Citation Nr: A25041282 Decision Date: 05/06/25 Archive Date: 05/06/25 DOCKET NO. 240905-471241 DATE: May 6, 2025 ORDER Entitlement to service connection for unspecified anxiety disorder is granted. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for trigeminal nerve paralysis is granted. Entitlement to service connection for status post left hand (ring finger) fracture with residual pain is granted. Entitlement to service connection for left knee strain is granted. Entitlement to service connection for dry eye syndrome is denied. REMANDED Entitlement to service connection for bilateral ankle strain is remanded. Entitlement to service connection for right hip strain is remanded. Entitlement to service connection for bilateral shoulder strain is remanded. Entitlement to service connection for cervical strain is remanded. Entitlement to service connection for bilateral wrist strain is remanded. Entitlement to service connection for migraine, including migraine variants, is remanded. Entitlement to service connection for traction alopecia is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, her unspecified anxiety disorder is at least as likely as not related to her military service. 2. The evidence of record persuasively weighs against finding that the Veteran has had bilateral hearing loss for VA purposes at any time during or approximate to the pendency of the claim. 3. Resolving reasonable doubt in the Veteran's favor, her trigeminal nerve paralysis is at least as likely as not related to her military service. 4. The Veteran's status post left hand (ring finger) fracture with residual pain is related to her military service. 5. The Veteran's left knee strain is related to her military service. 6. The evidence of record persuasively weighs against finding that the Veteran's dry eye syndrome began during her active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for unspecified anxiety disorder have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for bilateral hearing loss 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, 3.385. 3. The criteria for entitlement to service connection for trigeminal nerve paralysis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for status post left hand (ring finger) fracture with residual pain have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for left knee strain have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for dry eye syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from September 2018 to September 2022. For her meritorious service, the Veteran was awarded (among other decorations) a Marine Corps Good Conduct Medal, National Defense Service Medal, and Global War on Terrorism Service Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2023 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In her September 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the September 2023 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. Service Connection Claims Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). 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. 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). Moreover, where a veteran served continuously for 90 days or more during active service, and psychoses, sensorineural hearing loss, and/or arthritis becomes manifest to a degree of 10 percent within one year from date of termination of 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. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Medical evidence is generally required to establish a medical diagnosis or to address questions of medical causation; lay assertions of medical status do not constitute competent medical evidence for these purposes. Lay assertions, however, may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). 1. Entitlement to service connection for unspecified anxiety disorder. The Veteran contends that she has anxiety and depression related to her military service. The Veteran has a current diagnosis of unspecified anxiety disorder as evidenced by the July 2023 VA examination for mental disorders. An unspecified anxiety disorder is not a psychoses and the presumptive service connection provisions for a "chronic" disease under 38 U.S.C. § 1112 and 38 C.F.R. §§ 3.303(b), 3.307, and 3.309(a) are not applicable. See Walker v. Shinseki, 708 F. 3d 1131 (Fed. Cir. 2013). However, as previously noted, service connection may be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Board will thus turn to that analysis. The Veteran's report of separation, Form DD 214, shows that she served on active duty from September 2018 to September 2022. The Veteran's October 2017 enlistment examination listed her psychiatric status as normal. A medical history report, completed at that time, noted that she denied having any history of psychiatric symptomatology. A medical history report, completed pursuant to the Veteran's June 2022 separation examination, noted her history of nervous trouble (anxiety or panic attacks), trouble sleeping, and depression or excessive worry. The Veteran also reported having anxiety on a daily basis, intermittent depression, and trouble sleeping because of over thinking and anxiety. The June 2022 separation examination did not evaluate her psychiatric status. In February 2023, the Veteran filed her initial claim seeking service connection for anxiety disorder, depression, and adjustment disorder. She reported having anxiety attacks one to two times weekly and that she has sleep issues. In July 2023, the Veteran underwent a VA examination for mental disorders. The VA examiner reviewed the Veteran's claims file, considered the Veteran's contentions, and conducted a mental status examination of the Veteran. The Veteran reported that her father passed away suddenly ten days after she was sworn into the military. She further indicated that her mental health symptoms impacted relationships with friends and family members during her service. The report concluded with a diagnosis of unspecified anxiety disorder. In a December 2024 statement, the Veteran reported that the high-pressure environment and mistreatment she experienced during service significantly contributed to her anxiety. She reported that it impacted her inservice performance. In view of the foregoing, the Board finds that the evidence of record is at least evenly balanced as to whether the Veteran's unspecified anxiety disorder is related to her military service. As the reasonable doubt must be resolved in favor of the Veteran, entitlement to service connection for unspecified anxiety disorder is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for bilateral hearing loss. The Veteran contends that she has bilateral hearing loss related to her in-service acoustic trauma. The initial question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. For 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 at 500, 1000, 2000, 3000, and 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. The Board concludes that the Veteran does not have a current diagnosis of bilateral hearing loss and has not had one at any time during the pendency of the claim or recent to the filing of the claim. The July 2023 VA examination for hearing loss and tinnitus noted the Veteran's inservice history of noise exposure. An audiological evaluation conducted at the time did not reflect a current hearing loss as defined by 38 C.F.R. § 3.385. The Veteran had puretone decibel thresholds at 10 or below at each tested frequency, and her speech recognition scores were 100 percent in both ears. The report concluded with diagnoses of normal right and left ear hearing. The Board finds this examination adequate (as it performed all necessary testing required to determine if the Board has bilateral hearing loss for VA purposes) and probative (as it speaks directly to the issue of whether the Veteran has bilateral hearing loss). The Veteran's post service treatment records do not reflect audiological findings of or a diagnosis of bilateral hearing loss for VA purposes as defined by 38 C.F.R. § 3.385. While the Veteran believes she has a current diagnosis of bilateral hearing loss, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the persuasive weight of the evidence is against the Veteran's claim for bilateral hearing loss; there is no doubt to be resolved; and service connection for bilateral hearing loss must be denied. 3. Entitlement to service connection for trigeminal nerve paralysis. The Veteran is seeking service connection for trigeminal nerve paralysis. She attributes this condition to her inservice removal of four wisdom teeth. The Board concludes that the Veteran has a current disability, diagnosed as trigeminal nerve paralysis, that is related to her military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). An inservice treatment report, dated in December 2019, noted that the Veteran underwent extraction of all four of her wisdom teeth. A January 2020 inservice treatment report noted her complaints of left lower lip numbness. A February 2020 inservice treatment report noted the Veteran's complaints of paresthesia to the left lip and chin, and left anterior mandibular area. The report noted that her sensation was intact, except for the sensation of her left lower lip. If February 2023, the Veteran filed her initial claim seeking service connection for numbness of the lower lip, which she attributed to her inservice wisdom teeth removal. The August 2023 VA examination for cranial nerve conditions concluded with a diagnosis of trigeminal nerve paralysis. The examination report noted the Veteran's history of having her wisdom teeth removed during service, and that she has had persistent numbness in her bottom left lip ever since her inservice wisdom teeth extraction. Physical examination revealed mild numbness on the left side of her mouth. The VA examiner determined that the cranial nerve V (trigeminal) was manifested by left incomplete, moderate, paralysis. Upon review of the record, the Board finds the evidence of record to at least be in equipoise as to whether the Veteran's current trigeminal nerve paralysis is related to her military service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for trigeminal nerve paralysis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to service connection for status post left hand (ring finger) fracture with residual pain. The Veteran is seeking service connection for residuals of a left hand injury during service. Specifically, she claims she fractured her left hand while playing basketball. The Board concludes that the Veteran has a current disability, diagnosed as for status post left hand (ring finger) fracture with residual pain, that is related to an inservice injury to her left hand. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). The August 2023 VA examination for hand and fingers noted the Veteran's history of having broken her left hand playing basketball during her military service. She indicated that she was in a cast for a month, and that she still notices some tenderness with pressure. She also reported left hand pain while doing push-ups. Physical examination revealed mild pain on palpation of the shaft of the 4th metacarpal of the left hand related to status post left hand fracture with residual pain. The report also noted evidence of pain on weight bearing. X-ray examination of the left hand revealed an impression of fourth metacarpal fracture, consistent with slightly decreased fracture lucency and mild interval healing. The report concluded with a diagnosis of status post left hand (ring finger) fracture with residual pain. Thus, the question becomes whether the current disability is related to service. A review of the Veteran's service treatment records revealed treatment for a fractured ring finger of the left hand while playing basketball in April 2022. This condition was treated with a cast for one month. Upon review of the record, the Board finds that service connection for status post left hand (ring finger) fracture with residual pain is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for left knee strain. The Veteran is seeking service connection for left knee strain. In a December 2024 statement, she claimed that she injured her left knee in an inservice fall in the shower. She reported that her left knee continued to be painful and with limited motion ever since. The Board concludes that the Veteran has a current disability, diagnosed as left knee strain, that is related to her inservice injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). The August 2023 VA examination for knee and lower leg conditions noted the Veteran's reported history of having injured her left knee falling in the shower. She reported having ongoing left knee pain ever since. Physical examination revealed left knee pain with squatting and getting up from a sitting position. Range of motion testing of the left knee was normal, with pain during flexion on active and passive motion. Repetitive motion testing of the left knee revealed slightly reduced flexion to only 130 degrees. The report concluded with a diagnosis of left knee strain. Thus, the question becomes whether the current left knee disability is related to service. A review of the Veteran's service treatment records revealed treatment for left knee pain in May 2019. The report noted the Veteran's complaints of left knee soreness and sharp pain; and that this condition was exacerbated by running and going upstairs. It concluded with an assessment of pain in the left knee. Subsequent treatment reports, dated in September 2019, November 2019 and December 2021, noted additional complaints of left knee pain. The Veteran has reported having symptoms of left knee pain, with some limitation of motion, ever since an inservice fall in the shower. The Veteran is competent to report the onset and persistent nature of her observable symptoms; and the Board finds her contentions credible. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for left knee strain is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 6. Entitlement to service connection for bilateral ankle strain. 7. Entitlement to service connection for right hip strain. 8. Entitlement to service connection for bilateral shoulder strain. 9. Entitlement to service connection for cervical strain. The issues of entitlement to service connection for bilateral ankle strain, right hip strain, bilateral shoulder strain, and cervical strain are remanded to correct a duty to assist error that occurred prior to the September 2023 rating decision on appeal. The AOJ obtained August 2023 VA examinations for ankle, hip and thigh, shoulder and arm, and neck conditions. These VA examinations concluded with current diagnoses of bilateral ankle strain, right hip strain, bilateral shoulder strain, and cervical strain. During these examinations and in her December 2024 statement, the Veteran alleged that she first experienced symptoms of pain and functional limitations relating to each of these conditions during her military service. Although the Veteran is competent to report the onset and continuity of her observable symptoms, her June 2022 separation examination listed neck, upper and lower extremities as normal. The VA examiner did not provide a medical opinion addressing whether any of these conditions is related to the Veteran's military service. Under these circumstances, supplemental medical opinions should be obtained to determine whether these conditions are related to the Veteran's military service. Barr v. Nicholson, 21 Vet. App. 303 (2007). 10. Entitlement to service connection for bilateral wrist strain. The issue of entitlement to service connection for bilateral wrist strain is remanded to correct a duty to assist error that occurred prior to the September 2023 rating decision on appeal. The AOJ obtained an August 2023 VA examination for wrist conditions which concluded with a diagnosis of bilateral wrist strain. During this August 2023 VA examination and in her December 2024 statement, the Veteran reported the onset of bilateral wrist pain after her cast was removed following an inservice left hand fracture. The August 2023 VA examiner did not provide a medical opinion addressing whether the Veteran's bilateral wrist strain is related to her military service, including her service-connected status post left hand (ring finger) fracture with residual pain. Barr, 21 Vet. App. at 303. Under these circumstances, a supplemental medical opinion should be obtained to determine whether the Veteran's bilateral wrist strain is related to her military service. 11. Entitlement to service connection for migraine, including migraine variants. The issue of entitlement to service connection for migraine, including migraine variants, is remanded to correct a duty to assist error that occurred prior to the September 2023 rating decision on appeal. The AOJ obtained an August 2023 VA examination for headaches which noted the Veteran's reported history of headaches beginning in 2022. She indicated that they have continued to occur once every two weeks. The report concluded with a diagnosis of migraine, including migraine variants. The September 2023 VA examiner did not provide a medical opinion addressing whether this condition is related to the Veteran's military service. In a December 2024 statement, the Veteran reported that she began to experience frequent migraines during service. She attributed these headaches to the physical and emotional stress of the environment, as well as exposure to loud noises and bright lights. The Board cannot make a fully-informed decision on the issue of service connection for migraines because no VA examiner has opined whether this condition was incurred in or aggravated during the Veteran's military service. Accordingly, the AOJ should obtain a medical opinion addressing this issue. 12. Entitlement to service connection for traction alopecia. The issue of entitlement to service connection for traction alopecia is remanded to correct a duty to assist error that occurred prior to the September 2023 rating decision on appeal. A review of the Veteran's service treatment records is silent as to any complaints of or treatment for hair loss. The AOJ obtained an August 2023 VA examination for skin disease which noted the Veteran's reported history of hair loss during service, which has since improved. The August 2023 VA examiner did not provide a medical opinion addressing whether this condition is related to the Veteran's military service. The Board cannot make a fully informed decision on the issue of service connection for traction alopecia because no VA examiner has opined whether this condition was incurred in or aggravated during the Veteran's military service. Accordingly, the AOJ should obtain a supplemental medical opinion addressing this issue. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's bilateral ankle strain, right hip strain, bilateral shoulder strain, and cervical strain are at least as likely as not related to her military service. The examiner is asked to review and consider the Veteran's contentions as to each of these conditions in her September 2023 VA examinations for ankle, hip and thigh, shoulder and arm, and neck conditions; and in her December 2024 statement. The VA examiner must also review and consider the Veteran's service treatment records, including her June 2022 separation examination and the medical history report completed by her at that time. Provide a rationale to support each of the opinions provided. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's right and/or left wrist strains are at least as likely as not related to her military service, including her inservice left hand injury. If not, the examiner should provide an opinion as to whether the Veteran's right and/or left wrist strains are at least as likely as not due to or aggravated, i.e. made worse, by her service-connected status post left hand (ring finger) fracture with residual pain Provide a rationale to support each of these opinions. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's migraine, including migraine variants, is at least as likely as not related to her military service. The examiner is asked to review and consider the Veteran's contentions in the September 2023 VA examination for headaches; and in her December 2024 statement. The VA examiner must also review and consider the Veteran's service treatment records, including her June 2022 separation examination and the medical history completed by her at that time. Provide a rationale to support the opinion. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's traction alopecia. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the Veteran's traction alopecia at least as likely as not related to her military service, including her having to secure her hair for prolonged periods and having insufficient time for proper hair care. (Continued on the next page) ? The examiner is asked to review and consider the Veteran's contentions in the September 2023 VA examination for skin disease; and in her December 2024 statement. The VA examiner must also review and consider the Veteran's service treatment records, including her June 2022 separation examination and the medical history completed by her at that time. Provide a rationale to support the opinion. Cory M. Picton Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Yates, William M. 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.