Citation Nr: A25035756 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240530-448262 DATE: April 17, 2025 ORDER Entitlement to service connection for a right ear hearing loss disability is denied. Entitlement to service connection for tinnitus is granted. Entitlement to service connection for a chronic right wrist sprain is granted. Entitlement to service connection for a right lateral collateral ligament sprain (right ankle sprain) is granted. Entitlement to service connection for a left lateral collateral ligament sprain (left ankle sprain) is granted. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. REMANDED Entitlement to service connection for a left ear hearing loss disability is remanded. Entitlement to service connection for a chronic left wrist sprain is remanded. Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right foot disability is remanded. FINDINGS OF FACT 1. The Veteran does not have a right ear hearing loss disability as defined in VA law and regulations. 2. Resolving reasonable doubt in his favor, the Veteran's tinnitus is etiologically related to his active service. 3. Resolving reasonable doubt in his favor, the Veteran's chronic right wrist sprain was incurred during active service. 4. Resolving reasonable doubt in his favor, the Veteran's right lateral collateral ligament sprain was incurred during active service. 5. Resolving reasonable doubt in his favor, the Veteran's left lateral collateral ligament sprain was incurred during active service. 6. The evidence of record persuasively weighs against finding that PTSD began during active service, or is otherwise related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a right ear hearing loss disability are not met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.385 (2024). 2. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 3. The criteria for service connection for a chronic right wrist sprain are met. 38 U.S.C. §§ 101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 4. The criteria for service connection for a right lateral collateral ligament sprain are met. 38 U.S.C. §§ 101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 5. The criteria for service connection for a left lateral collateral ligament sprain are met. 38 U.S.C. §§ 101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 6. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304(f) (2024). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has had service in the United States Army Reserve since May 2016, to include periods of active duty for training (ADT) and inactive duty for training (IADT). This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2024 decision issued by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In May 2024, the Veteran appealed to the Board by filing a VA Form 10182 and selecting the Direct Review option. Therefore, the Board may only consider the evidence before the AOJ at the time of the April 2024 decision. 38 C.F.R. §?20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. Regarding the claims decided herein, if the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Regarding the claims remanded herein, because the Board is remanding the claims, any evidence the Board could not consider will be considered by the AOJ in the readjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). Service Connection - Right Ear Hearing Loss The Veteran maintains that he has a right ear hearing loss disability that was incurred in or is related to active service. There are specific requirements regarding what constitutes a hearing loss disability under VA law. The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. During a December 2023 VA audiology evaluation, audiometric testing results were as follows: 500 1000 2000 3000 4000 Right 25 20 25 30 20 Speech recognition ability was measured at 100 percent in the right ear. The above-cited testing results do not establish a current right ear hearing loss disability as defined by 38 C.F.R. § 3.385. The Board has reviewed the claims file; however, the Veteran has not presented or identified existing audiometric testing results that meet the requirements of that regulation for hearing loss in the right ear. Hence, the Veteran does not have a right ear hearing loss disability for VA purposes. The test results are controlling and more probative than the lay evidence. In order for a disability to be service connected, it must be present at the time a claim for VA disability compensation is filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). As noted, a hearing loss disability for VA compensation purposes requires specific findings, which are not present in this case. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence weighs persuasively against the claim and is not in approximate balance. Therefore, entitlement to service connection for a right ear hearing loss disability is not warranted. 38 U.S.C. § 5107(b) (2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Service Connection - Tinnitus The Veteran maintains that his tinnitus was caused by noise exposure during active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing ADT or for an injury incurred or aggravated by IADT. 38 U.S.C. §§ 101(24), 106, 1110, 1131. ADT means full-time duty in the Armed Forces performed by Reserve for training and full-time duty as members of the Army National Guard or Air National Guard of any State. 38 U.S.C. § 101(22)(a), (c). IADT means duty other than full-time duty prescribed for Reserve or the National Guard of any state. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d). The Veteran's service treatment records indicated that he reported experiencing persistent or recurring noises in his head or ears during periodic health assessments conducted in April 2020 and November 2022. In November 2022, the provider indicated that the Veteran had tinnitus in his ears bilaterally and had had tinnitus for a couple years. During a December 2023 VA examination, the Veteran reported that he noticed tinnitus shortly after extended active duty, after undergoing small arms fire qualifications. The examiner opined that it was at least as likely as not that the Veteran's tinnitus was caused by or a result of military noise exposure. As rationale, the examiner noted that the Veteran was exposed to excessive noise during service as indicated by conceded noise from qualifications annually, and that excess noise exposure was known to cause tinnitus. The Veteran is competent to identify tinnitus, including onset and continuity of symptomatology. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). The Board has no reason to doubt the credibility of his statements. Based upon the above, the Board finds that the evidence weighs in favor of the claim. Therefore, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for tinnitus is warranted. 38 U.S.C. § 5107(b); Lynch, 21 F.4th at 776. Service Connection - Right Wrist The Veteran maintains that his current right and left wrist disabilities are related to an injury he sustained when he fell and landed on his wrists during active service. An August 12, 2022, service treatment record indicated that the Veteran complained of pain in his right wrist after falling the night before going to the bathroom. He stated that that he fell on his right wrist. It was noted that the right wrist was a little swollen over the distal radius and scaphoid. There was no mention of any injury to the left wrist. He was treated with Ibuprofen and instructed to return if his symptoms got worse. During a November 2022 annual periodic health assessment, the Veteran reported that he received care from a private provider for right wrist pain. The clinician noted that the Veteran was staying in a tent and got up to go to the bathroom at night when he fell, injuring his right wrist. The clinician noted that it was found to be a sprain/strain, and that X-rays were later found to be negative for a fracture. It was noted that the Veteran reported experiencing intermittent right wrist pain. There was no mention of any left wrist pain. During a January 2024 VA examination, the Veteran stated that during training in Wisconsin, he got up in the middle of the night to use the bathroom and that he fell and injured both wrists. The diagnoses were chronic right and left wrist sprain. The examiner opined that the claimed conditions were at least as likely as not incurred in or caused by service, noting the November 2022 health assessment, which indicated that the Veteran fell on his right wrist and still had intermittent pain. In this case, the Board finds that the evidence weighs in favor of the claim. Review of the Veteran's military personnel records indicate that he served on ADT from August 8, 2022, to August 21, 2022. An August 12, 2022, service treatment record noted that he injured his right wrist the night before when he fell. A November 2022 health assessment indicated that he continued to have intermittent residual pain in his right wrist, and the January 2024 VA examiner diagnosed him with a chronic right wrist sprain. In addition, the examiner opined that the current right wrist sprain was at least as likely as not related to the injury he sustained during ADT. There are no medical opinions to the contrary. Based upon the above, the Board finds that the evidence weighs in favor of the claim. Therefore, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for a chronic right wrist sprain is warranted. 38 U.S.C. § 5107(b); Lynch, 21 F.4th at 776. Service Connection - Right and Left Ankles The Veteran maintains that his current right and left ankle disabilities resulted from a fall during training on October 16, 2021. His military personnel records indicated that he served on IADT from October 15, 2021, to October 17, 2021. In March 2022, a line of duty investigation report indicated that the Veteran injured his ankles on October 16, 2021, while conducting land navigation during training. It was noted that he walked onto an animal burrow that was hidden in the grass and sprained both ankles. A February 2022 private treatment record indicated that the Veteran complained of inversion injuries to his right and left ankles four months previously during a training exercise on October 16, 2021. His immediate symptoms were pain, immediate swelling, and the inability to bear weight after the injury. It was noted that his symptoms improved initially but never totally recovered and that sometimes his pain was severe. It was noted that there was pain and modest swelling at the lateral aspects of the ankles. X-rays revealed a minor chip of the right anterior ankle but were otherwise normal. It was later noted that X-rays showed some old degenerative joint disease per radiology. A service treatment record dated on August 15, 2022, indicated that the Veteran complained of increased bilateral ankle and foot pain over the prior two days. He had pain to the bilateral aspects of both ankles and the crown of the bilateral feet. He had been using Ace and Coban wrap for support. On examination of the ankles, there was no edema or tenderness. He had full range of motion of the ankles. The assessment was bilateral ankle pain. It was noted that he had a history of previous ankle injuries. A November 2022 annual periodic health assessment indicated that the Veteran reported having ankle injuries in 2020, and that he completed a line of duty for those injuries. He indicated that he received treatment for bilateral ankle pain. The clinician noted that he twisted his ankles 1 12 years ago when he stepped in a hole during training and sprained his ankles. It was noted that he continued to have pain off and on, but X-rays did not reveal a fracture. During a January 2024 VA examination, the Veteran reported that he fell on a few occasions in scattered fox/mole holes while performing land navigation during service. The diagnoses were right and left lateral collateral ligament sprains (chronic/recurrent). The examiner opined that claimed condition was at least as likely as not incurred in service, noting that the Veteran injured his ankles during training October 2021, and was seen again in February 2022 for continued ankle pain. In this case, the Board finds that the evidence weighs in favor of the claims. The evidence indicates that the Veteran sprained both ankles during IADT in October 2021. He complained of ankle pain and swelling in February 2022, bilateral ankle pain in August 2022, and intermittent bilateral ankle pain in November 2022. In addition, the January 2024 VA examiner diagnosed him with bilateral lateral collateral ligament sprains and opined that his current ankle disabilities were at least as likely as not related to the injuries he sustained during IADT. There are no medical opinions to the contrary. Based upon the above, the Board finds that the evidence weighs in favor of the claims. Therefore, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for right and left lateral collateral ligament sprains is warranted. 38 U.S.C. § 5107(b); Lynch, 21 F.4th at 776. Service Connection - PTSD In February 2023, the Veteran filed a claim for service connection for PTSD. He maintains that he has PTSD as a result of his friend, SSG A., committing suicide on January 27, 2023. He stated that he could not sleep and kept waking up with dreams. He reported that although he did not witness the suicide, he felt responsible as his medical provider. The Veteran's service treatment records are unremarkable for any complaints, treatment, or diagnoses related to a psychiatric disability. There are also no private or VA treatment records noting any complaints, treatment, or diagnoses related to a psychiatric disability. In this case, the Board finds that the most probative evidence weighs against the claim. The Veteran's military personnel records indicate that he was not serving on active duty, ADT, or IADT at the time that his friend committed suicide. Although he may have known his friend through his service in the Army Reserve, the claimed stressor did not occur during a period of active service. Therefore, even assuming a current diagnosis of PTSD, there is no basis for service connection. See 38 C.F.R. §§ 3.303, 3.304(f). The Board notes that the Veteran was not provided with a VA examination or medical opinion in conjunction with the claim for service connection for PTSD. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability; but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, however, there is no competent evidence showing that the Veteran might have a current psychiatric disability resulting from an in-service event, injury, or disease. See McLendon, 20 Vet. App. at 83; see also Waters, 601 F.3d at 1278. Accordingly, the Board finds that a VA examination and medical opinion are not warranted, and the evidence currently of record is sufficient to decide the claim. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced. Furthermore, the evidence indicates that he is a physician assistant and has some competence to provide statements based on his medical knowledge. However, in this case, even assuming the Veteran is competent to diagnose himself with PTSD related to his friend's suicide, the evidence does not indicate the stressor occurred during a period of active service. Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence weighs persuasively against the claim and is not in approximate balance. Therefore, entitlement to service connection for PTSD is not warranted. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776. REASONS FOR REMAND Service Connection - Left Ear Hearing Loss Prior to service, in December 2015, the Veteran underwent an examination for commission. The results of audiometric testing were as follows: ? 500 1000 2000 3000 4000 Left 5 0 5 10 60 The results indicated that the Veteran had some degree of left ear hearing loss prior to his service in the Army Reserve. His service treatment records indicated that he was given a H-2 profile and that he had minimal hearing loss, which was not considered disabling. During a December 2023 VA audiology evaluation, audiometric testing results were as follows: 500 1000 2000 3000 4000 Left 20 15 30 30 70 Speech recognition ability was measured at 100 percent in the left ear. The December 2023 VA examiner opined that the Veteran's left ear hearing loss was at least as likely as not caused by service. The examiner indicated that there were no audiograms in his service treatment records but that the Veteran reported that his profile was changed during service due to his hearing loss. The examiner also indicated that noise exposure had been conceded and the results of audiological testing were consistent with noise-induced hearing loss. The Board finds the VA examiner's opinion inadequate. It does not appear that the examiner reviewed the Veteran's service treatment records, which include numerous reports of audiometric testing. In addition, the evidence indicates that the Veteran had a pre-existing left ear hearing loss disability, which was not accounted for in the examiner's opinion. The opinion did not address whether there was an increase in the Veteran's left ear hearing loss during service, and, if so, whether the increase in disability was due to the natural progress of the disease. See 38 C.F.R. § 3.306. Therefore, the Board finds the December 2023 VA medical opinion inadequate, which constitutes a pre-decisional duty-to-assist error. Accordingly, a remand is necessary to correct that error. 38 C.F.R. § 20.802(a). Service Connection - Left Wrist Although the Veteran's service treatment record documented an injury to the right wrist on August 12, 2022, there was no mention of any injury to the left wrist at that time or during a November 2022 periodic health assessment. During a January 2024 VA examination, the Veteran stated he fell and injured both wrists during service. The diagnosis was chronic right and left wrist sprain. The examiner opined that the claimed condition was at least as likely as not incurred in or caused by service, noting the November 2022 health assessment, which indicated that the Veteran fell on his right wrist and still had intermittent pain. The examiner, however, did not provide any rationale for her opinion regarding the left wrist. Therefore, the Board finds the January 2024 VA medical opinion inadequate, which constitutes a pre-decisional duty-to-assist error. Accordingly, a remand is necessary to correct that error. 38 C.F.R. § 20.802(a). Service Connection - Back and Knee Disabilities The Veteran maintains that his current back and knee disabilities are related to an injury he sustained in during combat life support training when he had to drag a mannequin, which weighed over 100 pounds. His military personnel records indicate that he served on IADT from February 23, 2023, to February 25, 2023. Another record indicates that he was on duty status for the Army Reserve from February 23, 2023, to February 27, 2023, to support a combat lifesaver course as an instructor. A private treatment record dated on March 10, 2023, indicated that the Veteran reported that he had a back injury 14 days previously when lifting a mannequin during a training exercise. He stated that he tried ice and heat with some relief, and also meloxicam with some relief. It was also noted that he had bilateral knee pain from the same back injury. He reported that his knees had been clicking but felt good that day. On examination, the lumbosacral area revealed no redness, swelling ecchymosis, rash, or mass. Possible mild lumbar scoliosis was noted. He had painless and full range of motion of the lumbosacral spine. Straight leg raise testing was negative on both sides. On examination of the knees, both sides were normal with full range of motion and no pain on motion. There was no effusion, tenderness, masses, or ligamentous instability or deformity noted. An X-ray of the lumbar spine showed mild lumbar levoscoliosis centered at L3. Vertebral body and intervertebral disc space height was preserved. There was an anterior endplate osteophyte formation at L4-L5, and mild multilevel facet joint arthropathy. The diagnosis was acute midline low back pain without sciatica. There were no diagnoses provided for the knees. A VA back examination was conducted in January 2024. The Veteran reported that he injured his back doing a deadlift during an Army Combat Fitness Test in 2019. The examiner diagnosed the Veteran with degenerative arthritis and opined that the claimed condition was at least as likely as not incurred in or caused by service. As rationale, the examiner noted that the March 2023 private treatment record indicated that the Veteran injured his back during service and had continued complaints. The Board notes, however, that the private treatment diagnosed the Veteran with acute back pain, suggesting that the injury did not result in a chronic disability. Furthermore, although the Veteran has been diagnosed with degenerative arthritis of the spine, it is unclear how the injury he sustained during IADT resulted in arthritis. For these reasons, the Board finds the January 2024 VA examination inadequate, which constitutes a pre-decisional duty-to-assist error. Accordingly, a remand is necessary to correct that error. 38 C.F.R. § 20.802(a). Regarding the knees, there is some evidence that suggests the Veteran injured his knees during a period of IADT in February 2023. Under these circumstances, the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of his claimed right and left knee disabilities. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the AOJ failed to schedule a VA examination, constituting a pre-decisional duty to assist error. Accordingly, the Board finds that a remand is necessary to correct that error. 38 C.F.R. § 20.802(a). Service Connection - Right Foot In February 2023, the Veteran filed a claim for service connection for foot pain. He stated that he experienced pain in his ankles and feet during training in August 2022. He noted that he was seen at a military treatment facility on site and that he took Meloxicam for his bilateral ankle and foot conditions. The Board notes that although the AOJ denied service connection for bilateral foot pain, the Veteran only filed an appeal regarding the right foot. Therefore, only the right foot will be addressed. Prior to service, in December 2015, the Veteran underwent an examination for commission. It was noted that the Veteran had moderate pes planus with flexible arches, which was asymptomatic and not considered disabling. A service treatment record dated on August 15, 2022, indicated that the Veteran complained of increased bilateral ankle and foot pain over the past two days. He had pain to the bilateral aspects of both ankles and the crown of the bilateral feet. He had been using Ace and Coban wrap for support. The assessment was bilateral ankle pain. There were no findings made specific to the feet. A VA foot examination was conducted in January 2024. The Veteran reported that he started having pain during physical training while stationed in Texas. He indicated that he had an achy, burning sensation on the top of his feet. The diagnosis was bilateral pes planus. The examiner opined that the claimed condition was less likely than not incurred in or caused by service. As rationale, the examiner noted that the Veteran had moderate asymptomatic pes planus at his December 2015 commission examination, and that he was not treated in service for that condition as it was asymptomatic. The examiner, however, did not address the August 2022 service treatment record, which noted that the Veteran complained of bilateral foot pain. In addition, the opinion did not address whether there was an increase in the Veteran's pes planus during service, and, if so, whether the increase in disability was due to the natural progress of the disease. See 38 C.F.R. § 3.306. For these reasons, the Board finds the January 2024 VA medical opinion inadequate, which constitutes a pre-decisional duty-to-assist error. Accordingly, a remand is necessary to correct that error. 38 C.F.R. § 20.802(a). The matters are REMANDED for the following action: 1. Obtain a medical opinion from an examiner with appropriate expertise to determine the nature and etiology of the Veteran's left ear hearing loss. The claims file must be made available to and reviewed by the examiner. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that there was an increase in the Veteran's pre-existing left ear hearing loss during or as a result of active service. If so, the examiner should provide an opinion as to whether there is clear and unmistakable evidence (obvious and manifest) that the increase in disability during service was due to the natural progress of the disease. A rationale for all opinions expressed must be provided and include consideration of the Veteran's lay statements regarding his symptoms and medical history. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinion. 2. Obtain a medical opinion from an examiner with appropriate expertise to determine the nature and etiology of the Veteran's claimed left wrist disability. The claims file must be made available to and reviewed by the examiner. The examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the any currently present left wrist disability manifested during or is etiologically related to a period of ADT or an injury sustained during IADT. A rationale for all opinions expressed must be provided and include consideration of the Veteran's lay statements regarding his symptoms and medical history. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinion. 3. Schedule the Veteran for an examination by an examiner with appropriate expertise to determine the nature and etiology of his claimed back disability. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has a current chronic back disability as a result of the injury he sustained during IADT in February 2023, when he lifted/dragged a mannequin weighing more than 100 pounds. In other words, the examiner must indicate whether the back injury he sustained in February 2023 resulted in a chronic disability, and, if so, the nature of that disability. A rationale for all opinions expressed must be provided and include consideration of the Veteran's lay statements regarding his symptoms and medical history. 4. Schedule the Veteran for an examination by an examiner with appropriate expertise to determine the nature and etiology of his claimed right and left knee disabilities. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has a current chronic right or left knee disability as a result of the injury he sustained during IADT in February 2023, when he lifted/dragged a mannequin weighing more than 100 pounds. In other words, the examiner must indicate whether the reported injury he sustained in February 2023 resulted in a chronic right or left knee disability, and, if so, the nature of that disability. A rationale for all opinions expressed must be provided and include consideration of the Veteran's lay statements regarding his symptoms and medical history. 5. Obtain a medical opinion from an examiner with appropriate expertise to determine the nature and etiology of the Veteran's right foot pes planus. The claims file must be made available to and reviewed by the examiner. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that there was an increase in the Veteran's pre-existing right foot pes planus during or as a result of his active service. If so, the examiner should provide an opinion as to whether there is clear and unmistakable evidence (obvious and manifest) that the increase in disability during service was due to the natural progress of the disease. A rationale for all opinions expressed must be provided and include consideration of the Veteran's lay statements regarding his symptoms and medical history. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinion. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mishalanie, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.