronchitis and chronic obstructive pulmonary disease (COPD), and that steroid injections for these conditions contribute to his conditions of joints because there is medical literature informing that they may cause avascular necrosis and spinal stenosis. He further contends that these conditions, together with psoriatic arthritis, have caused "extreme pain" for which he was prescribed opioids. However, by these statements the Veteran has not indicated the existence of evidence linking his service-connected asthma and any steroid treatment for his asthma to his claim psoriatic arthritis, based on causation or aggravation. Hence, the Veteran's submitted statement fails to indicate the existence of evidence supporting a link based on causation or aggravation between the Veteran's service-connected asthma and claimed psoriatic arthritis. While the Veteran may sincerely believe that his claimed psoriatic arthritis is causally related to service or to service-connected disability, the Veteran, as a layperson, is not competent to address such questions of etiology or causality or aggravation, which require medical expertise and are beyond lay competence. The Veteran has not been shown to possess the requisite expertise or knowledge to address these questions. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). The Board finds the VA examiner's opinion more probative as it was provided by a medical profession and based on examination of the Veteran and accepted medical principles. The Board, accordingly, concludes that the evidence is persuasively against claimed psoriatic arthritis being causally related to service and is persuasively against psoriatic arthritis having been caused or aggravated by service-connected asthma or sleep apnea. Absent evidence supporting the presence of psoriatic arthritis within the first post-service year, the evidence also does not support service connection for psoriatic arthritis on a first-year-post-service presumptive basis. 38 C.F.R. §§ 3.307, 3.309. Because the evidence is persuasively against the claim based on all theories of entitlement presented, the benefit-of-the-doubt rule does not apply, and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, supra. 2. Entitlement to a certificate for financial assistance in the purchase of an automobile or adaptive equipment The Veteran seeks entitlement to automobile and adaptive equipment or for adaptive equipment only. Financial assistance may be provided to an "eligible person" in acquiring an automobile or other conveyance and adaptive equipment, or adaptive equipment only. 38 U.S.C. § 3902 (a), (b). Eligibility for assistance to purchase a vehicle and adaptive equipment is warranted where one of the following exists as the result of injury or disease incurred or aggravated during active service: (1) loss or permanent loss of use of one or both feet; (2) loss or permanent loss of use of one or both hands; (3) permanent impairment of vision of both eyes, meaning central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) severe burn injury precluding effective operation of an automobile; (5) amyotrophic lateral sclerosis (ALS); or, (6) for adaptive equipment only, ankylosis of one or both knees or one or both hips. 38 U.S.C. §§ 3901, 3902; 38 C.F.R. §§ 3.808, 17.156 (emphasis added). The term, adaptive equipment, means equipment which must be part of or added to a conveyance manufactured for sale to the general public to make it safe for use by the claimant, and enable that person to meet the applicable standards of licensure. Adaptive equipment includes any term specified by the Under Secretary for Health or designee as ordinarily necessary for any of the classes of losses or combination of such losses specified in §17.156 of this part, or as deemed necessary in an individual case. Adaptive equipment includes, but is not limited to, a basic automatic transmission, power steering, power brakes, power window lifts, power seats, air-conditioning equipment when necessary for the health and safety of the veteran, and special equipment necessary to assist the eligible person into or out of the automobile or other conveyance, regardless of whether the automobile or other conveyance is to be operated by the eligible person or is to be operated for such person by another person; and any modification of the interior space of the automobile or other conveyance if needed because of the physical condition of such person in order for such person to enter or operate the vehicle. 38 C.F.R. § 17.157. The term "permanent loss of use" is not defined under 38 C.F.R. § 3.808 for automobile and adaptive equipment. However, under other relevant VA regulations, "loss of use of a hand or foot" is defined as no effective function remaining other than that which would be equally well served by an amputation stump at the site of election below the elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance, propulsion, etc., in the case of a foot, could be accomplished equally well by an amputation stump with prosthesis. 38 C.F.R. §§ 3.350 (a)(2)(i), 4.63. Examples under 38 C.F.R. § 3.350 (a)(2) which constitute loss of use of a foot include extremely unfavorable ankylosis of the knee, complete ankylosis of two major joints of an extremity, shortening of the lower extremity of 3 1/2 inches or more, and complete paralysis of the external popliteal (common peroneal) nerve and consequent foot-drop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of that nerve. See also 38 C.F.R. § 4.63. Under Diagnostic Code 8521, complete paralysis of the common peroneal nerve encompasses foot drop and slight droop of the first phalanges of all toes, an inability to dorsiflex the foot, loss of extension (dorsal flexion) of the proximal phalanges of the toes, loss of abduction of the foot, weakened adduction of the foot, and anesthesia covering the entire dorsum of the foot and toes. 38 C.F.R. § 4.124a. Conditions associated with foot drop or the phalanges are not implicated for the Veteran's service-connected disabilities by the evidence of record. In Tucker v. West, 11 Vet. App. 369, 373 (1999), the Court stated that the relevant inquiry concerning loss of use is not whether amputation is warranted, but whether the claimant has had effective function remaining other than that which would be equally well-served by an amputation with use of a suitable prosthetic appliance. The Court also stated that in accordance with 38 C.F.R. § 4.40, the Board is required to consider the impact of pain in making its decision and to articulate how pain on use was factored into its decision. Id. "Loss of use" may be organic or "functional" in origin. See VAOPGCPREC 60-90 (Jul. 18, 1990) (holding that SMC was warranted for functional (as opposed to organic) loss of the foot due to service-connected functional hysteria or conversion reaction, where such loss was permanent in nature). Ankylosis is complete immobility of the knee joint in a fixed position, either favorable or unfavorable. See, e.g., Dinsay v. Brown, 9 Vet. App. 79, 81 (1996); Lewis v. Derwinski, 3 Vet. App. 259 (1992). In Jensen v. Shulkin, 29 Vet. App. 66, 78-79 (2017), the Court clarified that the standard for "loss of use of the feet" under 38 C.F.R. §§ 3.350 (a)(2)(i) and 4.63 is not the same as "loss of use of the lower extremities" for purposes of entitlement to specially adapted housing under 38 C.F.R. § 3.809 (b). That is, "loss of use of the feet" is a more stringent standard for a veteran to meet than "loss of use of the lower extremities." Id. The Jensen Court did note, however, that "loss of use" in a general sense was the "deprivation of the ability to avail oneself" of that extremity. Id. The ultimate responsibility for determining whether there is loss of use rests with the adjudicator and is a conclusion of law. Floore v. Shinseki, 26 Vet. App. 376, 381 (2013) (medical examiners are responsible for providing a 'full description of the effects of disability upon the person's ordinary activity, 38 C.F.R. § 4.10 (2013), but it is the rating official who is responsible for interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present). The Veteran is service connected for asthma with OSA, disabilities of the bilateral hips, bilateral hip scars, and tinnitus. There is no evidence of loss or permanent loss of use of one or both hands, permanent impairment of vision of both eyes, burn injury, ALS, or ankylosis of one or both knees, any of which is required for consideration of eligibility for entitlement to for payment or reimbursement for an automobile or other conveyance and adaptive equipment or adaptive equipment only. 38 U.S.C. §§ 3901, 3902; 38 C.F.R. §§ 3.350, 3.808. Therefore, the Board here specifically considers only whether the evidence supports a finding of loss or permanent loss of use of one or both feet, or ankylosis of the hips or impairment of the hips equivalent to ankylosis. In this regard, there is some evidence that the Veteran was confined to a wheelchair for a time before his January 2018 left hip replacement. Specifically, he reported at a December 2017 private orthopedic appointment that he had been "relegated to a wheelchair" the past several months, although he used crutches as well "to get around . . . where the wheelchair cannot fit." At a November 2020 VA hip examination, he reported that he was "wheelchair bound" for four years before his hip surgeries, and he also then reported that he could not walk. However, as discussed below, other evidence undermines some of these statements, leading the Board to conclude both that the Veteran's statements that he was wheelchair bound for four years and could not walk is not credible, and that the evidence is persuasively against the Veteran meeting criteria for payment or reimbursement for an automobile or other conveyance and adaptive equipment or adaptive equipment only. VA outpatient treatment records from the claim period suggest that he was ambulatory both before and after his January 2018 left hip replacement. Records from July 2017 note normal strength in all extremities and that he ambulated "with sticks." An August 2017 record noted that he walked 50 feet independently with forearm crutches. After the left hip replacement, an October 2019 treatment record noted he was ambulatory on arrival and discharge from the emergency department. A July 2020 VA social work record noted under "Physical ambulation" that he "goes about grounds or city." The record does not indicate that pain during such ambulation was of such severity as to preclude the ambulatory activity. Moreover, the record contains no direct evidence of any impairment of the feet, whether due to a service-connected disability or otherwise. The Veteran was afforded a VA examination in November 2020 to address his hips. The examiner noted that avascular necrosis of both hips and degenerative arthritis of both hips were diagnosed in September 2020. The examiner also noted a diagnosis in September 2020 of degenerative joint disease of the left hip and pelvis, status post left hip total arthroplasty. At the November 2020 examination, he stated that his left hip was better but his right hip was not. He reported that his left hip had stiffness, and his right hip was catching and giving out. He added that due to his right hip he was unable to go hiking or running due to weakness and limited range of motion. The Veteran did not report any functional loss or impairment associated with the left hip. On physical examination, range of motion for the right hip was 0 to 80 degrees forward flexion, 0 to 20 degrees extension, 0 to 30 degrees abduction, 0 to 20 degrees adduction, 0 to 60 degrees external rotation, and 0 to 30 degrees internal rotation. The examiner did not find that limitation of motion of the right hip itself caused functional loss. Pain was noted in the right hip on rest / non-motion. Pain was exhibited in the right hip on flexion, extension, abduction, and adduction. The right hip also exhibited tenderness to palpation. There was also evidence of pain in the right hip with weight bearing. Repetitive use testing did not result in additional loss of function or range of motion in the left hip. However, the examiner concluded that with repetitive use over time range of motion of the right hip would be affected by pain, fatigue, and weakness, with reduced right hip range of motion to 0 to 75 degrees forward flexion, 0 to 15 degrees extension, 0 to 25 degrees abduction, 0 to 15 degrees adduction, 0 to 40 degrees external rotation, and 0 to 25 degrees internal rotation. The examiner noted that the right hip was examined during flare-up, and the examiner found right hip range of motion limited during flare-up due to pain, fatigue, and weakness, with resulting range of motion limited to 0 to 80 degrees forward flexion, 0 to 20 degrees extension, 0 to 30 degrees abduction, 0 to 20 degrees adduction, 0 to 45 degrees external rotation, and 0 to 30 degrees internal rotation. On physical examination, the left hip range of motion was 0 to 115 degrees forward flexion, 0 to 30 degrees extension, 0 to 45 degrees abduction, 0 to 25 degrees adduction, 0 to 55 degrees external rotation, and 0 to 30 degrees internal rotation. The examiner did not find that limitation of motion of the right hip itself caused functional loss. Pain was not noted in the left hip on examination, including no tenderness to palpation. Repetitive use testing did not result in additional loss of function or range of motion in the left hip, and the examiner found that left hip range of motion would not be reduced with repetitive use over time. The Veteran denied experiencing flare-ups in his left hip. The Veteran did not use any assistive devices for normal locomotion. Having thus carefully assessed the functioning of the Veteran's left hand right hips, the examiner then found that there was no ankylosis in either hip. The examiner noted that the Veteran reported that he was not able to walk, that he was limited in bending to pick up objects off the floor, and that he could not lift more than five pounds. The examiner did not comment on these contentions by the Veteran. At a November 2020 VA contract examination addressing individual unemployability, the examiner concluded that the Veteran's service-connected disabilities did not preclude him from light work, which included ability to walk or stand to a significant degree. Thus, this examiner conclude that the Veteran was not then significantly precluded from walking, either due to his hips or otherwise. In an April 2023 statement in support of a claim for unemployability, the Veteran reported having significant pain and disability associated with his psoriatic arthritis, osteoarthritis, and an unresolved broken hip, caused him to be unable to "walk far" or perform "physical labor" or certain other activities. However, the Veteran thereby implied that he could walk shorter distances, which thus informs that he did not have loss of use of his feet since he could walk. As noted, a July 2020 VA social worker note informed that the Veteran reported that he ambulated about the grounds or in the city, and a November 2020 unemployability examination found that the Veteran could walk or stand to a significant degree. Based on these contradictory self-reports and examination findings, the Board concludes that the Veteran's report at the November 2020 hips examination that he could not walk is not credible, based on contradiction by self-reports and objective findings. Caluza, supra. The Board finds that the range of motion in each hip exhibited and found upon hips examination, including when considering during flare-ups or with repeated use over time, with due consideration of pain and other impairing factors, as well as the self-reports and findings of ambulatory capacity, are consistent with the November 2020 hips examiner's finding that the Veteran did not have ankylosis in either hip, and the Board thereby also finds that the Veteran did not have impairment equivalent to ankylosis in either hip during the claim period. Findings upon this examination also did not support incapacity to ambulate, consistent with other evidence of record, as discussed. The Board additionally notes that the November 2020 social worker note informs of results of brief questions of the Veteran's capacities for activities of daily living and instrumental activities of daily living, for which the Veteran was given scores of 24/24 and 23/23 respectively. These included traveling independently which included taking public transportation or driving his own car, which provide no indications of the presence of any incapacity as would qualify the Veteran for payment or reimbursement for an automobile or other conveyance and adaptive equipment or adaptive equipment only. Simply put, the record does not present competent, credible evidence of loss of use or one or both feet, either permanently or temporarily, or ankylosis of one or both hips, either permanently or temporarily. The Veteran has not presented credible evidence supporting of such loss of use. While the Veteran has reported inability to walk and associated disabling pain in his hips, the Board does not find such reports of ambulatory incapacity credible, as noted. The evidence, taken as a whole, does not reflect that the Veteran has loss or permanent loss of use of one or both hands or one or both feet, permanent impairment of vision of both eyes consisting of visual acuity of 20/200 or less in the better eye with corrective lenses or 20/200 central visional acuity or peripheral field of vision contracted to 20 degrees or less in the better eye, or burns precluding effective operation of an automobile, or ALS, or ankylosis of one or both hips or knees, either permanently or temporarily. Accordingly, the Board finds the evidence persuasively against the Veteran meeting any of the required criteria for eligibility for payment or reimbursement for an automobile or other conveyance and adaptive equipment or adaptive equipment only. 38 U.S.C. §§ 3901, 3902; 38 C.F.R. §§ 3.350, 3.808, 17.156. Because the evidence is persuasively against the claim for eligibility for payment or reimbursement for an automobile or other conveyance and adaptive equipment (Continued next page) or adaptive equipment only, the benefit-of-the-doubt rule does not apply, and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, supra. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechter The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.